Tip Sheet: Exchange Open Enrollment

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The first half of 2013 open enrollment is complete. It’s official: the new state and federal health insurance exchanges have opened up across the country. We’re now in the very beginning of the implementation of healthcare reform’s major provisions.

Over the past two and a half months, a lot has taken place. Some things not so good (you might even say bad). And some things good (in certain cases, really-really good).

For example, maybe you’re one of those people that found very affordable coverage at the exchange, and you’re thrilled. Or… maybe you’re someone who isn’t getting much financial help via the subsidies, and now you’re looking for a way to find coverage for yourself or your family that won’t break the bank. You could also be a person with a preexisting condition that finally got their much-needed coverage. Or… maybe you found out that you can’t keep that health insurance plan you liked.

Every person’s case is different, and we’ve made it through the first-half with you. We’ve helped people enroll in the new exchange. We’ve also helped people navigate plans outside of the exchange.

With the second half of exchange open-enrollment coming up, we’ve put together a tip sheet for you, based on what we’ve seen so far. No politics. No opinions. Just facts. Here’s the latest:

  1. There really are some outstanding options at the new exchange for certain people. For example, if you make between ~$16,000 and ~$28,000 per year individually, there is a good chance you might really like your plan and premium at the exchange. People in this range also qualify for what are called cost-sharing reductions (in addition to premium subsidies). If you’re making between ~$16,000 to ~$28,000 per year, take a good look at the exchange. Additionally, those people making up to ~$44,000 per year may also qualify for subsidies.
  2. It’s true: you can’t be denied coverage for having a preexisting condition. Some people are still having a difficult time coming to terms with this concept. If you have a preexisting condition, apply for a plan inside or outside of the exchange: you cannot be denied at either place.
  3. Dependent coverage is too expensive at my spouse’s employer. Some of you who are needing to get insured are finding out that access to your spouse’s coverage through his/her employer is very expensive. If your spouse has access to what is called “affordable” coverage via their employer (affordable defined here), unfortunately, you and any dependent children are no longer eligible for subsidies at the exchange (even if the coverage in the exchange is considerably more affordable). This has been an area where we have had difficulty helping people find coverage. Our advice: shop for a more affordable plan on the individual market until the employer can make adjustments (they may need to offer a more affordable plan, or not offer employer coverage at all).
  4. My individual (or family) health insurance plan was cancelled. Your health insurance plan may have been cancelled because it did not conform to new healthcare reform standards. The bad news: you may not be able to get that plan back (so the best you can do right now is shop for another plan). The good news: recently, there was a tax penalty exception granted to people who lost their coverage. In other words, if your plan was cancelled, you won’t have to pay the individual tax penalty in 2014.
  5. My premiums got more expensive. Many plans in the individual market have seen premium increases. This is especially true for individuals that do not qualify for health insurance subsidies at the exchange (ie: individuals making more than $44,000 per year). One of the reasons you’re seeing these increases is because of the newly mandated 10 essential health benefits. Our advice: have a broker shop with you for a more affordable plan.
  6. Check your physician and hospital networks. This is especially true if you’re participating in a plan from a public state exchange. If you’re looking for access to a specific doctor or hospital, make sure to check and see what plans they are accepting. Some doctors and hospitals are not accepting plans from the public exchange at all.

The above listed are some of the things we’ve run into while helping people enroll during the first half of exchange open enrollment. If you’ve participated at the exchange, you may be familiar with what we’ve discussed. If you’ve not yet enrolled, our biggest goal with this post is to get you some tips about what to expect.

The entire second half of 2013 open enrollment has just begun. Don’t forget you have until March 31st, 2014 to enroll this year. If you have any questions about enrolling in Covered California, please contact us. Policy Advantage Insurance Services is Covered California Certified.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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California Continues Rollout: Won’t Allow Cancelled Policy Reinstatements

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This Fall, hundreds of thousands of non-compliant health insurance plans began to be cancelled throughout the nation. These plans did not comply with the new requirements set forth in the new healthcare reform law, and for that reason, were deemed not “legal.” As a result, these non-compliant plans needed to go. For more information about why, see this blog post.

However… last week, in light of these cancellations, the Obama Administration made the decision to allow insurers to reinstate these cancelled non-compliant plans. This would allow those plans to be continued for at least the remainder of 2014.

