Archive | State Health Exchanges

ANTHEM BLUE CROSS CUTS COVERAGE IN CALIFORNIA

On Monday August 1st, Anthem Blue Cross announced that it is pulling out of the individual insurance market in California, except for three regions in Northern California: Redding, Santa Clara County, and Stockton/Modesto.

  • All other ACA individual Anthem plans will be terminated December 31,2017. This decision does not affect those who have employer based insurance or individuals enrolled in “grandfathered” plans (plans purchased before March 2010).

Anthem’s Medicare Supplement, Medicare Advantage, Part D Drug Coverage, and individual dental, vision, and life policies will be continued to be offered in California.

According to Covered California’s most recent enrollment snapshot from March, Anthem currently covers about 252,560 Obamacare customers, 61% of whom live in regions where the carrier will pull out of the market.

Those numbers do not include people who have purchased Anthem plans outside of the exchange. A Covered California spokesman said in an email that an additional 150,000 Anthem plans are estimated to be in place outside the exchange.

  • How will the termination of your Anthem policy affect your coverage?

On-Exchange plans through Covered California will be moved to another carriers’ plan offering similar coverage if the member does not take any action during the Open Enrollment period to directly change carriers and plans.

The full details of how this will work is still being formulated, and more details should be released shortly.

For those with Off-Exchange plans, you must move to another carrier offering plans in your zip code. The enrollment must take place on or before December 15th, to have a January 1st effective date.

In 2018, Blue Shield of California will be the only carrier offering both a PPO, and HMO plans throughout the state. All other carriers will only offer some form of narrow network plans such as an HMO or Exclusive Provider Organization (EPO).

  • All carriers offering On-Exchange and Off-Exchange plans are indicating double digit rate increases for 2018.

As an example, in Southern California Blue Shield has filed for rate increases of between 18% to 22% for their PPO plans and 9% for their ACO/HMO plans. Other carriers will be releasing information on rate increase during the next few weeks.

In addition to higher rates, most carriers will also narrow their provider networks by only offering HMO or EPO plans with specific provider networks. These plans will not reimburse for any out of network services; therefore, members may be required to change some or all their doctors.

California is still one of the few states where a carrier, Blue Shield of CA, still offers PPO plans. In Arizona, Nevada, and Colorado the only options for individual plans is some form of HMO/EPO.

In addition, California has at least one carrier offering individual coverage in all counties and zip codes in the state. This is not the case in in Arizona and Colorado.

If you are a current Anthem client with an Off-Exchange plan terminating December 31st, please call me (John Barrett) at 626 797-4618, and I will answer your questions.

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THESE TWO NEW OBAMACARE RULES WILL AFFECT YOUR OPEN ENROLLMENT OPTIONS FOR 2018

Your Open Enrollment for 2018, will not be impacted by any potential Congressional changes to the ACA (Obamacare). However, you need to be aware of two major changes the U.S. Department of Health & Human Services has made to the Open Enrollment process for 2018.

1. OPEN ENROLLMENT FOR 2018 HAS BEEN SHORTENED TO 45 DAYS. THE PERIOD WILL BEGIN NOVEMBER 1ST, AND END DECEMBER 15TH.

• This means if you intend to change insurance carriers or category of your plan (Bronze, Silver, etc.) you will need to make your decision during the shortened Open Enrollment period.

2. THE SECOND MAJOR CHANGE RELATES TO UNPAID HEALTH INSURANCE PREMIUMS.

Under current rules if your health insurance is cancelled by the carrier for non-payment of premium, you can re-enroll with the same carrier during Open Enrollment without consideration of any past owed premiums.

• Under the new rules an insurance company can deny coverage until all the back premiums owed have been paid before you will be able to enroll.

As an example, assume you are covered by an Anthem Silver EPO with a $400 monthly premium, and your last payment was for the month of May. However, you fail to pay your June payment, and after approximately 45 days your policy is cancelled for non-payment effective June 1st.

If you want to enroll in any Anthem plan for 2018, you will be required to pay all the back premiums owed for 2017 ($2800 – June 1st – December 31st).

