They’re at it again! – Efforts to Repeal Obamacare

There’s a new attempt to un-do the Affordable Care Act (ACA) going on in D.C. It’s disguised as an attempt to reform the law, but make no mistake, this proposed change will take us backward in time.
This time proponents say it should be up to the states to decide which health benefits should be offered. They want to allow insurers to charge older plan members (that’s people somewhere around age 50) 5-7 times more than they charge younger members. They suggest High Risk pools for folks with pre-existing conditions. (Did you know that  a pre-existing condition could be something as seemingly simple as eczema?)
 

What’s the matter with letting states decide such matters?

The problem with all these ideas is that once again care will not be available to people who need it. It’s a move right back to where we were before the ACA was passed.
 
What benefits are likely to get dumped? Maternity care and mental health benefits are right up there on the list. Both can be very expensive. Both need to have a large pool of premium-payers in order for insurance companies to offer them. When they are optional benefits, insurers only offer them on their most expensive policies (we saw that before the ACA in California). Far too many people who need such care cannot afford to purchase the policies that offer coverage for it.
 
Not intending enter the controversy over abortion or to say anything about the pros and cons of abortion accessibility, I must note that when maternity care is not affordable, more women find their options for continuing a pregnancy limited. The abortion rate is more likely to go up.
 
We know that lack of mental health care raises the risk of homelessness, violence, and the use of emergency room care for conditions that could have been prevented with stable housing, food, and employment. Cutting out that benefit would again take us backward in time.
 
We’ve also tried High Risk pools in the past. The ones we had pre-ACA were limited in the number of people who could be covered, had annual limits on the amount of care they would pay, and were much more expensive than regular policies. A return to that will not help reduce the cost of care or access to care for people with pre-existing conditions.
 
Much of what the GOP is now proposing is simply a return to what we had before the ACA was passed. It’s being presented as a way to fix Obamacare. Don’t be fooled. It won’t fix the problems with the ACA / Obamacare. It will take out basic protections and ultimately make health insurance more expensive. It will also result in much larger numbers of uninsured people.

 

Contact your representatives in Congress.

Let them know that the Affordable Care Act does not need to be reversed or repealed. It needs to be fixed, but not by going back to the way things were before March 2010 when the ACA was passed. And don’t take your eyes off what’s going on in D.C. They think we might not notice what’s happening if they just change a few things here or there and call it returning control to state and local governments.

 

A Benefit in the National Interest

Health care and health insurance are topics of national interest, governed at the national level for the vast majority of Americans through Medicare, the VA, Medicaid, and employer-based insurance programs. Let’s not let anyone take protection away from the small number of other of Americans who have so recently received the benefits of comprehensive coverage. Good health and access to care are truly fundamental to making America a great place to live, work, and raise our families.
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Policy Renewal Time Approaches

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

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

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?

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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