SHORT TERM MEDICAL COVERAGE – A BRIDGE UNTIL OPEN ENROLLMENT

Has your individual health insurance policy recently been cancelled?

Are you between jobs, and need coverage for a few weeks or months?

Are you a college student in need of coverage until classes begin?

THE ANSWER TO ALL THESE QUESTIONS IS SHORT TERM MEDICAL COVERAGE.

  • Short term medical is a limited form of health insurance designed to bridge you to permanent individual or employer based group coverage.
  • Short term medical insurance is designed to protect your assets by paying for catastrophic hospital medical costs.
  • The coverage will only pay for your inpatient hospital, ER, or Urgent Care medical services.
  • Some policies may include some form of office visit co-payments before or after the deductible.
  • Drug coverage is usually limited to inpatient hospital; however, some carriers may include a drug discount card.
  • Pre-existing conditions diagnosed during 12 months prior to enrollment are normally excluded. In addition, carriers may also decline enrollment if a major illness has occurred within the last 5 years.
  • The coverage is sold on a month to month basis, up to a maximum of 6 months. Some carriers may allow the policy to roll over for additional days or months.
  • You may tailor the coverage to the actual number of days needed until the effective date of permanent insurance.
  • You may select policy maximums that range from $750,000 to $2,000,000 per person.
  • You may select a deductible from $500 to $7500; co-insurance (the amount you pay after deductible) of 20% or 50% making your total out of pocket costs (your maximum financial risk) $1,500 to $10,000, including deductible.
  • You have a choice of having an effective date the day after enrollment or up to 30 days in the future.
  • You may pay on a monthly basis or the total premium up front for the actual number of days of the policy.
  • The premiums may only be paid by credit card.
  • You may enroll directly online, and after approval the carrier will automatically download your ID card(s) and Certificate of Coverage.

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

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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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UnitedHealth To Stop Selling Obamacare Coverage In California

UnitedHealth Group Inc. told brokers that it has filed paperwork to offer plans in just six states’ health-law marketplaces next year, providing the most complete picture so far of its previously announced widespread withdrawal.

The biggest U.S. health insurer said in April that it would pull out of all but a handful of the 34 states where it was selling the Affordable Care Act exchange plans, in the wake of mounting losses in that business.

Since then, the insurer’s 2017 exchange decisions have been emerging piecemeal as various state regulators disclosed that UnitedHealth wouldn’t be in their exchanges next year.

Tuesday, California officials became the latest to say UnitedHealth was leaving, when a spokesman for the Covered California exchange confirmed that the insurer wouldn’t participate in 2017.

  • The carrier also told brokers that during the next few weeks it would begin informing consumers enrolled in its exchange plans in states where it will pull out. Existing plans are effective through the end of 2016, and consumers can switch to different insurers during the fall’s open enrollment period.

In a statement Tuesday, UnitedHealth said “the smaller overall market size and shorter term, higher risk profile within this market segment continue to suggest we cannot broadly serve it on an effective and sustained basis.” But it said the company is “an advocate for more stable and sustainable approaches to serving exchange markets and those who rely on it for care.”

  • Overall, insurers’ approach to the exchanges for next year is mixed, in the wake of financial results that have been disappointing for many companies. Several insurers, including state Blue Cross Blue Shield plans, have reported similar challenges in recent months. And more than a dozen nonprofit insurance cooperatives created through the law have closed because they were overwhelmed by medical claims they couldn’t afford.

Many other insurers are sticking with the new marketplaces, though state filings have shown that several are seeking significant rate increases for next year.

  • Many consumer groups welcomed UnitedHealth’s arrival in Covered California in order to give people more choice and inject more competition into the market. The top insurers in the exchange, led by Blue Shield of California and Anthem Inc., control more than 90% of Covered California enrollment.

The state exchange had limited UnitedHealth to selling exchange plans in several smaller markets for 2016 because it didn’t participate the first two years

*Modified from online articles from WSJ.com, LAtimes.com, CNNmoney.com, Townhall.com, and other online data sources.

 

 

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Obamacare Premiums Expected To Rise Sharply Amid Insurer Losses

Health insurance companies are laying the groundwork for substantial increases in ObamaCare premiums, opening up a line of attack for Republicans in a presidential election year.

Many insurers have been losing money on the ObamaCare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases.

“There are absolutely some carriers that are going to have to come in with some pretty significant price hikes to make up for the underpricing that they did before,” said Sabrina Corlette, a professor at Georgetown University’s Center on Health Insurance Reforms, while noting that the final picture remains unclear.