This change was requested by the insurance carriers to ensure individuals would maintain coverage (and premiums) throughout the year. Carriers had complained that an insured would enroll in a policy, have a medical procedure, and drop coverage for the remainder of the year. This became an issue because policyholders could drop coverage during the year, and enroll in new coverage during Open Enrollment for the next year without regard to pre-existing conditions or any past premiums owed.

The obvious solution for someone who owes past premiums is to change to another carrier for 2018.

If you have questions, please email me at john@healthinsbrokers.com or call me at (626) 797-4618.

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DON’T LET YOUR HEALTH INSURANCE BE CANCELLED FOR NON-PAYMENT OF PREMIUM!

Open Enrollment has closed for 2017, and for those of you enrolled in individual coverage your plans are either effective or will be by March 1st.

It is vital that you understand that if your individual policy is cancelled for non-payment it will not be reinstated.

There are usually three reason for cancellations:

  1. Intentional nonpayment of premiums because of financial hardship.
  2. The inability of the carriers to debit the credit card or bank account established to pay the premiums.
  3. The failure to send in an actual check in a timely manner to the insurance company.

It’s important for those of you with Off Exchange plans (those without a Federal subsidy or on MediCal), to understand the grace periods offered by insurance companies for late payments.

  • IF YOU DO NOT GET A FEDERAL SUBSIDY, YOU HAVE 31-DAY GRACE PERIOD FOR MAKING PAYMENTS.

Your monthly premium payments are due the first of each month. If the premium payment is not received by approximately the 7th of the month, you will be mailed a late payment notice.

The grace period for payment begins the POSTMARKED DATE of the warning notice that your premium is overdue. It is not when you receive the letter, which can be anywhere from two days to a week after the actual letter’s postmark.

The letter will tell you when your grace period ends, and warns that you will lose coverage unless the full past due amount is paid before the 31-day grace period ends. After the grace period ends, the carrier has the right to cancel the policy, even if you have mailed in your premium payment.

If you receive a late notice, react immediately by contacting your insurance broker or the carrier directly. Do not wait until you discover your policy has been cancelled, by then it will be too late.

  • IF YOUR POLICY IS CANCELLED YOU WILL BE REQUIRED TO WAIT UNTIL THE 2018 OPEN ENROLLMENT PERIOD TO ENROLL IN INDIVIDUAL PERMANENT COVERAGE.
  • Your only option if your policy has been cancelled is short term medical coverage to bridge you to January 2018, or to an event such as going on group or student coverage. Short term coverage will not cover any pre-existing conditions diagnosed within the twelve months prior to enrollment.    

If you have questions, please call me at (626) 797-4618

or email john@healthinsbrokers.com

 

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Anthem Threatens Obamacare Retreat If Results Don’t Improve

According to a Bloomberg article published online, Anthem Inc., which has so far stuck with the Obamacare markets as rivals pulled back, said it may retreat in 2018 if its financial results under the program don’t improve next year.

  • If California becomes one of the states exited, those with Anthem individual policies will be affected.
  • For 2017, Anthem has already significantly raised rates, and reverted to more network Exclusive Provider Organization, (EPO) from PPOs in Southern California, and most of Central and Northern California.

“If we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018,” Anthem Chief Executive Officer Joseph Swedish said on a call Wednesday discussing third-quarter results. “Clearly, 2017 is a critical year as we continue to assess the long-term viability of our exchange footprint.”

Anthem expects to post a narrow profit margin next year in exchanges created under the ACA, following losses that Swedish called “disappointing.” Profitability will improve thanks to plan changes and premium increases averaging more than 20 percent, but Anthem said it will take more than that to stabilize markets that have so far drawn about half the membership it was planning for.

The company called for eliminating a tax on health insurers, as well as changes to regulations that govern how plans are sold and administered.

“Both the pricing and regulatory environment need to be improved,” Swedish said. He said the company would be “surgical” in assessing where to sell ACA plans for 2018.

Anthem sells health coverage under the Blue Cross Blue Shield brand in 14 states (including California), and has a big position in the market for plans sold directly to individuals. The Indianapolis-based company said Wednesday that it had 889,000 people signed up under individual Obamacare exchange plans, and a total of about 1.4 million members in individual plans.