During his campaign to promote healthcare reform, President Obama reiterated that “If you like your plan, you can keep your plan.” However, in this example (the cancellation of these non-compliant health plans), this did not hold true. For this reason, the administration felt it was responsible for not “honing up” to the promise that it made. As a result, Obama decided that those plans that were cancelled needed to be reinstated for at least an additional year.

However, California was one state that did not agree with the Obama Administration’s decision to reinstate these cancelled policies. The executive board of Covered California (the new state health insurance exchange) unanimously voted to continue to move on with reform implementation, and not reinstate cancelled health insurance policies. This decision was on-par with many state insurance commissioners, and also with certain insurance company executives within the industry.

Here are some of the reasons why some states, insurance commissioners, and insurance executives thought policy reinstatements would be a bad idea:

  • Insurance Companies: Reinstatement of cancelled plans would contribute to the destabilization of an already turbulent insurance market.
  • Covered California (the new state exchange): Covered California was already leading the way with exchange enrollments. Nearly one-third of those enrolled in the first month at both the state & federal exchanges (in other words, nation-wide) were Californians. It made little sense to slow down.
  • Insurance Commissioners: Being this far into the implementation of reform, various insurance commissioners throughout the country also felt that it was inappropriate to reinstate health insurance plans that had been cancelled.

For these reasons (and others), a handful of states made the decision to tell the Obama Administration “thanks, but no thanks” when it came to reinstating policies. Certain states continued to move along with reform implementation as-is, and California was one of those states.

As a result, individuals now have more time to enroll in the state health insurance exchanges. The original open enrollment deadline for a 1/1/2014 plan start was 12/15/2013. This has now been moved back to 12/23/2013. 

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

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Diners & Restaurants: Three Good Reasons to Look at Healthcare Reform

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Today’s blog post is about how healthcare reform can help businesses in the restaurant and dining industries. There are a few really good reasons that these industries should take a close look at what’s going on with regard to reform. In many cases, employees may now be able to access better coverage at much more affordable prices.

In the past, restaurants and diners have had a tendency to be challenging groups to work with when it comes to health benefits for a number of different reasons. Some of those reasons will be addressed in this post. We’ll then offer some solutions about how healthcare reform can help.

 

Here are why restaurants and diners (especially those under 50 employees) should take a close look at healthcare reform:

  1. Many workers are part-time. Part-time workers are usually: A) not eligible for health insurance at work because of their part-time status, or B) not making enough money to want to contribute to health insurance premiums. For these reasons, part-time workers are usually more difficult to help insure. Healthcare reform fits the part-time worker to a T. There is a good chance many part-time workers will be eligible for financial assistance in the form of tax subsidies. 
  2. Many workers are younger. The employees of these groups have a tendency to be younger. Many employees at diners and restaurants hold positions like servers, hostesses/hosts, bar-tenders, waitresses, cooks, etc. Healthcare reform plans can be very affordable for those in the “30 and under” age category (ie: certain plans for younger people who are eligible for subsidies based on income can cost well under $100/month).  
  3. Healthy employees are important in the diner and restaurant industry. If you’re serving people food and drink, you want your employees to be healthy. Employees who have good access to doctors and medical services can be a very valuable asset to business owners in this industry. It can also help with the group’s overall morale.

The above reasons are why healthcare reform can be very important in the restaurant and diner industries. The new healthcare reform law (ie: the state health insurance exchanges) can give these kinds of employees excellent access to good coverage, at very affordable prices. 

Recommended: make a “Covered California Certified” insurance agent available to your employees. Allow he or she to help your employees navigate the new reform laws, and find health plans that make sense both cost and coverage wise. Employees can now make individual decisions on their own at the exchange, without any employer contribution. In other-words, with the proper guidance, they can take care of it themselves. And in many cases, exchange plans can be better than typical small-business employer plans. 

Educate your employees about these new options at no cost to your company. Policy Advantage Insurance Services can help you with healthcare reform, and can help your employees navigate it. If you have further questions about how healthcare reform can fit businesses in the restaurant and diner industry, please contact us any time.

Thanks for stopping by, we hope you found our information to be valuable. Check back at our blog to get further information about funding healthcare. Also, please share with your friends, clients, colleagues, and family. Here are a few of our other information outlets:

Home Page: http://www.PolicyAdvantage.com

Twitter: http://www.twitter.com/PolicyAdvantage

Facebook: http://www.facebook.com/PolicyAdvantage

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