Insurers are already making the case for premium increases, pointing to a pool of enrollees that is smaller, sicker and costlier than they expected.

The Blue Cross Blue Shield Association released a widely publicized report last month that said new enrollees under ObamaCare had 22 percent higher medical costs than people who received coverage through their employers.

“The industry is clearly setting the stage for bigger premium increases in 2017,” said Larry Levitt, an expert on the health law at the Kaiser Family Foundation.

The proposals for premium increases, which will be rolled out over the next couple of months, still have to be approved by state insurance commissioners. The ultimate impact on consumers will be hard to determine, as ObamaCare’s tax credits often soften the blow.

“Companies are either going to have to raise their prices significantly or drop out,” said Sen. John Barrasso (R-Wyo.), pointing to a poll from NPR that found a quarter of the public says the health law has personally hurt them.

“UnitedHealth has announced it is pulling out of the Obamacare exchanges,” one Senator wrote in a statement. “That’s the latest in a string of Obamacare failures that have led to American families losing their doctors, having few or no insurance options, and facing skyrocketing premiums and deductibles.”

“In almost every year I remember since 2013 started, there were projections of double-digit premium [increases] that turned out not to be correct,” said Chris Jennings, a former Obama White House adviser on healthcare reform. “Now, do I believe this year may be a little bit different? I think it could be.”

About 15 percent of ObamaCare enrollees do not receive a tax credit, so they would bear the full burden of price hikes, though they, like other enrollees, can shop around for the best deal.

State regulators may be forced to approve some hefty rate increases for next year, given the need for insurers to stop losing money.

*Modified from Hill.com, IBD.com, WSJ.com articles, and other online sources.

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THE SELF EMPLOYED ALSO NEED BENEFITS

Are you one of the many individuals who has become self-employed either voluntarily or involuntarily due to the changes in today’s economy?

In the past if you voluntarily left your employer or were laid off, you would have been able to move to another company; however, because of economic changes in California, you may now be forced to become self-employed, classified as an independent contractor or “consultant” to survive financially.

In addition to the financial implications, the biggest shock is the realization that by leaving your former employer you have suddenly lost the safety net for you and your family of health insurance and related benefits previously provided by the company.

  • As a health insurance broker, a specific area of my focus is the self-employed who have left companies to work independently. My goal is to provide these individuals and their families with creative strategies to replicate, on an individual basis, the benefits once provided by their previous employers.

Over the next few weeks I will be focusing my newsletter, and my other publications, on the risks faced by the self-employed through the loss of company employee benefits. I intend to recommend specific strategies to reduce or eliminate these financial risks.

A few of the issues, and questions that I will address:

  • The risk of medical expenses caused by illness or accidents.

Health insurance policies are nothing more than financial instruments designed to mitigate medical financial risks.

Do you know how to tailor the four (Bronze, Silver, Gold, Platinum) health insurance plan categories to your specific needs?

  • The risk of large out of pocket financial requirements of health insurance policies.

Currently these amounts range from $4,000 to $6,850 for individuals, and $8,000 to $13,700 for families. In 2017 these amounts will increase to $7,150 and $14,300 respectively.

How will these amounts be paid, and by whom?

  • The risk of a direct loss of income by being unable to work for a period of time (or permanently) as the result of an illness or accident.

Health insurance only pays for the medical expenses; it is not designed to replace lost income.

What types of policies can be used to protect income, and how do insurance companies view the self-employed vs. W2 employees?

  • The risks of requiring skilled nursing, assisted living or other long term care arrangements caused by an illness or accident.

Can insurance policies be structured to pay these benefits, and still provide other benefits?

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Obamacare Enrollees Sicker, Causing Premiums to Soar Again

A study finds that a larger portion of recent Obamacare enrollees are sicker and far more costly to cover. As a result, the insurance industry is seeking yet another series of premium hikes to cover the quickly rising costs.

According to The Washington Post, Obamacare enrollees in Blue Cross Blue Shield (BCBS) had higher instances of diabetes, more propensity for heart disease, and had higher rates of depression than previous, pre-Obamacare members of the plan.

Newer enrollees who came into BCBS through the Affordable Care Act’s (ACA) insurance marketplaces, commonly called Obamacare, caused costs to rise 22 percent on average more than plan members who received their insurance through an employer.

“Average monthly medical spending per member was $559 for individual enrollees in 2015, for example, versus $457 for group members,” the Post wrote.

The report is the best evidence to show why premiums have soared and why they are showing no signs of stopping since President Obama’s signature takeover of the nation’s healthcare insurance system was implemented.

