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SPF Mashup May 2015 – What You Need To Know About Health Insurance Changes

by Tim Thompson
What You Need To Know About California Health Insurance

The SPF Mashup is a collection of note-worthy articles, report, and information that have come out in the last month, and will have an impact on your health insurance and your health.

The last month has been filled with health insurance changes in California that will take effect in 2016 or 2017.  Here’s what you need to know about health insurance changes in California.  Three sections are about changes that will effect the rates we see in 2016. The fith section is for those of you over the age of 65. The last section is a MUST READ piece for everyone.

Quick Snapshot (click on item to go to that piece)

Here’s What You Need To Know About Health Insurance Changes

Bill Would Make Pregnancy a Qualifying Event for Covered California

pregnancy as qualifying event in California“California lawmakers are advancing legislation to add pregnancy to the list of so-called 'life-qualifying events' allowing people to buy health insurance outside the regular open enrollment period.”

Read more here:

AB 1102 has passed the California Assembly and is headed to the Senate.  This bill faces an uphill battle because it would violate Federal rules that say a woman can only change or enroll in health plans after giving birth.

This potential change would help SPF Insurance since we are contacted by many families in California that are looking for health insurance with maternity coverage.  

However, I see this as the beginning of a slippery slope.  If this spread to other medical issues like cancer or diabetes, then fewer people would get coverage during open enrollment periods because they could get coverge when diagnosed with a medical issue.

New Preventive Services Are Added To 2016 Health Plans


 “The newest recommended services are hepatitis B screening for adolescents and adults at high risk for infection and low-dose aspirin for pregnant women who are at high risk for preeclampsia “Credits: More Preventive Health Services Approved For No-Cost Coverage

Read more here:

These two preventive services will be covered at no cost to the patient starting in 2016.  All plans, Bronze through Platinum, will provide these tests.    

Both of these preventive services are low cost, so the effect on health insurance permiums should be minimal.  

Covered California’s prescription drug price cap may open doors for thousands

Covered California Prescription Drug Cap Changes 2016“A new decision by Covered California to adopt a policy that helps customers pay for high-cost speciality drugs sparked hope for an expanded state law that could assist thousands with HIV, diabetes, multiple sclerosis and other chronic illnesses, health advocates say. Under last week’s policy change, a first in the nation, those who bought health plans through Covered California, the state’s health insurance plan exchange, will see their specialty drugs capped at $250 per month per prescription. Overall, the caps will range from $150 to $500 and were crafted to help reduce the monthly out-of-pocket costs for enrollees.”

Read more here:

This change to all the Obamacare plans in California will increase the rates we pay for health insurance.  According to various experts, drug costs are a little over 9% of all health care costs.  Plus  some new blockbuster drugs  are extremely expensive.  According to a recent Reuters article:

Number of Americans using $100,000 in medicines triples -Express Scripts

“Of the estimated 575,000 Americans who used at least $50,000 in prescription medicines last year, about 139,000 used at least $100,000 worth of medication, nearly triple the 47,000 who hit that mark in 2013, the report said. The total cost to health plans for U.S. patients with prescription drug expenses in excess of $50,000 was $52 billion in 2014, Express Scripts said in its report: “Super Spending: Trends in High-Cost Medication Use.”

Read more here:″ target=”_blank”>

 Generic drugs are 86^ of all prescriptions in 2013We'll have to wait until October this year to see what the effect will be on health insurance premiums in 2016.  But if if the number of people using over $100,000 doubles or triples again this year, you can see that the effect on rates may be noticeable.

The one thing keeping prescription costs from skyrocking is the fact that more and more prescriptions are for generic medications.  A recent report from the pharaceutical industry shows that 86% of all prescriptions filled in 2013 where generic.

California May Allow Undocumented Immigrants To Enroll In Covered CA

immigration health insurance in california is heating up“Senate Bill 4 would allow undocumented immigrants to purchase health insurance on the state exchange, pending a federal waiver, and enroll eligible people under the age of 19 in Medi-Cal, the state’s insurance program for the poor. A capped number of undocumented adults would also be allowed participate, if additional funding is appropriated in the state budget.” California Senate approves health care for undocumented immigrants

Read more here:

This Bill was just passed by the Assembly and will now become law inn California. It enables undocumented immigrant children from low-income families to apply for Medi-Cal. Providing coverage for the children of undocumented immigrants was the main goal of the Bill.

The Bill also allows some adult immigrants to apply for health insurance on Covered California. However, enabling undocumented adults to apply on Covered CA will require a federal waiver, because the Affordable Care Act specifically forbids the exchanges from enrolling undocumented immigrants.

What SB4 does not do is enable these applicants to get federal assistance with their monthly premiums. As a result, I don’t believe many undocumented adults will enroll if California receives a federal waiver.

Will Your Medicare Advantage Plan Survive?

California Medicare Advantage Changes“For the past few years, U.S. health plans that cover Medicare Advantage (MA) beneficiaries have been struggling to hold out against a string of reimbursement cuts. … We predict that consolidation will accelerate in Medicare [Advantage], and that 30-50 percent of all beneficiaries will change plans in the next several years.” Credits: How Medicare Advantage Plans Can Thrive In A Winner-Take-All Market

Read more here:”>Credits: How Medicare Advantage Plans Can Thrive In A Winner-Take-All Market#storylink=cpy

I've been telling my Medicare clients and those turning age 65 that Medicare is going through ACA pains.  This new change to the plan rating method will make it even harder for the smaller Medicare Advantage (MA) insurance companies to survive.