Large rivals UnitedHealth Group Inc., Aetna Inc. and Humana Inc. have all retreated from many of the Obamacare exchanges. If Anthem pulls back in 2018, it would leave mostly regional and not-for-profit firms on the markets, along with the Medicaid companies Centene Corp. and Molina Healthcare Inc.

Anthem expects the overall market for ACA compliant plans — both on- and off-exchange –will shrink next year, Chief Financial Officer John Gallina said. The insurer’s membership in the individual market will fall as well, he said.

*Modified from a Bloomberg.com article, Political.com and other online sources.

 

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HIGHER PREMIUMS FOR HEALTH INSURANCE PLANS IN CALIFORNIA

Are you prepared for 2017 rate increases of your individual health insurance plans?

Obamacare premiums are set to skyrocket an average of 22% for the benchmark silver plan in 2017, per a government report released Monday. In California, the Covered California Exchange, and the Department of Insurance have reported these rate increases average around 13%.

Covered California maintains the premium increases won’t affect those who purchase their coverage through the Exchange to receive a Federal Premium Subsidy or are covered by Medi-Cal. While that may be true regarding Covered California, it is not true for millions who purchased their coverage Off Exchange directly with the insurance company.

 There are three reasons why premiums are going up so much.

  1. More sick people than anticipated enrolled. Insurers are just catching up to the fact that premiums weren’t covering their costs.
  2. The end of the reinsurance program, which was designed to make up losses incurred by insurance companies accepting very sick enrollees. That expires at the end of this year; therefore, they must raise premiums to account for the end of that program.
  3. Health care costs seem to be trending upward.

Those without a Subsidy will pay a hefty increase in their 2017 premiums.

If you live in Southern California rates will increase substantially higher than 13%.

  • In the five Southern California counties of Los Angeles, Orange, San Bernardino, Riverside, and San Diego the rate increase ranges from 18% to 37%. The average rate increase for Blue Shield is approximately 20%, while the rate increases for Anthem averages 25%, with some rates 37% higher than 2016 rates.

In addition to the rate increases, carriers have also narrowed their 2017 provider networks. For 2017, the only carrier with a full PPO throughout California will be Blue Shield. All other carriers will have a narrower provider network, such as an HMO or Exclusive Provider Organization (EPO). To control their costs Blue Shield also offers, for the first time, Silver through Platinum HMO plans.

In Southern California, Anthem changed from a PPO or Tiered PPO back to an EPO. Anthem will only keep their PPO structure in several Central and Northern counties.

As with an HMO, an EPO will not pay for any medical services out of network. Any medical expense out of network will require the insured to pay 100% of the costs with no reimbursement.

Because all carriers offering individual plans have two distinct networks individual and group, it requires the person seeking individual coverage to determine if a provider will accept a specific carrier’s individual plans.

  • In Orange and San Diego counties there is a further complication because the Anthem EPO will not have some of the top hospitals in network. As an example, in Orange County 24 hospitals have been eliminated from the network. Major hospitals such as Hoag, St Joseph, St Jude, and Mission are not in network for the EPO. In San Diego County, 11 hospitals have been eliminated, including the Scripps group of hospitals.

For 2017, even though the categories of plans remain the same (Bronze, Silver, Gold, Platinum), deductibles and co-insurance have increased making the maximum financial liability for a family with a Bronze plan as high as $14,300. Silver and Gold plans have increased their total financial liability for a family to more than $13,000. Only Platinum plans have remained the same with a maximum financial liability for a family of $8,000.

  • Open Enrollment for 2017 (November 1st – January 31st), will allow the enrollment in new coverage, changing carriers, and changing categories of plans. It is important for those who enroll in Off Exchange plans to understand that rates are higher for PPO plans than for the narrower HMO plans of the same category.

If you purchase your health insurance Off Exchange without a Subsidy you will need to make a choice between premiums vs. networks. If you desire a more liberal choice of providers, you will select a PPO with a higher premium. If a want a lower premium you will select a narrow network HMO or EPO plan. The difference in rates between a PPO and HMO/EPO for the same category of plans ranges from 15% to 20%.

