2015 Open Enrollment Preparation – What You Must Do To Be Ready


Don't Be Puzzled By The 2015 Open Enrollment Period

The next open enrollment period begins on November 15th and ends on February 15th, 2015. During this period you can choose to stay on your current plan, move to another plan, or enroll in health insurance for the first time.

For the 2015 Open Enrollment Period in California there are many changes taking place, and you need to be aware of the following:

  1. Changes to health plans.
    a. Health plan benefit changes.
    b. Standardization of all health plan names.
    c. Health plans that are going away.
    d. Rate Changes.
  2. Timeline for open enrollment changes.
  3. Covered California renewal process.

    a. Required income verification authorization.
    b. Required proof of identity.
    c. What to do if you are keeping your current plan.
    d. What to do if you are changing plans.

We’ll give you an overview of each of these changes. Then we’ll show you what steps you need to take if you’ve signed up for coverage using Covered California or directly from a health insurance company. The links in the list above will take you directly to that section of the post.


2015 Health Plan Changes

In 2015 the benefits of the Bronze, Silver, and Gold plans have been changed, the names of the plans have been standardized, some plans have been deleted, and there are new, mostly higher, monthly premiums.

Benefit Changes

Covered CA benefit changes  in 2015The benefit changes for 2015 are mostly minor and apply to health plans on the Covered California exchange as well as the plans offered directly by the health insurance companies. The Generic Prescription Co-payment has been reduced from $19 to $15 in the Silver and Gold plans. This co-payment will remain unchanged at $5 in the Platinum plans.

The second change is that the Out-Of-Pocket Maximum has been reduced from $6350 to $6250 in the Bronze, Silver, and Gold plans. The Platinum plans will keep the maximum at $4000. For the Minimum Coverage plan, or Catastrophic plan, the deductible and out-of-pocket maximum have increased from $6350 to $6600.

The third change applies only to Bronze plans. For non-HSA compatible plans, the Rehabilitation and Habilitation services will change from a 30% co-insurance to a fixed $60 copay.

For individuals and families with income between 200 – 250% of the federal poverty level, the Cost-Share Reduction plans will have changes. The deductible will increase from $1500 to !600, the preferred brand drug copay will increase from $30 to #35, and the non-preferred brand drug copay will increase from $50 to $60.

Plan Name Standardization

In 2014 the names of the metal level plans were not standardized. Each insurance company could name plans whatever they wanted. As a result, Anthem Blue Cross called the Bronze plan “Core DirectAccess” while Blue Shield of California called the Bronze plan “Basic Bronze PPO.” This confused many health insurance shoppers.

For 2015 the names of all plans will be standardized. Each insurance company will use the same names for their plans.

  1. Bronze Plans are called Bronze 60 HMO or PPO or EPO or HSA
  2. Silver Plans are called Silver 70 HMO or PPO or EPO
    a. Cost Share Silver Plans are called Silver 73, Silver 87, and Silver 94 PPO, HMO, or EPO
  3. Gold Plans are called Gold 80 HMO or PPO or EPO
  4. Platinum Plans are called Platinum 90 HMO or PPO or EPO

Disappearing Health Plans

On Covered California there are some plans that will no longer be available. All the Contra Costa Health plans will no longer be offered on the Covered California exchange. Contra Costa Health will be available if you enroll directly with Contra Costa.

California health plan magically disappearHealth Net will no longer offer their PPO plans on CoveredCA.com. These plans will be replaced with an EPO (Exclusive Provider Organization) plan in Northern and Central CA and a HSP (Healthcare Service Provider) plan in Southern CA. The CommunityCare HMO plans will continue to be offered in selected regions of California.

If you are enrolled in a Contra Costa or Health Net PPO plan through Covered California, you will have to select a new plan during the 2015 open enrollment period. If you do nothing your coverage will end on December 31st.

Outside of the exchange the insurance companies intend to make a few changes and eliminate plans that experienced “adverse selection.” Adverse Selection means that the people in the plan used a much higher level of medical services than would be expected if only average people were in the plan. As a result, these plans will be eliminated.

