What’s the matter with letting states decide such matters?
Contact your representatives in Congress.
According to Santa Cruz health insurance specialist, Kathleen Brewer de Pozos, more individual subsidized ObamaCare health plans offered by Covered California in Santa Cruz County will be limiting the number of doctors you can choose. The physician networks contracting with each plan may not be finalized until October or November, possibly later. (Blue Shield, for example, did not reach agreement with one of its major providers two years ago until January, two months after the beginning of open enrollment.) Nevertheless, carrier websites continue to offer regularly updated search functions that will assist members in selecting network providers.
Blue Shield will be the only carrier offering a PPO (Preferred Provider Organization) in Santa Cruz County in 2017. PPOs have bigger networks and fewer controls on getting specialty care. PPO plans will also allow members to go out of network, but they will face higher up-front deductibles for those services and be left with paying the difference between what the PPO will pay and what the out-of-network doctor charges.
Anthem and Health Net are offering EPO (Exclusive Provider Organization) plans for 2017. EPOs are more restrictive and may have smaller networks. Members do not need a referral from their primary care doctor to see a specialist. Because they have smaller networks and don’t pay for any non-emergency services outside of the network, EPO premiums are generally lower than those for PPOs.
The Kaiser Foundation Health Plan will offer its HMO (Health Maintenance Organization) plan to Santa Cruz County residents for the first time in 2017. Many local residents have been lobbying for Kaiser to come to the region for over 25 years. Kaiser almost always contracts with its own doctors, The Permanente Medical Group (TPMG).
HMO plans are sometimes called gate keeper plans because members must have a referral from their primary care provider (PCP) in order to consult with a specialist.
Watch for physician network information in October and November. This year (2016) Physician’s Medical Group and certain solo practice doctors contracted with Health Net. Dignity Health (Dominican) contracted with Anthem, Blue Shield, and United Healthcare, as well as some other smaller groups and solo practitioners. The Palo Alto Medical Foundation (PAMF) contracted with Blue Shield.
Provider networks change, so be sure to confirm that your doctor(s) are in-network for the plan you select.
Open enrollment for new members as well as existing plan members begins November 1 and continues through January 31, 2017. For a plan effective date of January 1, 2017, it is essential to complete an application by December 15, 2016. Start early to avoid the rush! The last few days and hours before each monthly deadline typically get a bit crazy and waits for help are long.
For questions or help anywhere in California call Kathy Brewer de Pozos at: 831-713-6438 or email her at: KathyPozos2000@gmail.com
Increasing costs are causing many employers to raise deductible and co-pays on insurance offerings. Take a look at supplemental benefits. Aflac offers hospital and accident policies that pay you directly for all of those costs not covered by your insurance, including deductibles and co-pays.
Smaller employers are often raising deductibles to $1,000 or more. People who don’t qualify for subsidies at Covered California — the Affordable Care Act exchange — can get help from supplemental insurance policies from Aflac. There are group and individual plans with policies for short term disability, dental, life, and cancer.
For more information ask Randy Pozos: Randolfo_Pozos@us.aflac.com. Call or text: 831-588-3423
1. Update your contact information. Covered California, “the Exchange,” will be sending out policy renewal and change information in October. If you have moved or changed other contact information let your agent know before September 30. You can also do it yourself directly online through Covered California. Be sure to let your insurance company know of any changes as well.
2. Renew your Permission to Verify Income. You can’t get a subsidy from Covered California if the State cannot verify your income. Permission has to be renewed periodically. Check with your agent to be sure your permission is up to date or go directly to Covered California and do it yourself.
3. Do you want to keep your doctor? Know your provider options. Different insurance plans contract with different doctors. Plans outside of Covered California may have the same provider networks as those on the Exchange. However, some of the older plans and group plans may have different networks. Be sure to check with your doctor’s office to confirm that they take Covered California insurance plans.
4. Check with your agent about individual plans that are not subsidized as part of Covered California if your subsidy is going to be small or if your income is above the subsidy range. But be careful. Some of the plans outside Covered California can have less expensive premiums up front but be more expensive faster when care is needed than the standard plans on the Exchange.
For questions or help anywhere in California call Kathy Pozos at 831-713-6438 or email KathyPozos2000@gmail.com
On Covered California, look for Kathleen Brewer de Pozos as agent. (The only agent at Covered California with that last name!)
We’ve now entered Renewal season for existing health insurance policies. Open enrollment for people new to Covered CA doesn’t start until November 1, but those with existing policies can make any necessary changes and renew their policies now.