If a MA insurance company is acquired, the new company typically will cancel the plan and transition customers into the new companies' MA plans.  That can be a benefit though.  

If a MA plan is cancelled, you are given a “guaranteed issue” period to move back into Medicare with a “Medigap” (Supplemental) plan to take care of what Medicare does not cover.


An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

This is a long article, but the message is very important. The author is a doctor with a specialty in Thyroid surgery, and he tells it like it is, and how it should be. If you want to know what to look out for when you go see your doctor, read this article.

How to be a good California health insurance shopper“We’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference.
We’ve learned these lessons the hard way. Over the past two decades, we’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all. …(Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.) It’s all over-diagnosis. We’re just catching turtles.”

I hope you liked this quick review of the changes that have occurred in the last month. This is what you need to know about health insurance in California. We’ll be doing this fairly often (monthly…I hope).  

Tell us what you liked (or disliked) the most in a comment below.

3 Easiest Qualifying Life Events To Change Your Health Insurance

by Tim Thompson

Qualifying Life Events For Health Insurance Changes

Qualifying Life Events For Health Insurance Changes

Now that the annual health insurance open enrollment period has closed you can not change your health plan unless you have a qualifying life event. There is a list of 12 total qualifying life events, but many of them occur very infrequently. Of the remainder, some are more common, and we’ll show how you can use these to create a special enrollment period that allows you to change or get new health insurance coverage.

The 3 easiest qualifying events to use are:

  1. Involuntary loss of Minimum Essential Coverage
  2. New resident of California due to permanent move, or a resident moving to a location where new health plans are available
  3. You become newly eligible or ineligible for subsidy assistance or Cost Share Reduction benefits, whether you are enrolled in Covered California or not

Involuntary Loss Of Minimum Essential Coverage

This qualifying life event occurs when you leave a job that provides company-sponsored health insurance, or your insurance company terminates your coverage. A key distinction about this event is that it can not be Voluntary. When you quit your job, the company will stop paying for your health insurance, and you will have to choose between COBRA and getting your own medical plan. The company decision to stop paying for your coverage makes this loss Involuntary.

Warning! If you accept COBRA coverage, you will NOT be able to leave COBRA until the next open enrollment period.

Opting to leave your health plan by not paying the premiums, or by cancelling it, is considered a Voluntary loss1. This will not create a special enrollment period for you. You will have to wait until the next open enrollment period before you can apply for a new medical plan. This also applies to removing your spouse or children from a company medical plan.

Proof Of Involuntary Loss Of Medical Insurance

To prove this qualifying life event is valid, you need to provide a letter from your employer stating your medical insurance has ended on a specific date. If your insurance company cancels your plan, they will provide you with a letter about it. This letter is your proof.

New Resident Of California Or A Move Within California

Moving within California may be a qualifying life event

Did You Move Between Regions In CA?

If you have recently moved to California from another state or country, this qualifying life event applies to you.

The other way this is used is if you move between the 19 regions in California, and your current plan is not available in the new region, or there are new plans that were not offered in your old region. As an example, if you have a Health Net PPO plan and live in San Diego. Moving to Crescent City would create a special enrollment period for you because only Anthem Blue Cross and Blue Shield plans are offered there.

Proof Of California Residency Change

To prove this qualifying life event, you’ll need a couple pieces of documentation.

  • A copy of a utility bill showing your previous address
  • A rental agreement or purchase agreement for your new address

You Become Subsidy Eligible or Ineligible Due To Income Change

This qualifying event is probably one of the most useful life events. It’s also the most frustrating one. You can use this condition if your income changes enough to qualify for an increase or decrease in cost share reduction benefits, or if your adjusted gross income crosses 400% of the federal poverty level.

However, you can only use this qualifying life event IF YOU ARE ALREADY ENROLLED ON Covered CA. That’s the frustrating part!

As an example, if your adjusted gross income drops from $30,000 to $28,000, you would qualify to change your health plan. This occurs because $28,000 qualifies you for a cost share reduction Silver 73 plan with enhanced medical benefits, while the $30,000 would put you into the regular Silver 70 policy.

Proof Of Income Change Event

There are a variety of documents that can be used to prove your income has changed. The most common are pay-stubs, bank statements, and income tax returns.

60 Day Special Enrollment Period To Make Any Changes

With each of these qualifying life events, you have only 60 days from the date of the event to enroll or change your health plan. This deadline is very firm, so don’t delay.

With the Involuntary Loss of coverage, and the permanent move life events, you are also allowed to apply for coverage up to 60 days prior to the event. This change was made to prevent gaps in your health insurance coverage.

If any of these 3 events apply to you…

What Should You Do Now?

The primary thing to do is get started collecting your supporting documentation. Once that is ready, you can begin the process of changing your health insurance.

  1. Check to see which networks your doctors are in by searching for them in the provider directory search tools located here.
  2. Determine if you can qualify for subsidized coverage based on your adjusted gross income.
  3. Run a health insurance quote On-Exchange or Off-Exchange and tell the quote engine what you expect your 2015 income to be.
  4. Select the plan that best fits your needs. Check here for descriptions of the Bronze, Silver, Gold, and Platinum policy benefits.
  5. Apply online for your new health insurance using the green “Apply Now” button in the quote. If you are subsidy qualified, call us and we’ll help you correctly complete the Covered CA application and qualifying life event information.

Just because the open enrollment period is closed, does not mean you can’t get new medical insurance. You just have to know how, and IF, it is possible based on your life events. Let SPF Insurance help you through those questions.