If you have questions regarding 2017 Open Enrollment, call me at (626) 797-4618 or email me at john@healthinsbrokers.com

 

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Penalties For Not Having Insurance Have Failed, And The Result Is Higher 2017 Premiums For Everyone

The most controversial part of Obamacare — the mandate that people buy health insurance — is also the glue that was supposed to make the whole scheme work.

An article appearing on lifezette.com, and other information provided by the Wall Street Journal details the mounting evidence that indicates the mandate is failing. The failure of the mandate is causing insurance companies to raise their premiums substantially for 2017.

Congress got insurance companies to go along with the Affordable Care Act in 2010 by striking a grand bargain — private insurers would accept new rules and restrictions in exchange for millions of new customers, many low-cost healthy people who would not break the bank.

The government offered subsidies to help lower-income Americans afford the premiums and threatened to fine people if they did not comply.

But the stick was not enough, and critics contend that the Obama administration weakened it further by wielding it with less-than-enthusiastic vigor.

“Nobody really wants to enforce it … Enforcing the individual mandate is going to hurt politically,” said a health policy counsel for the American Action Forum.

“The size of the penalty is not enough for someone who’s relatively healthy to think it’s worth it for them to pay for insurance,” said a senior research fellow at George Mason University. “Congress took all of the IRS’ enforcement tools away”.

  • Although Congress authorized penalties for failure to purchase health insurance, it limited the ability of the IRS to enforce it. The agency cannot sue, file criminal charges, or place liens on bank accounts to collect. It can send a warning letter or withhold money from tax refunds — if the taxpayer is owed a refund.

The government could crack down. “But aggressive enforcement could backfire politically”, said a senior policy analyst at The Heritage Foundation. “In order to enforce this, it would be pretty ugly”.

  • The analyst said it is not just the stick of enforcement that has proved inadequate — it’s also the carrot of insurance. He said it has been difficult to persuade young and healthy people “to pay for something they might not want or need … A lot of people value holding onto their own money and eating the mandate.”

The result is much lower sign-up rates than experts initially forecast. The Congressional Budget Office forecast 21 million enrollees by 2016. The Urban Institute projected 23.1 million. The Centers for Medicare and Medicaid Services guessed 24.8 million. And the Rand Corp. estimated 27 million.

The actual number was about 12.7 million. With attrition that occurs throughout the year, the number by the end of 2016 is likely to be 10 million to 10.5 million. The people who find the health plans most attractive are those who receive subsidies that cover most of the cost and those who use a lot of medical services.

  • The Urban Institute report from January 2015 projected that 36 percent of enrollees this year would have household incomes below 200% of the federal poverty line, and therefore be eligible for a subsidy. The actual percentage was 66%.

But while the Urban Institute projected that a 25% of enrollees would have incomes above 400% of the poverty line and thus be ineligible for subsidies, the actual share is just 2%. As one analyst said, “If you have a really expensive medical condition, Obamacare made insurance a good deal for you,”. “If people spend their own money, they don’t value the product.” “We know that insurers have enrolled a much more expensive pool than they expected,”. “We know that because they’ve had huge losses.”

To make up the difference, insurance companies have increased premiums. Preliminary research indicates that the average increase was 15% to 16.5% between 2015 and 2016, and that the increase for 2017 will be “much worse.”

*Modified from a lifezette.com article, WSJ.com articles, and other data provided by various online sources.

If you have questions, please call me at (626) 797-4618 or email john@healthinsbrokers.com

 

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California Obamacare Rates To Rise 13% In 2017, More Than Three Times The Increase Of Last Two Years

Premiums for Californians’ Obamacare health coverage will rise by an average of 13.2% next year — more than three times the increase of the last two years and a jump that is bound to raise debate in an election year.

The big hikes come after two years in which California officials had boasted that the program helped insure thousands of people in the state while keeping costs moderately in check.

