Category Archives: Covered California

Higher Deductibles and Co-pays? Look at Aflac

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Aflac for Peace of Mind

Help with deductibles and co-pays

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

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Policy Renewal Time Approaches

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Mark-your-calendar-clip-artAvoid Hassles and Heartburn – Start Early to Renew or Change Individual Health Insurance Plans

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!)

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Renewal Time Is Here

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calendar3-240x240We’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.

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Using Your New Health Insurance

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StethoscopeCongratulations! 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!

 

 

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Health Insurance from Costco?

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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!

 

 

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Policy Cancelled? Get Enrolled and You Can Have Insurance Coverage January 1

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As health insurance cancellation letters arrive in mailboxes across the country, anecdotes are circulating about people who are seriously ill and fear they will not have insurance to pay for their medical care after December 31, 2013. Beneficiaries in states whose health insurance marketplaces have been established by the federal government are particularly concerned because the sales website has not worked properly. However, alternative ways exist to enroll in a new health plan and coverage is guaranteed, as long as the policy is purchased within an Open Enrollment period and the premium is paid on time.

Paper Application

Paper applications have been developed for consumers to use for purchasing health insurance through any of the state or federal marketplaces. Download and fill out the application. Send it to the address listed on the application. You will be contacted with information and instructions on how to complete your enrollment in an insurance plan, including what plans are available to you, what they cover, how much tax credit subsidy might be available to help pay for the insurance, and what your cost will be.

Get a paper application right away if you plan to use this method to apply. It will take around two weeks longer than applying on-line. If you absolutely must have insurance in place by January 1, 2014, now is the time to start the process.

Work with an Agent, an Enrollment Counselor, or a Navigator

Certified insurance agents and enrollment counselors/navigators are trained and ready to help consumers get enrolled in health insurance plans.

Certified insurance agents bring specialized training and experience to the table to assist their clients in selecting the plan that will best serve their needs. Since each insurer that offers plans on the individual and family market must offer identical plans and pricing through the marketplace and outside the marketplace, agents will have up-to-date information even if the website is not working well.

Certified enrollment counselors/navigators have also been trained to assist consumers in the enrollment process. These individuals can help answer questions about the application and the process of enrolling. They do not make recommendations regarding which policy might be better suited for an individual or family’s needs. They refer consumers to Certified Insurance Agents when policy selection recommendations are needed.

Enroll On-line, With or Without Help from an Agent

Marketplace websites are improving in reliability and functionality by the day. The federal site, www.healthcare.gov, includes many tools and resources consumers can use to learn about the policies being offered in their county of residence and how much they will cost. The federal site includes links to each state site as well.

For those shopping before beginning the application process, there is a simple-to-use set of questions and drop-down boxes to develop a list of possible plans and their price. Another link takes consumers to the Kaiser Foundation’s calculator that can be used to estimate eligibility for advanced tax credit payments (subsidies) and cost sharing reductions.

Certified Insurance Agents are ready to help consumers enroll on-line. Contact information can be obtained through the marketplace websites. Designate an agent and that person will contact you to answer your questions and help you get enrolled.

It’s a New Day

Prior to the Affordable Care Act, cancellation letters would indeed have spelled disaster for their recipients. Insurers were allowed in many states to cancel coverage in case of high expenses or to set monetary limits on the benefits each beneficiary could receive for medical care. A person dropped from coverage by an insurer could not normally qualify for a policy from another insurer due to a pre-existing condition.

Today, with the coming of the Affordable Care Act (aka, Obamacare), insurance policies all include the same benefits. All legal residents of the country can shop for insurance and enroll in plans through their state or federal marketplace. Those who have been priced out of the market or excluded due to health conditions can once again have health insurance and access to care. Plans even exist that provide minimal coverage at lower prices for those who don’t qualify for subsidies but cannot afford the plans offered on the marketplaces. (These plans require a waiver before they can be purchased by anyone over age 29.)

Consumers can obtain the protection from catastrophic health care costs, paying their “fair share” of the cost of their insurance, while still being able to afford food, shelter, and the other necessities of daily life. All they need to do is enroll by December 15, 2013 and pay their premium by December 26, 2013. Their insurance will be there ready to be used on January 1, 2014.

For Help in Santa Cruz, California

For help enrolling in Santa Cruz County, please contact Kathleen Brewer de Pozos at 831-713-6438. Kathy is a Covered California Certified Insurance Agent and is happy to answer your questions and help you through the process of selecting and enrolling in a plan to meet your needs.

 Se habla Español.

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The Health Insurance Marketplace is Here

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Effective October 1, 2014, health insurance marketplaces in each of the 50 states and the District of Columbia are opening for business. These marketplaces, also called exchanges, are one-stop shops through which consumers can purchase health insurance coverage for themselves and their families. Small business owners can go to the state marketplace to get quotes and insurance for themselves and their employees. Low income citizens and legal residents may also apply for Medicaid coverage for themselves and their families under expanded eligibility rules in many states. In California, these plans are all available through Covered California.

The marketplaces are designed to help the approximately 15% of Americans and legal immigrants who currently purchase their own insurance or who have been unable to obtain insurance due to pre-existing conditions or the high cost of the insurance. Policies are now available that offer affordable insurance and the access to healthcare that they provide. Through a program of tax credits for persons with income from 138-400% of the Federal Poverty Level (FPL), premiums will become affordable for millions of people. These tax credits can be used to reduce the monthly cost of the insurance or they can be claimed when filing income tax returns in the next year.

Small business owners who purchase coverage for their employees may also qualify for income tax credits that help reduce their cost of providing insurance for those employees. Prior to the Affordable Care Act, small business owners were at a disadvantage when they looked for employee health insurance because the pool of insureds was too small for them to get the lower rates offered to large groups who brought larger pools of employees to the table. With the Affordable Care Act’s Small Business Health Option Program (SHOP), small employers will be offered more coverage options, rates that reflect a larger pool of insureds, and options to bring the cost of offering insurance under better control. Some will also receive tax advantages for offering insurance. Through this program, it is hoped that more Americans will join the ranks of those whose insurance comes through their employers.

As the roll-out of the Affordable Care Act continues, more information and updates will be available here. At Pozos Insurance Services, we are committed to helping our clients select the best plans that meet their personal and business needs for health insurance. We look forward to hearing from you.

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