Assurant will eliminate the CoreMed Gold 3 plan and the CoreMed Platinum 1 plans. Cigna will eliminate the myCigna Health Savings 1900 HSA plan. These plans had very small out-of-pocket maximums and were popular if you knew you were going to have medical expenses for a surgery or the birth of a baby.

Trying to keep these plans in place and simply increasing the monthly premiums was not an option. Getting the California department of insurance to approve a large rate increase would have been very difficult, and would have resulted in negative publicity. So the plans were quietly eliminated.

In 2015, all health plans sold on Covered California and off the exchange, will have integrated pediatric dental benefits. There will be no way to get a plan without pediatric dental benefits.

All of the stand alone Dental Plans sold on Covered California in 2014 will be eliminated and replaced with new 2015 dental plans. If you currently have one of these plans you will be required to select a new plan, or have your current plan end on December 31st.

California Health Insurance Rate Increases For 2015

One key to remember about the rate increase in your renewal letter, is that you will be older in 2015. Part of your increase is because you are 1 year older. The remainder is the actual plan rate increase. Every insurance company will show you slightly higher rates because of your new age.

Across the entire state, the average rate increase for 2015 is 4.2%. The increase in rates varies across the 19 regions California. With the highest increases occurring in San Francisco (6.6%), Orange County (6.3%), and San Diego (5.8%). The lowest rate change (-1.9%) occurs in the central Valley counties of San Joaquin, Stanislaus, Merced, Mariposa, and Tulare (Region 10).

2015 Silver Rate Plan Comparison Across California
“Have” and “Have Not” Gap Getting Bigger

In 2014 the lowest cost Silver plan for a 40 year old in San Diego cost $269 and in 2015 the lowest cost is $295. A change of 9.7%. While in Region 10 the lowest cost of a Silver plan was $295 and now it will be $288. This might lead you to believe the net result of the 2015 rate changes was to make the rates across California more similar.

The opposite is actually true. The 2015 gap between the lowest and highest cost region was $154, while the 2014 gap was only $116. Where you live still plays a major role in determining how much your health insurance will cost.

As of this date, only a couple of the insurance companies have their 2015 rates approved by the California Department of Insurance. When all the rates are approved and published, we will send out a newsletter announcement so you can begin checking your rate for next year. If you would like to receive this notification, you can sign up for our newsletter in the side-bar on the right side of each page in the website.


Timeline For 2015 Open Enrollment In California

As mentioned before, the California open enrollment period 2015 begins on November 15th and ends on February 15th, 2015. During this 3 month period you can make any changes you want. After this open enrollment period ends you will only be able to change your coverage or add coverage if you have a qualifying event.

Here is the timeline for open enrollment period in California 2015:

  • November 15, 2014
    2015 Open Enrollment Begins
  • December 3, 2014
    Must notify Covered CA about health plan change, or you will be automatically renewed in your current plan
  • December 15, 2014
    Last date to get a January 1st, 2015 effective start date
    Insurance companies will send invoice for January premiums
  • December 26, 2014
    Premium payment for January is due
  • December 31, 2014
    All 2014 Health Insurance Plan coverage ends
  • January 1st, 2015
    New 2015 Health Plans begin
  • January 15, 2015
    Last date to apply for February 1st, 2015 effective start date
  • February 15, 2015
    Last date to apply for coverage during the the open enrollment period
    Coverage will start on March 1st 2015

  • Covered California Open Enrollment 2015 Renewal Requirements

    There are a number of things you need to know about how the open enrollment period will work on Covered California. We’ll start with some of the new requirements and then the changes in subsidies (or Advanced Premium Tax Credits) and the new penalty for not having insurance in 2015, and then cover the steps you need to take if you are keeping your current plan or changing to a new plan.

    Income Verification Authorization For Covered California

    Covered California requires Income Verification Authorization
    When you filled out the online application at coveredca.com during the last enrollment period, near the end of the Eligibility section you were asked to give Covered CA authorization to check your tax records and verify the income you stated on your application. You were given 5 choices for how long your authorization would last: 1 year, 2 years, 3 years, 4 years, and 5 years. The default was 5 years, but about 15% selected the 1 year option.

    If you know that you selected 1 year, then you need to give Covered CA authorization to check your 2015 application. If you do not update this income verification authorization, then Covered CA will turn off your subsidies on December 31st 2014. Your January health insurance bill will be for the full premium amount, and you will get no payment assistance from the government.