Has anything changed in your life or income? A new member of the family? A child who is no longer a dependent? Have you moved? Did you get a raise? Did your income go down? Did you get a new job or lose a job? If there have been changes we’ll need to open a Change Report and enter the new information into the system that way. If there will be changes for next year, but things haven’t changed for this year, we report that by beginning the renewal process directly.
Once all information has been entered, you can select your policy for next year. Some of the carriers have new types of policies and premiums will be quite different. However, for those who have subsidized policies, the out-of-pocket share does not seem to be going to go up too much. That share is still based primarily on household income.
There is one new carrier in our Central Coast market area, United Healthcare. Many Dignity doctors are on their network provider list. They don’t seem to have a contract with PAMF at this time. Other independent providers are also in their PPO network.
If you want to get a sense of what your premium might be before making any changes, I’ve found the Shop and Compare tool at www.Coveredca.com works with Chrome or Internet Explorer better than with Firefox. I haven’t tried it with Safari.
This year Pozos Insurance Services also offers Aflac supplemental policies that can enhance your protection by providing benefits to fill some of the gaps in traditional health insurance policies. Accident, disability, hospitalization, cancer, dental, and vision supplemental policies are available to groups and individuals. We also offer life insurance.
As always, if you have questions or need help with selecting or managing your policy or Covered California account, or if you’d like to know more about life insurance or Aflac options, please contact us. We’re happy to help you with these important decisions about protection for you and your family.
Anthem has contracted with AllClear ID, an identity theft and personal identity protection service, to offer identity theft and credit monitoring and repair services to current and former members and employees whose personal information may have been stolen during the recent breach of Anthem databases. To access and sign up for credit monitoring services and/or identity theft repair, visit www.AnthemFacts.com.
Para información en español, haga clic aquí.
Credit monitoring and identity theft repair are offered at no charge to persons affected by the Anthem breach for a 24 month period beginning this month (February 2015). There is no deadline for signing up for this service. Nevertheless, it is easier to fix any breach of personal accounts when the event is detected shortly after it occurs rather than when significant damage has already been done, so early enrollment in this security program is encouraged.
Services offered by AllClear ID include: ID repair, ID theft monitoring, Credit monitoring, Secure Alerts, Lost wallet protection, $1million theft insurance, and Child ID protection. The cost of all of these services will be covered by Anthem.
To enroll in the AllClear ID program, visit www.AnthemFacts.com.
When you sign up for the program you will receive a redemption code. That code will be used to set up your personal account. Each person covered by your plan will need a separate account, though all can be monitored by one member of the household. It will be necessary to get a redemption code for each person.
If you do not have internet access, call the Anthem response line at: 877-263-7995. Leave your number and we’ll get back to you if you don’t get through immediately.
Anthem is required by law to send email notifications to any member or employee (past or present) whose personal information may have been breached. Emails from Anthem will not include any live links or requests for any of your personal information. Do not open any link on any email that claims to come from Anthem.
Anthem will also be sending information regarding ID protection by regular mail. Again, do not give information to anyone other than Anthem at 877-263-7995 or through AnthemFacts.com.
Regular Anthem calls reminding clients to visit their doctors regularly or get services that are recommended for persons of their age will continue. However, Anthem never asks for personal identity information or member policy numbers during these calls.
AllClear ID will never ask for access to your computer or other electronic device. They will not request personal identification information, passwords, log-in IDs or any other sort of information that could compromise your identity. Report any incident of telephone or computer contact in which someone is doing this at: 877-263-7995.
To get accurate, up-to-date information, visit AnthemFacts.com.
Para información en español, haga clic aquí.
I received this email just now from my Anthem Regional Sales Manager. It has the most recent information you need regarding how to protect your personal information in the wake of the cyber-attack announced this week.
The following is cut and pasted directly from the email:
California residents who have may have been impacted by the cyber-attack against Anthem Blue Cross should be aware of scam email campaigns targeting current and former Anthem members. These scams, designed to capture personal information (known as “phishing”) are designed to appear as if they are from Anthem and the emails include a “click here” link for credit monitoring. These emails are NOT from Anthem.
DO NOT click on any links in email.
• DO NOT reply to the email or reach out to the senders in any way.
• DO NOT supply any information on the website that may open, if you If you have clicked on a link in email.
• DO NOT open any attachments that arrive with email.
Anthem is not calling members regarding the cyber-attack and is not asking for credit card information or social security numbers over the phone.
This outreach is from scam artists who are trying to trick consumers into sharing personal data. There is no indication that the scam email campaigns are being conducted by those that committed the cyber-attack, or that the information accessed in the attack is being used by the scammers.
Anthem will contact current and former members via mail delivered by the U.S. Postal Service about the cyber-attack with specific information on how to enroll in credit monitoring. Affected members will receive free credit monitoring and ID protection services.