1 Look for an upcoming post that will show how you can opt out of group health insurance plans and still qualify for individual coverage on or off the Covered CA exchange.

Cigna Health Insurance In California – 2015 Plan Changes

by Tim Thompson

In 2013, Cigna Health Insurance enabled you to sign up for their non-Obamacare plans and avoid having to sign up for a Health Care Reform health insurance plan until 2015. This was a great strategy to keep your health insurance costs lower in 2014. Unfortunately, we are nearing the end of 2014, and your Cigna health insurance plan is ending December 31. Here’s the best alternative health plans to replace your Cigna coverage.

Where do you go to get answers? How do you make the decision? Which is the right plan for you?

The answer to those questions are based on three specific things.

The first one is, are you subsidy qualified based on your adjusted gross income? If so, then we want to apply on Covered California. That’s going to reduce a few of the insurance company choices you have, but free money in the way of subsidies is hard to pass up. So we’ll go that route.

The second question is, do you have doctors that you want to maintain a relationship with? If so, we need to search those doctors first and figure out which networks they participate with before picking an insurance plan. It really doesn’t make a whole lot of sense to pick a plan your doctor does not take.

The third question is, do you take prescription medications? If so, are they generic or are they brand name, and how many prescriptions m are there? If everything you take is a generic prescription, it might make sense to be in a Bronze Health Care Reform Plan because the retail cost of those generic prescriptions may be low enough to offset the cost difference between Silver and Bronze. If it’s only $20 for your generic medications and the price difference is $80 between Bronze and Silver, then it makes more sense to stay with that Bronze plan.

Given the answers above as the starting point, the mapping is going to work like this:

  1. if you have one of the Health Savings Plans, the HSA-compatible plans that Cigna offered, there’s really not a good mapping for you. There’s two options inside of the new Obamacare plans, and that’s basically a $4,500 deductible, and in some cases there’s a $6,000 deductible at the Bronze level. For Assurant and Cigna, they have one Silver HSA-compatible plan, and it’s typically at a little bit lower deductible level, $2,500 and $3,500. So that’s what your mapping looks like.
  2. cigna health insurance california 2015

  3. For those of you who are in the Managed Choice Open Access Value plans – those are plans that gave you unlimited office visits for a co-payment, but then only provided generic coverage for a co-payment; they did have brand coverage, but it had a $3,000 brand deductible, so I viewed the plans as generic only.

    Those Value plans really don’t map into the new Affordable Care Act plans. They are closest in benefits to the Silver plans, which give you unlimited office visits, and cover generic prescriptions with a co-payment. But the Silver plan has a $2,000 deductible, and a lot of people in the Value plans from Cigna were in the higher deductible plans, the $5,000 and the $3,500. So it’s not a direct apples-to-apples comparison, but it’s closest to the Cigna plans. If you didn’t use the medication or the prescription part of it, you might actually fit in the Bronze plans if you don’t need a lot of office visits.

  4. The last type of plan that Cigna offered was the Managed Choice Open Access plans. They basically gave you unlimited office visits, generic and brand prescription covered for just co-payments, and they do map very well to the new Silver plans.

To see what the Cigna replacement plan options are, run a California health insurance quote for yourself, and use this mapping to select your plan.

Hopefully that will help you in terms of making the choices. If you’d like some help picking the plan that’s specific to what you need, then give us a call. We’ll be happy to help you with that.

This is Tim Thompson with SPF Insurance. Protect the health of your wealth by protecting your wealth of health. Bye now.


California Open Enrollment Period Update – Deadline Extension To 12/21/14

by Tim Thompson

As most of you are probably aware, this year the California open enrollment period started on November 15th, and to get a January 1st start date, the deadline was December 15th, or yesterday. Well, not a whole lot of surprise, but Covered California announced yesterday that they were going to extend the deadline from December 15th out to December 21st. So for everybody that was a little bit late, or couldn’t quite get to it by the 15th, there’s a little bit more time.

However, the caveat to that is the only way to sign up now and get a January 1st start for your health insurance is to do so through Covered California. That means whether you qualify for a subsidy or not, using Covered CA is the only way to get a January 1st start date. If you sign up directly with an insurance company right now, then your plan is going to start on February 1st, not January 1st.

There’s a drawback to actually signing up with Covered California that I think everybody needs to understand. If you qualify for subsidies, by all means, that is the way to go. Free money is hard to beat no matter how you look at it.

But if you’re not going to qualify for subsidies, what you actually are doing is increasing the rates that everybody is going to have to pay in California in 2016. The way that works is that right now, Covered California is currently 100% funded by the federal government until December 31st. On January 1st of 2015, Covered California has to be self-sufficient. The way they generate income is by charging the insurance companies $13.95 for every person that signs up for coverage on the exchange, whether they qualify for a subsidy or not.

Between December 15th and December 21st, Covered California is really hoping that they get some people that qualify for subsidies, but even more, they want everybody that was just a little bit late and doesn’t qualify for a subsidy to sign up on the exchange, because that way Covered California collects that $13.95 per person the rest of the year.

Open Enrollment In California Lasts until Feb 15 2015There’s a simple solution to that problem, and it’s something that is going to be really easy to do. The solution is basically we sign up now for Covered California; we get you a plan that’s going to start on January 1st, and at the same time, we also apply for that same plan directly with the insurance company. So we have an application for Covered California and an application with the insurance company both going out at the same time.