    The application does not indicate what you selected when you originally submitted it. Therefore you should automatically update this to make sure you continue to get the subsidy, regardless of whether you keep your current plan or change to a new plan.

    Here’s how to update your income verification status:
    1. Login to your Covered CA account.
    2. On your home page you will see an “Actions” box on the right side of your screen.
    3. The first link inside the Actions box is “Update Consent for Verification”.
    4. Click that link.
    5. Change the value in the drop-down box to say 1, 2, 3, 4, or 5 years.
    6. Then click the yellow “Save” button in the lower right corner of the screen.
    You have now updated your income verification.

    Changes To Application Information Require Proof Of Identity

    Obamacare Identity Proofing In California
    Scan or Photograph You Driver’s License Before You Renew or Apply

    As part of the process of making sure you are who you say you are, Covered CA will require some form of identity proof if you report a change to your application. This will also apply if you are just starting a Covered CA application for the first time.

    To verify your identity, you will be asked to upload an accepted form of identification. The application will not allow you to proceed until you have satisfied this requirement.

    The accepted forms of identification are the following:

    {i} A copy of a valid identification;card issued by a federal, state,’or local
    governmental entity that bears a recognizable photograph of the
    applicant or other identifying information of the individual such as name,
    age, sex, race, height, weight, eye color, or address, including school
    identification card, voter registration card,. Military Dependent’s
    identification card, Native American Tribal document, U.S. Coast Guard
    Merchant Mariner card, or
    {ii} Two of the following: a birth certificate, Social Security card, marriage
    certificate, divorce decree, employer identification card, high school or college diploma (including high school equivalency diplomas), property deed or title.

     
    The simplest form of identification is your CA DMV issued driver’s license. Just scan it into a pdf file, or take a jpeg photo of your license and have that ready before you begin.

    Click here For more details on this process and alternatives to this process in the regulations at Coveredca.com.

    What To Do If You Are Keeping Your Current Plan

    If you are planning to keep the health plan your currently have, then you can simply DO NOTHING and Covered California will automatically renew you into your existing plan. Just pay your January premium and you are done.

    A word of caution if you are currently enrolled in a Minumum Coverage or Catastrophic plan. You must apply for a hardship exemption every year unless you are younger than 30 years old. If you do not reapply for the exemption, your Minimum Coverage plan will end on December 31st and you will have no insurance. You can get more information about hardship exemptions and get a new copy of the application here.

    To make sure your 2015 Advanced Premium Tax Credits are calculated correctly in 2015, I would recommend that you review the Income Section of your Covered CA application. Be sure to update your income based on what you expect to earn in 2015.

    How To Change To A New Covered California Health Plan

    Changing to a new health plan on Covered California requires you do a little bit of homework first. You’ll want to consider your current health condition, your expected adjusted gross income in 2015, which networks your doctors are in, and which plans have the best benefit levels for your needs.

    To change plans, you will need to follow this 3 step process (or contact us and we’ll help you make this change):

    1. Determine which insurance companies your doctor accepts.
    You can do this using the Provider Search Links on the Health Care Reform Resources page to search for your doctor’s name in each network.

    2. If all the insurance companies have released their 2015 rates, then run an On Exchange Health Insurance Quote to compare prices and benefits and pick the plan that is the best fit for your needs.

    If the rates are not released yet, then log in to your Covered CA application and click on the RENEW link on your home page. Make any necessary changes to your application, including changes in your Income section, then complete the signature process for the Eligibility Determination. When that is complete, click on the “Select Health Plan” button in the upper right corner of your screen. This will take you into the health plan shopping screen where you can select the plan you want, and then “checkout” and sign the application to complete the process.

    3. Log in to your Covered CA application, click on the “Renew” button, and then go to the “Select Health Plan” section by clicking on the furthest right linked box at the top of your screen. In this section you can choose the plan you want, then view your cart, check-out, and sign your completed CoveredCA.com application.


    Over the next couple weeks we will be posting information about how to renew or change plans if you have signed up directly with an insurance company.

    If you need help with any of this, please contact us and one of our advisors with assist you.


Leave a Reply

Your email address will not be published. Required fields are marked *