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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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Welcome back to another edition of “Phrases Made Easy.” This series at our blog aims to help make all of those long, drawn-out insurance phrases easier to understand. One thing we notice when talking about health insurance (and health benefits in general) is that the concepts can be “wordy” and boring. We emphasize fixing that here!

Today we’ve selected the phrase “Cost Sharing Reductions.” The primary reason we’ve selected this phrase, is because it can be a very important concept for certain people in the new Covered California state health insurance exchange. Like many other phrases in our “Phrases Made Easy” series, this one sounds difficult, but it’s really not that bad at all.

If you are shopping in the health insurance exchange, you may start to see the phrase Cost Sharing Reduction (or CSR). Here is what a Cost Sharing Reduction is:

Cost sharing reduction plans are offered through Covered California for consumers whose income is between 133% to 250% of the federal poverty level (FPL). These plans offer lower cost-sharing to reduce your clients’ out-of-pocket costs when accessing medical care. These plans are available only through Covered California.

Quite simply: Cost Sharing Reductions reduce your out-of-pocket expenses. If you purchase what is called an “Enhanced Silver Level Plan” through Covered California, and are eligible for Cost Sharing Reductions, you will get help with your co-payments, deductibles, and other out-of-pocket medical expenses.

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Question: What is the criteria for Cost Sharing Reduction eligibility?

Answer: There are two criteria:

  1. You need to purchase an “Enhanced Silver Level Plan” on the Covered California state health insurance exchange.
  2. Your yearly income must be between 100% and 250% of FPL (or approximately $11,490 per year & $28,725 per year for individuals).

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Here are the three tiers of Silver Level Plans that include Cost Sharing Reductions (or CSRs) in the new state health insurance exchange in California. A standard Silver Level Plan without Cost Sharing Reductions has 70% actuarial value:

  • Enhanced Silver 94: 100% FPL to 150% FPL (94% enhanced actuarial value)
  • Enhanced Silver 87: 150% FPL to 200% FPL (87% enhanced actuarial value)
  • Enhanced Silver 73: 200% FPL to 250% FPL (73% enhanced actuarial value)

Essentially, these are additional benefits that help people who make less, reduce their out of pocket costs. If you have additional questions about “Cost Sharing Reductions” (or CSRs), and how they may apply to you, please contact Policy Advantage Insurance Services. We are “Covered California Certified” and can help you with your questions when navigating the exchange.

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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Today’s blog post is about Covered California’s “Certified Insurance Agents.” As you know, the new state health insurance marketplaces recently opened up for enrollment on October 1st, 2013. The marketplace in California is called Covered California.

With the opening of these marketplaces, a number of new ways to enroll in an individual health insurance plan emerged. One of those ways is finding the help of one of Covered California’s “Certified Insurance Agents.”

The “Certified Insurance Agent” training program allows licensed insurance agents in the state of California to assist the public in enrolling in the new state marketplace programs. Effectively, a “Certified Insurance Agent” becomes a guide for you. They can help you navigate the nation’s largest new insurance marketplace. Here is the official Covered California Certified Insurance Agent marketing badge. You will see it begin to appear on insurance brokerage websites, business cards, letterhead, etc:

CCCertified

If an agent in California is a “Certified Insurance Agent,” they have accomplished the following:

  • Obtained an insurance license to do business in California.
  • Are in good standing with the California Department of Insurance.
  • Have been through an in-person 8 hour Covered California training seminar.
  • Have completed 4 hours of Covered California self-study.
  • Have passed the “Covered California Certification Exam” with a score of 80% or better.
  • Registered and completed the agreement with Covered California to be a “Certified Insurance Agent.”

After completing each of the above requirements, a Covered California “Certified Insurance Agent” is then able to help the public navigate one of two programs at the exchange:

  1. The individual health insurance marketplace.
  2. SHOP (Small Business Health Options Program), for small business.

A Covered California “Certified Insurance Agent” can be a valuable asset for you in navigating the current healthcare reform conditions. They can also help you navigate the new insurance marketplace website, apply for coverage, and provide suggestions about which programs may fit best. Policy Advantage Insurance Services is a Certified Insurance Agent for Covered California. Please contact us with your questions today.

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

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E is for:

“Exchange”

GreyE

Exchange: When used as a noun, an exchange is a place where goods or services are bought or sold. In this blog post, we’re specifically referring to exchanges that sell major-medical health insurance policies. These are otherwise known as health insurance exchanges.