The Covered California plan will start on January 1st; the direct application with the insurance company starts on February 1st. And then right before the beginning of February, we cancel the plan from Covered California, and now for the rest of the year, your coverage is through the insurance company directly. So we just have that one-month hit on the $13.95 per person.

That’s the strategy. If you’d like some help implementing this yourself so that we can keep the rates for everybody in California a little bit lower next year, then give us a call.

This is Tim Thompson with SPF Insurance. Remember to protect the health of your wealth by protecting your wealth of health.

Update to post:
As of Friday, 12/19, many of the health insurance companies also extended their enrollment period to help minimize the effect of Covered CA extension of the deadline. Anthem Blue Cross, Cigna, and Health Net extended their deadlines.

Anthem Blue Cross Open Enrollment California 2015 – What To Do

by Tim Thompson

By now, you’ve received your letters from Anthem Blue Cross telling you what your 2015 rates are going to be. Depending on your experience this year, and the rate change you got, you may be asking yourself, “is there a better plan for me?” We’ll show you what steps to take to make sure you get through the California open enrollment period with the least amount of hassle.

Anthem Blue Cross logo - Open Enrollment 2015

Open Enrollment For Anthem Blue Cross of California

As a starting point, some of the information in the letters was incorrect. The subsidy income qualification levels should have been, “modified adjusted gross income of $16,105 to $46,680 or $32,913 to $95,400 for a family of four.” The second discrepancy is that Covered California plans only provide for Therapeutic Abortion (a federal limitation). You will receive updated letters to correct the misinformation.

For 2015, Anthem is changing their rates by -3% to 19% depending upon where you live and which health plan you have. For EPO plans the range of rate changes is 4% to 16%. For PPO plans the range of rate changes is -3% to 9%, and for HMO plans the range is 0% to 19%.

In many areas, Anthem Blue Cross had the lowest cost plans in 2014. For 2015 Anthem’s plans will priced more in line with the other health insurance companies, so it might make sense to check your renewal rate against the other options. If you do decide to shop around, make sure you determine which networks your physicians are in (or stated another way, which insurance company plans your doctors accept).

Anthem Blue Cross Open Enrollment Process

The renewal process for the Anthem Blue Cross open enrollment will be pretty simple. The instructions on what to do are shown below depending upon how you obtained your coverage.

  1. Anthem Blue Cross On Covered California

    If you want to keep the plan you currently have, then follow the steps outlined in the Covered California Open Enrollment post. When you get to the “Select Health Plan” part, you will select the plan you currently have, and then check out and sign the renewed application. This renewed application will then be transmitted to Anthem Blue Cross along with any information you updated.

    If you are changing plans, then you will need to follow this 4 step process (or contact us and we’ll help you make this change):

    1. Determine which insurance companies your doctor accepts.
    2. Run an On Exchange Health Insurance Quote to compare prices and benefits and select the plan that is the best fit for your needs.
    3. Go to the “Select Health Plan” section of your Covered California application and choose that plan. Then view your cart, check-out, and sign your completed application.
    4. Make your “binder payment” to Anthem by 12/26 so your health plan can begin on January 1st, 2015. Covered CA will now allow you to make this payment through the website, at the end of your application. This functionality is scheduled to be available on 11/15, and will be the fastest way to pay for your first month’s premium.
  2. Directly With Anthem Blue Cross

    If you want to keep the plan you currently have, then you won’t need to do anything. Just pay your January 2015 premium and you will stay in the same plan. In late December you will receive new insurance cards showing the new standardized name for your health plan, along with a benefits description.

    If you want to change your plan then you will need follow a simple 3 step process.

    1. Determine which insurance companies your doctor accepts.
    2. Get an Off Exchange Health Insurance Quote to check the price and benefits of the plans from those companies, and select the plan that best fits your needs.
    3. Complete a new application for the new health insurance plan.

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

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

by Tim Thompson

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 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 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

    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 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.

Can I Get Health Insurance After Open Enrollment?

by Tim Thompson

Health Insurance After Open Enrollment Closes 3/31There are a great number of people that believe they can sign up for health insurance whenever they need to because of health care reform. Polls have shown that 55% of Americans don’t know that the open enrollment period ends on March 31st. Media outlets (aka newspapers, and magazine sites) are not helping, and are sometimes a source of horrible mis-information. There are only a few qualifying events that will allow you to get health insurance after open enrollment. We’ll show you what those are, and how you can make use of them to sign up for coverage.

You Can’t Enroll To Get Health Insurance After 3/31, unless…

Make no mistake, you can not enroll to get health insurance after 3/31 unless you qualify for an exception. Major publications, and media sites have made the mistake of saying you can.

What to Know About the March 31 Health Insurance Deadline
Don’t be caught off guard about the consequences of missing the deadline. After March 31, consumers looking to purchase plans through the marketplace won’t be able to do so until open enrollment begins again in October. If you miss the deadline, you can purchase insurance outside of the marketplace at any time – but be aware that you won’t receive any premium subsidies (think “discounts”), and you will likely be subject to a penalty for the time you were uninsured.
March 3, 2014 – Article in US News online.

This is WRONG! If anyone could sign up at any time, then health insurance costs would be significantly higher. Massachusetts tried this when their “Obamacare” plan was introduced a number of years ago. What some people did was wait until they needed care, and then they signed up for health insurance. Once they were healed, they dropped the coverage. The insurance companies quickly increased the premium costs for everyone to compensate for the people that were abusing the system.

Obamacare avoids this problem by having an open enrollment period. Once the window closes, there are only selected situations that allow someone to enroll for coverage. These are called Qualifying Events, and create a Special Enrollment period.