Since insurance companies are no longer allowed to deny pre-existing conditions, payouts for medical services have wildly increased, and the study is likely to serve as a basis for the industry to submit its next wave of higher premiums.

Obamacare proponents say the skyrocketing medical costs were fully expected and that the law was written expecting the influx of young people forced to buy insurance to cover the higher costs of service to older, sicker enrollees.

But the bigger problem young people face is that they often have far less income to afford the much higher insurance costs they are now being forced to pay due to the passage of the ACA. Therefore many are not signing up and preferring to pay the tax penalties.

Because of these spiraling costs, people under 35 have lagged in signing up, compared to older ACA enrollees. And while it was recently reported that more young people had begun the enrollment process to avoid the tax penalties in the law, the numbers are still not balancing what is needed to pay the greater costs for the older, sicker plan members already enrolled.

“If participation among young adults had matched their share of the population, then 4.8 million young adults would have enrolled — but just 3.25 million selected plans.”

But even that 3.25 million is an inflated number because a large number of younger enrollees never completed signing up and did not end up paying for the new, more expensive healthcare policies.

*Modified from a WSJ.com and Washington Post articles, 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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2016 OPEN ENROLLMENT FOR INDIVIDUAL HEALTH INSURANCE

Open Enrollment for 2016 individual plans will begin on Monday November 1st, and continue until January 31, 2016. During this period of time, you will be able to change insurance carriers and your individual plan category (Bronze, Silver, Gold, Platinum).

All carriers have made minor changes to their individual plans based upon Obamacare mandates. There are low or moderate increases in premiums for plans offered through the Covered California State Exchange (for those who need a federal premium assistance subsidy), and for Off Exchange plans for those that do not qualify for the subsidy.

Based upon review of next year’s plans, only Anthem Blue Cross and Blue Shield of California will have PPOs available in every county in California. Both carriers have increased for 2016 the number of providers that make up their individual plan provider networks. In addition, both carrier’s individual plans will have access to the full Blue Cross / Blue Shield nationwide provider network.

Anthem and Blue Shield have added new Bronze and Silver plans available for Off Exchange enrollment. These plans have unique features, and lower non subsidized premiums than On Exchange (Covered CA) plans.

If you choose Covered California in order to obtain a federal premium assistance subsidy, you need to begin the enrollment process immediately, because of the paperwork required to prove your anticipated 2016 income level.

For Off Exchange enrollment, you have adequate time to review options. Your application must be submitted by December 15th to have a January effective date.

If you have questions regarding Off Exchange plans and enrollment, please call me at (626) 797-4618 or email me at john@healthinsbrokers.com.

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ANTHEM CHANGES INDIVIDUAL PLANS FOR 2016

Are you ready for Open Enrollment for 2016? Under the ACA (Obamacare), individual health insurance plans are issued as a twelve-month contract that begins in January and ends in December. New rates on individual plans will begin on January 1st, and remain in effect until December 31, 2016.

  • If you currently have an individual Anthem Exclusive Provider Organization (EPO) policy, Anthem Blue Cross will change your plan to a Tiered PPO for 2016. In Southern California these EPO plans are offered in Los Angeles, Orange, and San Diego counties. Beginning in 2016, plans in these counties will be changed to Tiered PPO plans.

The major difference between EPO and PPO plans is that EPO plans do not offer any out of network benefits. The means you will receive no reimbursement for out of network medical expenses. PPO plans do offer out of network benefits.

Anthems Tier PPO plans split hospitals in their provider network into two categories: Tier 1 and Tier 2. Members utilizing Tier 1 hospitals pay a lower share of cost (co-insurance). The maximum out of pocket (OOP) is the same for both Tiers.

The other major change for Anthem individual plans is they will become part of the nationwide Blue Cross/Blue Shield provider network. Currently, other than emergency services, all providers outside of California are considered out of network, and not subject to reimbursement.

Structurally. deductibles and out of pocket costs will increase for Bronze plans. The maximum deductible will increase to $6,600, and the maximum OOP will increase to $6,850.

The maximum deductible for Silver plans will increase to $2,250, and the OOP to $6,350. For Gold and Platinum, which have no deductibles, the OOPs of $6,200 and $4,000 respectively will remain the same for 2016.

  • The 2016 plans offered in Southern California have small rate increases for Bronze and Silver plans, and larger increases for Gold and Platinum plans. In Southern California the lowest rates are still in the Pasadena/San Gabriel Valley, and the highest rates are in San Diego County.

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

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