For more guidance on recognizing scam email, please visit the FTC Website: http://www.consumer.ftc.gov/articles/0003-phishing.
Blue Shield announced today that the company has reached an agreement on a two year extension of its contract with Sutter Health, including the Palo Alto Medical Foundation (PAMF). This agreement, whose terms are not public, protects both carrier and clients according to Blue Shield.
Sutter Health and the Palo Alto Medical Foundation are major players in the Northern California health care scene. In some counties, including Santa Cruz, Blue Shield will be the only carrier whose network of providers for individual policies includes Sutter and PAMF, in contrast with 2014 in which these providers contracted with both Health Net and Blue Shield. Patients who had already moved from their Health Net policies to Blue Shield effective January 1, 2015 in order to keep their providers were facing the possibility of having to find new doctors anyway. News of the agreement will be welcomed.
The lack of a contract between Blue Shield and Sutter Health/PAMF affected both individual and group members of the plan.
Open Enrollment for individual and family health insurance continues through February 15, 2015. Contact us today for a free consultation and help enrolling in a plan to meet your needs.
Congratulations! You’ve completed the daunting task of researching options for health insurance, finding help to enroll in a plan, confirming which plan will work best for you and/or your family, and completing the application. Once your first premium payment has been made, you move into what may be a brave new world of having and using health insurance. Even if you have always had health insurance, today’s policies differ in important ways from the ones available only two years ago.
Covered California has a new web page specifically for people who have purchased an insurance policy through California’s state exchange/marketplace. I found it instructive, with a video and useful links.
Now it’s time to take advantage of the opportunity to get your preventive care visit and any lab tests or immunizations needed to help keep you healthy. Flu shots are considered to be preventive services, for example. So are vaccinations for illnesses such as whooping cough (pertussis) and shingles. Mammograms, PSA tests, and many other diagnostic exams are also included as preventive care.
If you have questions about whether a service is covered, you can call your health plan directly or speak with your agent. Before you see your doctor, make sure he or she is a contracted provider with your health plan’s network. When your doctor refers you to a specialist, double check that the specialist is also in-network. If the provider is not in the network, it’s possible that your plan will not pay for your care. Insurance plans have “provider finders” on their websites if you need to find a doctor who is in your plan’s network.
In the event you need urgent care rather than emergency care and your doctor’s office is closed, it’s better to go to an urgent care center that is in your network than the hospital emergency room. (Emergency care is for conditions that are life-threatening.) With Bronze and Silver plans, emergency room visits are subject to the deductible. This means that you will have to meet your medical deductible first before the visit will be priced at only the copayment set for your plan. Some of the Enhanced Silver plans have this deductible waived, but regular Silver and Silver 73 plans require payment of the deductible for emergency room visits. Urgent care visits will cost less.
I hope that you will not need any serious medical care in this coming year, but if for some reason you do need care, your purchase of a health insurance policy now has set the stage for a more positive outcome.
To your health!
Costco is offering health insurance to members and the question arises whether the policies offered and the pricing are better than what is available through Covered California or directly from the insurance companies. A bit of research resulted in the following:
Costco is working with a brokerage firm out of Nevada that has agents licensed in California. It offers plans from Blue Shield, Anthem, Health Net, and Assurant Health Plans. The Blue Shield, Anthem, and Health Net plans offer the possibility of subsidy, because they are the ones offered by Covered California, our state Affordable Care Act (ACA) marketplace. Assurant does not offer plans on the marketplace, so no subsidies are available.
The only plans offered are the Bronze, Silver, Gold and Platinum, with many variants of each to match the marketplace and non-marketplace options offered by these carriers. I checked the prices and they are essentially the same. Some are $1-3 per month less expensive. Some are a dollar or two more expensive on the Costco side.
The Minimum Coverage plan is not offered through Costco, at least not for anyone over age 29. It is not subsidized anyway, so clients would be dealing with essentially the same price for coverage as through the other carriers offering policies in this area. Minimum Coverage plans are available to persons over age 29 when the cost of insurance is above 9.5% of their adjusted gross income – a level deemed unaffordable. For 2014, they had to be purchased directly from the carriers, with a copy of the Federal Hardship Exemption application attached to the carrier’s application. The Assurant plans were all more expensive than the plans offered by the other carriers for the same benefits.
Given Costco’s reputation for discounted sales, this is one of the areas where they actually don’t offer any real pricing benefit and the products are identical to those that any licensed insurance agent in California can offer.
Remember, a local agent can provide a level of service that someone from out of state may not offer, if only the knowledge of which medical groups contract with which carriers. There is no additional cost for purchasing a policy through an agent, so don’t hesitate to call and take advantage of our training and experience. We look forward to hearing from you!