Special Enrollment Qualifying Events

The following qualifying events create a special enrollment period that lasts for 60 days from the event. The qualifying events are:

  1. Involuntary loss of Minimum Essential Coverage (MEC)
  2. Give birth or adopt a child
  3. Get married or divorced
  4. Become a citizen, a national or a lawfully present individual
  5. There was an unintentional, inadvertent or erroneous mistake in your CoveredCA enrollment that prevented you from getting coverage, or caused you to be enrolled in the wrong plan
  6. You can prove to CoveredCA that the CoveredCA Health Plan in which you are enrolled substantially violated a material provision of its contract with you
  7. You become newly eligible or ineligible for subsidy assistance or Cost Share Reduction benefits, whether you are enrolled in CoveredCa or not
  8. Existing company-sponsored health insurance won’t be considered affordable or provide MEC at annual renewal time
  9. New resident of California due to permanent move, or a resident moving to a location where new coverage is available
  10. You become eligible or ineligible for Medi-Cal
  11. Native Americans can enroll at any time, or change to another plan once each month
  12. You are released from incarceration

A special note for number 1 above is that you can not cancel your existing plan, or lose coverage by not paying the premium, and then sign up for new health insurance.

The qualifying events that will occur most frequently are having a baby, getting married, losing group or COBRA coverage, becoming naturalized, or having an income change that makes you eligible for subsidized coverage using premium assistance tax credits.

If you forget to enroll for coverage during the open enrollment period, know that it will be much harder to get health insurance after open enrollment. Sign up before 3/31. Should one of the qualifying events happen later this year, then contact us and we’ll help you through the paperwork to enable your special enrollment period, and prove the existence of your qualifying event.

For everyone else, we’ll talk to you between November 15, 2014 and February 15, 2015 during the next open enrollment period for plans that start on January 1st, 2015.

Go to the Obamacare Impact On Families And Individuals page.

Test Your New Obamacare Health Insurance Plan Before It’s Too Late

by Tim Thompson

Your new Obamacare health insurance plan is now in place, congratulations. Do you know if you choose a good plan? Are your prescriptions covered? Does your doctor take your plan? Now is the time to find out, because you won’t be able to change your plan after March 31, 2014.

Make Sure Your Doctor Takes Your Obamacare Plan

Test Your Obamacare health insurance plan

Not Sure If You Got The Right Health Plan?

The simplest way to test your Health Care Reform insurance plan is to get an annual physical and refill an existing prescription. The annual checkup will require setting an appointment to see your physician, so you will be able to determine if the doctor is in your provider network.

Many people called their physician’s office to find out what networks the office would accept before they picked an Obamacare health insurance plan. However, 90% of Californians have group health insurance through their employer. Simply asking the doctor’s office which networks they accept usually results in getting the name of the group networks, not the individual networks.

When you check in for your appointment, tell them you have new insurance and give them your new card. They may be able to tell you right then if they can accept it. If not, you will find out once you receive a bill from the doctor’s office for any charges associated with your physical.
The new Obamacare health insurance plans all provide no-cost preventive care, including an annual physical exam and typical labs.

Check Your Prescription Coverage

This involves refilling your prescriptions at the pharmacy. Most typical medications will be included on each insurance companies’ formulary. However, some my not be preferred brands, and could result in a larger co-pay.

If you have a Bronze health care reform plan, do not expect to have a co-pay for your prescriptions. Bronze plans provide no benefits until after you reach a $5,000 combined medical and prescription deductible. If this is not what you were expecting, then perhaps you should look at getting a Silver plan.

With a Silver, Gold, or Platinum plan you will get immediate coverage for generic drugs, and after you reach a small brand name prescription deductible ($250 to $500), you will then have a co-pay for brand name drugs..

What If Your Plan Does Not Provide The Coverage You Thought It Would?

After you’ve had your annual physical and refilled your prescriptions, you can now see how your current Obamacare insurance will work. If you had problems with the coverage, your Physician did not accept the plan, or your prescriptions were not covered, then it’s time to get a different plan.

 Obamacare insurance plans from all major health companies in California. Get the best plan!

During the initial open enrollment period, from October 1st, 2013 to March 31st, 2014, you can change plans to find one that fits your needs. The plan that is in-force on April 1st, 2014 will be the plan that you must keep until January 1st 2015.

There are a number of qualifying events that allow you to change coverage outside of the enrollment period, however disliking the plan is not one of them.

Test Your Obamacare Health Insurance Before It’s Too Late

The best time to make sure your new health insurance works is right now. This way you have time to schedule a visit to your physician, get the explanation of benefits statement from the insurance company and any bills from your doctor’s office, and determine if the Obamacare plan will meet your needs for 2014. If not, then you have till March 15th to apply for different coverage that will start on April 1st.

If you are not sure how to find a plan your physician accepts and which covers your medications, then you can ask us at SPF Insurance. Our advisors can make this an easy transition for you that won’t take much of your time.

Covered CA Cancelled Your Health Plan

by Tim Thompson
Covered CA Cancelled Your Policy


By now, everyone in California has received a letter telling them that their health insurance plan is being cancelled on December 31st. However, the Affordable Care Act (ACA) does not say that all these plans have to be cancelled at the end of December. Why then is your health insurance plan being stopped?

