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Okay, it is the day after--now what?

11-10-2016by Colleen King

In a word, NOTHING.  It's November 9th, day after THE election. Sun came up, most birds were still singing, but as far as health insurance and the god awful rates we're looking at for 2017, nothing will change right now.

First of all, Trump doesn't take office until January. When he does I hope he will have been spending a lot of time on building teams to look at many areas, especially health care and how to fix the Unaffordable Care Act. In case he or any of his team catch my blog, I have some opinions of what could help. And no, I don't have the stats to back how much could be saved, or insurance costs could be cut--this is just gut instinct:

  • Modify the 'actuarial values' structure--this is where the law says a Platinum plan has to cover 90% of your costs, Gold covers 80%, Silver covers 70% and Bronze covers 60%. This needs to be modified, especially the Gold and Platinum levels, because these structure are unsustainable. Gold and Platinum plans usually have no deductible. Great, but that makes these plans really expensive.
  • We used to have plans that would offer generic drug coverage only. Government said that wasn't good enough. But what if that's all you wanted, and you were willing to chance it? Shouldn't that be your choice? That would help.
  • Maternity coverage is required on all plans. And to the guys that say 'they' don't need it, 1. you're usually involved when a woman gets pregnant, and 2. I have coverage for prostate exams I don't need. I would like to see it permissible to have a few plans without Maternity coverage, but require carriers to have it on the majority of their plans, like 75-80%--that spreads the cost out, otherwise plans with maternity are ridiculously expensive.
  • Revamp the exchanges--how did they expect to add a whole NEW bureaucratic layer in health insurance administration and bring the cost of insurance down? Shrink the exchange concept down to where they help administer/answer questions about that kind of eligibility. Agents at least in California have been involved in the majority of insurance plan sales on Covered CA. Maybe expand their ability to answer questions about the MediCal side, since it's 'hands off' for them once one is eligible for MediCal and the case goes to the 'Local County Office'--yikes!

That's it for now. I'm sure there's more, like oh, cost containment in the pharmaceutical industry? I'm done....for now....

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But I have a PPO--what do you mean I have a PCP now?

11-02-2016by Colleen King

One of the main reasons people tend to like PPOs, unless they've had a good HMO experience, is the freedom to choose which doctors they go to. You can see someone contracted with your health plan, or not. If they aren't contracted, you pay more of the cost. And there is no 'discounted,' contracted rate to help contain your costs.

So when Covered CA came out this year and dictated that even if you have a PPO you will be assigned to a primary care provider (PCP) agents were very alarmed, because we knew the phone would start ringing. No, you still have a PPO, you just have a PCP to go with it. Here are the points, good, bad or indifferent, that you need to know about this new thing for 2017:

  • You will automatically be assigned to a PCP. Maybe it's someone you know, maybe not. The carriers are saying they may review claim info to try to assign you to someone that you've been using.
  • You don't have to use that doctor EVER--the theory is, maybe there will be a higher utilization of preventive services if a member has someone to go to, since a lot of people don't have a regular doctor. If you want to change your assigned PCP, just like with an HMO, you can at any time.
  • You can still go to anyone you want, you don't need a referral for a specialist--BIG difference from an HMO PCP.
  • This doctor supposedly is NOT being paid to be your PCP. With HMOs your PCP is paid 'capitation'--$X amount per member, per month, whether they see you or not. So the new PPO PCP, they will be compensated like they are now, when they see a patient.

So, is this going to make a difference, will it increase the use of preventive services? Dunno. Is it going to improve the quality of care? Maybe. Are patients and doctors going to like this? Remains to be seen. Just another change in our health care system that supposedly wasn't going to change once the ACA hit. So stay tuned....

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Whats the reality of the increases for indivdiual health plans this year?

10-27-2016by Colleen King

Okay, it's hit the news, yes my phone is ringing, and yes the email volume is definitely up. Nightly news came out yesterday talking about how rates were going to be going up 25% in 2017. This is true, and some are going up more--I have clients whose rates are going up as much as 35%. So now what?