The reason that we’ve selected this topic is because you’re going to hear a lot about “exchanges” over the next few years (and into the future in general), when it comes to health insurance. There are two types of health insurance exchanges:

  1. Public Health Insurance Exchanges
  2. Private Health Insurance Exchanges

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A Public Health Insurance Exchange is an exchange that is set up, funded, and administered by the government. There are a combination of ways that this takes place:

  • A) State-only administered exchanges.
  • B) Joint state/federally administered exchanges.
  • and C) Exchanges administered by the federal government only.

Public Health Insurance Exchanges were a large part of healthcare reform (ACA/Obamacare). These are the new exchanges that are mandated by the law. The purpose of these exchanges is to help expand affordable coverage to the uninsured. The state exchange in California is called “Covered California.”

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A Private Health Insurance Exchange is an exchange that is set up, funded, and administered by private parties. In other words, the government is not involved (examples of private parties: employers and their employees).

There are a number of different strategies when setting up a Private Health Insurance Exchange. Most of these strategies revolve around the “defined contribution” health planning concept that we’ve discussed in past blog posts. This concept (defined contribution) is gaining importance as we move forward in health benefits planning. Third party administrators (or TPAs) facilitate the administration of Private Health Insurance Exchanges.

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

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As you know, state health insurance exchanges were a large part of healthcare reform (PPACA). Each individual state was required by the law to set up these new exchanges, and have them ready for enrollment by October 1st, 2013. Some states have elected not to set up an exchange (deferring administration to the federal government). Other states have set up a joint state/federal partnership to operate their exchange.

California has continued along the path to setting up a state-only administered exchange (ie: no help from the federal government, except for funding). The state has taken a more aggressive approach to setting up their exchange, and further information is continuing to roll out. The California state health insurance exchange is called “Covered California.”

coveredcaliflogo

Covered California is anticipated to be the largest insurance exchange in the country. Here are some general questions and answers about the exchange:

Question: How can Covered California help me find affordable insurance?

Answer: Covered California is an online marketplace where you will able to shop for and compare health insurance coverages. If you can’t afford health insurance, and are unable to obtain it through employer, individual or other government programs, the exchange will be something you may want to look at.

Question: How can I participate in the Covered California exchange?

Answer: Eligible individuals will be able to enroll in the exchange plans online, over the phone, or in person.

Question: Can Policy Advantage Insurance Services help me enroll in the exchange?

Answer: Yes. Policy Advantage Insurance Services, and any other “exchange certified” agents/brokers can help you with your questions and enrollment in the Covered California exchange. The exchange has not rolled-out further information about “exchange certification” yet, but we (Policy Advantage Insurance Services) will be getting certified.

Question: How much will my premiums cost at Covered California? 

Answer: Depending on your income bracket (400% of FPL or less), you may received a subsidy from the exchange. Covered California has provided a premium estimation calculator here.

Question: Who will receive subsidies from the Covered California exchange?

Answer: California was one of the states that expanded Medicaid eligibility to 138% of FPL. So, individuals who make between 138% and 400% of the federal poverty level (FPL) should be eligible for subsidies. If you make less that 138% of FPL, you will be eligible for Medicaid in California.

Question: When can I enroll in the Covered California exchange?

Answer: Enrollment is set to begin on October 1st, 2013, and coverage begins on January 1st, 2014.

Question: What types of plans will be available in the Covered California exchange?

Answer: Plans inside of the exchange must contain the same benefits as those outside of the exchange (plans that are being offered within the exchange are private plans that are funded by the federal government). They are essentially identical to those that will be found outside of the exchange. Here are the levels of coverage:

  • Platinum (90% paid by health plan, 10% paid by plan member)
  • Gold (80% paid by health plan, 20% paid by plan member)
  • Silver (70% paid by health plan, 30% paid by plan member)
  • Bronze (60% paid by health plan, 40% paid by plan member)

That’s all for now about the Covered California state health insurance exchange. If you have questions, please feel free to contact us at anytime. As soon as further information is available, we’ll be getting “exchange certified” and helping our clients and potential clients enroll starting on October 1st, 2013. The Covered California website is: www.coveredca.com.

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

YouTube: http://www.youtube.com/policyadvantage

Pinterest: http://www.pinterest.com/policyadvantage

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