President Obama has said many times, “If you like the plan you currently have, you can keep it.” After the cancellation letters arrived, the administration changed the story and justified the cancellations because the cancelled plans offered “poor coverage.” In many states this may be true, but in California our health insurance market is highly regulated by the department of insurance, so our plans are required to have better benefits than most other states.

Are our cancelled California plans providing “poor coverage?” Why are the plans being cancelled on December 31st, instead of on the annual renewal date which is what the ACA says? The answers are pretty interesting.

Covered CA Requires Cancellation Of Your Plan

California created a health insurance marketplace called, Covered CA. The federal government gave California over $900 Million to design, build, promote, and operate the Covered CA exchange through the end of 2014. In 2015, the Covered CA exchange must be self-sufficient and able to generate enough revenue to support it’s operation. To accomplish this, Covered CA has imposed an health exchange fee of $13.95 per person per month for everyone getting insurance through the exchange.

This health exchange fee will be paid by insurance companies starting in January 2014. Therefore, Covered CA wants to maximize exchange signups during this initial open enrollment period. To increase the number of potential enrollees, Covered CA required participating insurance companies cancel their non-grandfathered health plans on December 31st.

Simple probability says that if you increase the number of people required to enroll, the the odds are that more people will enroll on Covered CA. That’s why your policy was cancelled.

The insurance companies didn’t want to cancel your coverage, Covered CA cancelled your health plan.

Your Plan Provides “Poor Coverage”

The Obama administration decided to justify the discontinuation of your health plan by saying that most plans provided “poor coverage.” But they did not define what poor coverage was. Should you be glad that your low-cost health plan was cancelled so you can sign up for good coverage at higher prices?

As you heard Obama say in the video, “You’re going to get a better deal.” Let’s see if that’s true by comparing one of the popular current plans with a Bronze plan on the exchange. We’ll compare benefits and prices using a couple in Orange county that is 46 and 50 years of age (this is an actual client example).

The Health Net PPO Advantage 3500 plan has been very popular for the last 1.5 years since its introduction in California. This current plan is one of the lowest cost plans in most of California.

Comparing Obamacare Plan Versus Current Plan

In Southern California, the Anthem Blue Cross Bronze DirectAccess EPO plan is the lowest cost bronze plan available. Comparing this Bronze plan to the current Health Net plan we can quickly see there are many similarities. Both have an out-of-pocket-maximum of either $6,350 or $6,500, both offer 2 or 3 doctor visits with just a simple co-payment, and most other benefits are available after you reach the plan’s deductible.

The difference in the two plans is also very obvious. The Bronze plan has a $5,000 deductible and the current plan has only a $3,500 deductible. The Bronze plan provides no coverage for prescriptions until after the combined medical and drug deductible of $5,000 is met, while the current plan provides generic coverage for a simple $15 co-pay.

Finally, the current plan provides no coverage for acupuncture and habilitative care, and the co-insurance is 50% versus the Bronze plan with a 30% co-insurance.

Based upon the comparison above, both plans appear to be equal in overall medical value. In a worst-case scenario, the most an individual would pay for medical expenses in a year using either plan is just $6,500 or $6,350. However the monthly premium for the two plans is dramatically different. The current plan costs $276/month for the couple, and the Bronze plan costs $556/month. The Bronze plan costs 100% more, but provides the same benefit levels.

This makes the Obama “poor coverage” excuse sound pretty lame here in California. We have plans today that are just as good as the new health care reform metal plans. Obama and his administration were speaking in generalities about poor coverage, and many states do have plans with lower medical value. However, California is not one of them.

As you can see, it’s important to take what you read and hear in the media, and filter it based on what reality is here in California. We don’t have “poor coverage”, the health plans we have now are equal to the new health care reform plans. The insurance companies and the ACA didn’t cancel your plan, Covered CA cancelled your health plan. Many times, things you read about health care reform won’t apply here in California because of state regulations or Covered CA rules. Having a local authority you can turn to is important.

Let SPF Insurance be that local expert for you.

What You Need To Know About Health Care Reform




Obamacare Enrollment In California – What’s Missing From Covered CA?

by Tim Thompson
Covered CA Exchange Home Page


On Tuesday October 1st, the Obamacare enrollment period began. Health insurance exchanges across the US opened their doors and begin accepting applications for coverage to start on January 1st, 2014. In California, the exchange, called Covered CA, has spent $80 million promoting itself for the last month and encouraging consumers to enroll once it opens. Is it really going to be that easy?

Probably not.

There are a number of key things that are missing on day one of health care reform. Some are critical for the success of Obamacare. The missing pieces are:

  1. Only a limited number of insurance company plans have been approved for sale ON or OFF the exchange.
  2. Lack of consumer awareness about ON exchange and OFF exchange options.
  3. Lack of awareness about the limited doctor networks offered by some ON exchange insurance companies.
  4. There are few certified agents available to help consumers in California at this time.

Only A Limited Number Of Health Plans Approved In California

As a broker, I keep a close eye on what the health insurance companies are offering. Most have expressed frustration with California regulators because of how slowly their new Obamacare plans and pricing are being approved.

This will have a big impact as health care reform begins in California. The primary effects are that it will steer more shoppers to the exchanges, and limit the plan choices consumers have. Both of which are not beneficial to Californians.

You could say that this delay in approving OFF exchange health plans might be on purpose. By steering more people to sign up on the Covered CA exchange, the exchange garners additional fees to help fund operations in 2015.

In 2014 the Covered CA exchange is funded in full by the federal government, but in 2015 the exchange must be self funded. The funding mechanism for 2015 is the $14 per person per month Exchange Fee that each insurance company must pay the exchange starting in 2014. The Exchange Fee applies to every person that applies on the Covered CA exchange, but will be spread across all enrollees in California.