Covered California, the health benefits exchange here it the Golden State, has been saying that the average rate increase is just over 13%, but that's okay, because about 90% of consumers received financial assistance. That's not what I'm seeing, nor my peers. While Covered CA is putting out a good effort, the reason why there's such a high number of enrollees that are subsidized is that most agents only put cases through Covered CA if their clients are potentially eligible for assistance. Otherwise, it's a more lengthy application to do, and there have been problems. Definitely an improvement over the fall of 2013 when this insanity started, but there are problems.

I'm being challenged on that statement by some, about subsidies, but I know how I do things, and a lot of my agent peers. And I've not seen the math on this 13% 'average' number. Is that factoring in the new MediCal enrollees, most of whom don't have a payment, not sure. But when you have a plan that is offered both on and off Covered CA, by state law, it has to be 'the same'--meaning same benefits, same network and same rate. So why are the 'off exchange' plans so high? Whether they are on and off exchange plans, or off exchange only, things are shooting up.

Long story short, you have to 'shop' your plan. We have fewer choices, but check with an independent agent in order to be sure you aren't paying more than you have to.

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How fast can you get me health insurance?

10-19-2016by Colleen King

When a call starts like this, it’s rarely good. This usually means someone has something wrong, or someone’s pregnant.

Problem is, the intent of Health Insurance is in case something goes wrong. If something has already happened, you don’t need insurance, you need financing and insurance companies don’t classically do that. This whole idea is why requiring people to buy insurance unfortunately is going to be important if health care reform is going to work. Otherwise, what will happen is people will only apply when they have an issue, then drop coverage when all’s well. The concept of insurance, all types of insurance, is that people have to pay in whether they need it or not then there is money in the risk pool for when something is needed. And a risk pool is never something you want to be in the shallow end of, that’s for sure.

This makes the open enrollment season more important than ever. Before 2014 we didn't have this in individual health insurance, just group health insurance with your employer. Now, you can enroll between November 1st and January 31st, but that's it. Unless you have a 'qualifying life event,' like getting married or divorced, having a baby, moving into a new service area where you existing plan won't work, losing a job or your company dropping their group health plan. Those situations, and few more obscure, give you a 'special enrollment period,' where you can enroll outside of open enrollment, but generally you only have a 60 day window.

My main point is, we can’t close the barn door after the horse is out, so that’s why you need health insurance. Before something happens!


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Why work with an independent insurance agent instead of doing it on your own? Read on...

10-16-2016by Colleen King

Well, okay so your broker doesn’t have to be physically down the street, but it’s looking more and more like getting some help in sorting out options from someone when shopping for health insurance, available to you at no cost, makes sense. Seriously--agents are paid by the carriers they place the business with, you aren't charged for it.

Several articles talk about rates had shooting up and and people looking for new coverage. Often people found working with an independent broker helped find something manageable. You can go to the big major online sites but honestly, the past few years, I’ve helped people change plans several times after they bought something online then found it didn’t work the way they expected.

The California Small Business Association (CSBA) which I’m a member of has a program titled Buy California Small Business First which is aimed at drawing attention to doing business with people and companies within California. The reason to do this is to keep more money/revenue in the state; it’s not necessarily more expensive to do business with local smaller stores.  Now obviously not all insurance companies are based within California, but the local broker is. You will most of the time end up with more personal service when working with a broker. And if you don’t, then you need to look elsewhere; there are thousands of us.

The point is with health care reform in full bloom, there is way too much to keep track of and relying on your broker to help you where needed can be a real plus. Rate increases are hitting–and HARD this year. we don’t have all the information yet like we have in years past but do you want to sit on hold with Anthem Blue Cross or any other carrier for 20-30 minutes? I’m already doing it, so just add you question to my list. It’s all about trying to save clients money on their health care coverage where we can while making sure as close as we can that your needs are met-–that what we do.


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