On Tuesday, officials blamed next year’s premium hikes in the program that insures 1.4 million Californians on rising costs of medical care, including expensive specialty drugs and the end of a mechanism that held down rates for the first three years of Obamacare.

Two of the state’s biggest insurers — Blue Shield of California and Anthem Inc. — asked for the biggest hikes.  Blue Shield’s premiums jumped by an average of more than 19%, according to officials, and Anthem’s rates rose by more than 16%.

  • The rates vary significantly by region and insurer. Los Angeles and the rest of southwest Los Angeles County will see an average increase of almost 14%.

Blue Shield’s preferred provider organization rate in Los Angeles, chosen by 21% of those using the exchange, is increasing by an average of 19.5%.

Blue Shield, in an email to brokers, stated three reasons for the increase:

  • Underpricing of 2016 Rates: 2016 pricing was completed in the first quarter of 2015 and relied heavily on the favorable 2014 healthcare expense experience to set rates.
  • Higher than Anticipated Member Utilization of Healthcare Benefits: According to data, the higher trend was driven by prescription drugs and by members who joined during the special enrollment period. The SEP population had up to 30% higher utilization than members who joined during the standard open enrollment period.
  • Removal of ACA Reinsurance: The reinsurance program had provided funds to plans with higher-cost enrollees to offset those medical costs and guarantee coverage regardless of health status. The end of this program alone added 4.6% to our 2017 rates.

An Anthem spokesman stated “Factors such as increased use of medical services and added costs of drugs and medical therapies put upward pressure on rates and underscore the additional work that needs to be done to moderate the growth in healthcare costs.”

Covered California officials defended the system Tuesday, saying that the competition between insurers offering coverage on the exchange was working to keep rates lower than they otherwise would be.

Around the country, several insurers, including giant UnitedHealth, have stopped selling health plans on the exchanges, and a number of new nonprofit health insurance coops have gone out of business.

Americans who make too much to qualify for subsidies are likely to feel the brunt of the premium hikes. That may increase pressure to review the exchanges in 2017, for ways to make health plans more affordable.

If you have questions, please call me at (626) 797-4618 or email john@healthinsbrokers.com

*Modified from LATimes.com and Hotair.com online articles; Blue Shield notification to brokers.

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California Voters Are Becoming More Concerned About Healthcare Costs

The cost of getting healthcare remains a major concern, eclipsing worries about having insurance, according to a new USC Dornsife/Los Angeles Times poll. The widespread worry about costs indicates a potential shift in the debate over healthcare.

Lawmakers increasingly have been hearing complaints from their constituents about the cost of care, and polls have found that prescription drug prices, surprise medical bills and other pocketbook issues concern voters more than the future of the health law.

Echoing that national trend, almost two-thirds of voters in the USC/Times survey say they worry “very much” about rising health costs, with only 10% saying that is not something they worry about.

Cost concerns were most widespread among those in their 50s and early 60s. Indeed, that age group consistently showed the highest levels of anxiety on a series of healthcare concerns.

  • For a significant number, the healthcare law itself takes blame for rising costs. Just over half of those surveyed said they believed that costs for average Americans have “gone up a lot” because of the law, compared with roughly one-third who said that the law had not caused that to happen.
  • Most Americans have been forced to confront increased costs for health coverage for years – a trend that began long before the passage of the reform law. Employers have continued to shift costs to their workers, mostly in the form of higher deductibles and co-payments. Although those higher costs may not have been caused by the new law, many blame it.
  • The law clearly has raised costs for one relatively small slice of Americans – mostly healthy, self-employed people with middle-class or higher incomes who were previously able to buy low-cost policies on the private market.
  • The new law requires those people to buy more comprehensive policies, which provide greater coverage, but at a higher price. Covering sicker customers who used to be denied insurance has also led insurers to raise some premiums.

Low- and middle-income Americans get subsidies under the law that lower their monthly premiums, but higher-income Americans do not.

Most California voters have a positive view of their own healthcare and a somewhat positive view of healthcare in the state, the poll found. Seven in 10 rated their own healthcare as “excellent” or “good” while just under three in 10 called their care “fair” or “poor.”