ON Exchange And OFF Exchange Options

Most people don’t realize that there are other options outside the Covered CA exchange. However, each of the major insurance companies in California offer their ON exchange plans outside the exchange. The reason is because of the Exchange Fees, and because they offer additional plans also.

Anthem Blue Cross offers 5 additional plans, along with copies of the Covered CA plans, outside the exchange. Cigna, which is not participating inside the exchange, will only offer plans OFF exchange. None of these plans is currently available due to regulatory approval delays by the California Department Of Insurance.

These OFF Exchange plans offer more flexibility to consumers. Although the plans must meet the Bronze, Silver, Gold, and Platinum benefit levels, the actual benefits themselves can be “tweaked”. Different deductibles, copays, coinsurance levels are possible for the OFF exchange plans, and this might result in lower pricing.

Limited Doctor Networks In New Health Care Reform Plans

Obamacare Provider Networks Are SmallerThe benefits of the plans ON the exchange are defined by Covered CA. All plans ON the exchange must provide the defined benefits, so Silver plans are all identical. The only tool insurance companies had available to reduce the cost of Covered CA plans was the provider network.

As a result of this, most carriers have reduced the size of the network they offer on the Covered CA exchange. Each carrier threw out their existing networks, and created a new network by approaching each physician separately rather than by medical groups. This is a slow process and is the main reason why the carriers provider networks are changing every week.

These frequent changes caused the Covered CA exchange to remove their provider network look up tool until the networks stabilized, and the “import” tool at the exchange could be improved.

Checking to ensure your physician accepts your health care reform plan is extremely important. The only option right now is to check the provider network tools at the insurance companies’ websites.

There Are Only Limited Certified Insurance Agents In California

A certified insurance agent is able to help consumers shop and apply for health insurance on the Covered CA exchange. The Navigators and Certified Enrollment Counselors are only able to help people with enrollment questions, not health plan information and recommendations.

On October 1st there were only 7 certified insurance agents in California. At the end of October there are only 2,700 certified out of over 15,000 that applied to be certified. At this rate only half the agents in California will be certified by the end of 2013.

Obamacare enrollment is not a simple process. Most people need help to understand what it’s about, and how to pick the right plan for their needs. Certified Agents have that knowledge and the ability to help people make good choices in a shorter time-frame.

All of these issues make Obamacare enrollment a challenging task. Not many people have been able to get through the Covered CA application process. Enrollment outside of the exchange is currently limited to only Blue Shield and Kaiser Permanente, because they have the only approved applications. If you want to apply with Anthem Blue Cross, Health Net, Cigna, or any other carrier, you must wait until the California Department of Insurance approves the plans, pricing and the applications.

Consequently, many people are in waiting mode. Waiting for more information, waiting for applications, waiting for a broker to help them. The Covered CA goal of getting 2 million Californians enrolled in this initial open enrollment period does not look like it will happen at this pace.

Go here for more information about what health care reform is and how health care reform will impact you.

UnitedHealthcare Leaving California – See The Replacement Plans Here!

by Tim Thompson
United HealthGroup Leaves California

The second domino in a linked chain has tipped over. Two weeks ago Aetna announced its departure from California’s individual and family health insurance market, and yesterday UnitedHealth Group, Inc (parent of UnitedHealthcare) announced that UnitedHealthcare (UHC) is leaving California. With UnitedHealthcare leaving California, about 8,000 members will need to get new health insurance before December 31st, when their UHC coverage ends.

In this article, we’ll show you the best replacement health insurance plans from the remaining California insurance companies.

UnitedHealthcare Leaveing CaliforniaIn California, UHC provided individual health insurance through their Golden Rule subsidiary using the brand name UnitedHealthOne. Golden Rule was created by UHC over the last 10 years as they acquired various regional health insurance carriers in their quest to the biggest health insurance company in the United States. The 2005 UHC purchase of California’s PacifiCare Health Systems, was primarily for it’s Medicare subscribers in the SecureHorizons Medicare Advantage plans, and the HMO subscribers in the group health insurance market. Although PacifiCare had an 8% market-share in California in 2008, by 2011 it had shrunk to 5%.

Current UHC subscribers will be able to find lower cost replacement plans amongst one of the remaining major health insurance companies, Anthem Blue Cross, Blue Shield of California, Cigna, Health Net, and Kaiser Permanente. To simplify the process we’ve analyzed the UnitedHealthOne plans and provided the best mapping into replacement plans.

Look for the name of the UnitedHealthOne plan in each header to find the mapping for those plans.

UnitedHealthOne Copay Select Replacement Plans

The Copay Select plans are Golden Rule’s top of the line products. They offer unlimited office visits for a $35 copay, provide both generic and brand name prescription coverage with a $500 brand deductible, and offer deductibles of 1,000, 1,500, 2,500, 3,500, 5,000, 7,500, 10,000, and 12,500. Although there are many things to like about the plans, their Out-Of-Pocket maximums and pricing kept them from being very popular in California.

The best replacement plans are:

  1. Anthem Blue Cross Premier plans – these plans are the top of the line from Anthem
  2. Cigna Open Access plans – the high-end Cigna plans
  3. Blue Shield Shield Secure Plus plans – Blue Shield’s top end plans
  4. Cigna Open Access Value plans – Cigna’s low-end plans. Similar to the Golden Rule plans but lacking brand name prescription coverage, and at lower premiums

Look a the deductible amount on your UnitedHealthOne plan and then find a similar deductible amount in one of the plans listed above.