*Modified from an latimes.com article, and other online sources

 

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2016 OPEN ENROLLMENT IS COMING TO AN END

Have you taken advantage of Open Enrollment for individual health insurance for 2016?

If not, you have until January 31st to complete your enrollment in an ACA (Obamacare) compliant plan.

Open Enrollment will also give you the opportunity to change carriers or categories of plans (Bronze, Silver, Gold, and Platinum), even if you have already selected a plan that went into effect January 1st.

If you enroll on or before January 15th, your effective date will be February 1st. From January 16th until January 31st, your effective date will be March 1st.

After January 31st, you will not be able to enroll in an ACA approved plan until next year’s Open Enrollment.

The only exception to this rule is the occurrence of a “qualifying event”, which will allow you to enroll in coverage outside of Open Enrollment.

For those living in California the most common “qualifying events” are losing employer based group coverage, marriage, divorce, or the birth of a child. You will have 60 days from the date of the event to enroll in a new individual policy. If you miss the 60-day window you will be required to wait to enroll in a plan until the next Open Enrollment.

If you fail to enroll in a plan for 2016, the penalty for not being covered has increased. For an individual it’s THE GREATER of $695 or 2.5% of household income, not to exceed the average national cost of a Bronze plan of approximately $2700.

For a family calculation of the penalty is bit more complicated: $695 for adults, and $347.50 per child up to $2,085 OR 2.5% of household income, up to a maximum of approximately $13,300, WHICHEVER IS GREATER.

If you miss Open Enrollment you can still obtain short term medical coverage, hospital coverage plans, and other types of coverage for accidents or other specific occurrences.

However, these plans do not serve as a substitute for ACA approved plans, which means you still will be subject to the Obamacare penalty for lack of proper coverage.

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More People Turn to Faith-Based Groups for Health Coverage

In a trend that could challenge the stability of the Affordable Care Act, a growing number of people are turning to health-care ministries to cover their medical expenses instead of buying traditional insurance according to a Wall Street Journal article published last week on their wsj.com website.

The ministries, which operate outside the insurance system and aren’t regulated by states, provide a health-care cost-sharing arrangement among people with similarly held beliefs. Their membership growth has been spurred by an Affordable Care Act provision allowing participants in eligible ministries to avoid fines for not buying insurance.

But now, some insurance commissioners are concerned that the ministries could put consumers at risk if bills aren’t paid. The ministries aren’t overseen by state commissioners, which generally guard against unfair practices and ensure solvency.

  • Ministry officials say they aren’t offering insurance, don’t guarantee claims will be paid, and don’t need to be regulated. The nonprofits are well managed, according to ministry officials, with third-party audits and a sterling history of sharing members’ claims.
  • Ministries generally don’t allow members to sue and require disagreements to be settled by arbitration and mediation.
  • Most ministries don’t always share bills for certain pre-existing conditions, whereas the ACA requires insurers to cover anyone regardless of their past or current medical history.

State regulators also say health ministries disrupt the insurance market because they tend to attract healthier consumers, siphoning them from commercial plans that can be left with sicker or older customers. Insurance commissioners in some states have moved to shut down the ministries’ state operations.

Many of the estimated 50 health-care ministries in the U.S. are small operations, and some churches have their own programs limited to parishioners. There are several large Christian ministries, and at least two other ministries open to people regardless of specific religious faith.

Members typically must abide by Biblical principles such as not having sex outside of marriage, and may have to sign a statement of religious faith.

Some consumers say they joined ministries to avoid rising deductibles and premiums on the health law’s exchanges, and to be free from the law’s penalty, which starts at $695 for 2016.

Consumers generally pay a set monthly amount that goes into a general account or directly to others who have eligible medical bill. They can also submit their own eligible bills to be shared by other members. In some ministries, members make contributions directly to others—and tuck gifts, personal cards and get-well wishes into the envelopes. Preventive care in some cases isn’t covered.

There have been lawsuits by ministry members against a cost-sharing ministry, claiming particular medical bills that should have been shared were not. The cases were ultimately settled or resolved through arbitration.

*Modified from a wsj.com article and other online sources.

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