Most of the time, the alternative plan from Anthem, Cigna, and Blue Shield will be lower cost, but you should check the rates in your area of California by clicking on the “Get Rates” button below.

 UHC alternative plans from all major health insurance companies in California. See your rates!

UnitedHealthOne High Deductible Health Insurance Replacement Plans

The High Deductible Health Insurance plans are very unique in the California marketplace. These plans are the low-cost offerings from UnitedHealthOne. These plans offer only preventive care until the patient pays the deductible amount. Once the deductible is reached the three plans either pay for all additional care, or the patient and UHC begin sharing costs with the patient paying a 20% coinsurance, and UHC paying the other 80%.

The Saver 80 plan offers no benefits for doctor office visits or prescription drugs, and once the deductible is reached the coinsurance is 20% until you reach the Out-Of-Pocket maximum (OOPM). The Plan 80 offers office visits and prescription drug benefits after the deductible is reached, and a 20% coinsurance is paid for these benefits. The Plan 100 pays 100% for office visits and drugs, after the deductible is reached.

These plans are very similar to some old plans that the other carriers stopped marketing about 3-4 years ago, such as the RightPlan 40 from Anthem Blue Cross, the ActiveStart plans from Blue Shield, and the Budget PPO plans from Health Net.

There are only a couple of comparable plans available in California at this point:

  1. Health Net CFB PPO Standard plans – the OOPM in these plans is equal to the deductible, and they provide 2 office visits for a copay
  2. Cigna Open Access Value 5000/100% – the OOPM is the same as the deductible, and the plan offers unlimited office visits

If we map Saver 80, Plan 80, and Plan 100 to the current low-cost plans that ARE available in California, we get the following replacement plans:

  1. Health Net PPO Advantage 3500 – offers the best cost vs benefits
  2. Health Net PPO Advantage 6500 – typically the lowest cost plan in California
  3. Anthem Blue Cross CoreGuard 5000 – Anthem’s lowest-cost plan

UnitedHealthOne Health Saving Account (HSA) Replacement Plans

The UnitedHealthOne HSA plans were originally very low-cost plans when they were introduced back in 2004. But over the years the rates climbed faster than other non-HSA plans, until these plans were priced in the middle of the pack. As a result, having an HSA compatible health insurance plan only makes sense for people that can benefit from the tax savings associated with the savings account, and have the ability to contribute the full amount to the HSA each year.

UnitedHealthOne’s HSA 70 is their low-end HSA plan. The plan provides only preventive care until you reach the deductible, and then you begin sharing costs with UHC (you pay 30%) until you reach the Out-Of-Pocket maximum. The HSA 100 plan is very similar to the HSA 70 except that once you reach the deductible, you are done for the year, and UHC pays 100% for everything else. Both plans offer various deductibles from 1,250, 2,500, 3,000, 3,500, and 5,000.

The best mappings for these HSA plans is the following:

  1. Health Net CFB HSA plans – these offer the best value in the HSA market, with the HSA 4500 plan being the overall best HSA plan in California, and the HSA 6000 being the cheapest
  2. Blue Shield Saver HSA plans – these plans are the next lowest cost HSA plans
  3. Cigna Health Savings 4900 plan – good all around HSA plan, but higher cost
  4. Anthem Blue Cross Lumenos 5950 plan – Anthem’s last HSA plan but not the best choice unless having an Anthem plan is more important

UnitedHealthcare Leaving California Means What?

With UnitedHealthcare leaving California, not much will really change. The subscriber base in their individual and family health insurance plans was very small, and their plans were not competitive. So over the next few months I expect everyone will transition to a replacement plan.

This is the second domino to topple, and it won’t be the last. Health Care Reform is about the health insurance companies competing with each other, and to compete requires a large subscriber base. Over the next 3 to 5 years we will see plenty of other insurance companies leaving California. This is just the beginning.

Do this transition from UHC now, before then end of the year and the beginning of the Affordable Care Act Initial Enrollment period on October 1st. This will make the process easier and less time consuming. So go ahead and get started by getting quotes on your replacement plans below.

 UHC alternative plans from all major health insurance companies in California. See your rates!

If you have any questions about how to change plans, when to change, or want some specific recommendations for your situation, just call us and we’ll be glad to help you.

Related Posts

Aetna Health Insurance Leaving California – Recommended Replacement Plans

Aetna Health Insurance Leaving California


Aetna Health Insurance announced they are leaving the California marketplace for individual and family plans. The end date of all their plans is December 31, 2013. All 49,000 Aetna clients still have six months to figure out what health plan they should move to. In this article we’ll give you a simple mapping that recommends which plans you should move to based upon the Aetna health plan you currently have, a “gotcha” to watch out for, and a couple of silver linings to feel good about.

The simplest way to replace your Aetna Health Insurance is to simply look for an alternative plan with the same (or similar) deductible amount. The recommendations below will make that easy to do. With just a little more effort, you could re-think what you need in yearly medical benefits and pick a plan the is a better fit for your current needs. Either way, you should be able to find a good solution listed below.

Aetna Health Insurance Underwriting Is More Lenient

This will be the gotcha for some people. Aetna has always been more willing to accept people with some health conditions. I know a number of my clients are in Aetna plans because they had specific health conditions that the other carriers either would not accept, or would “rate” much higher than Aetna. So this is something you have to be aware of and be careful about.

If you have existing health conditions, or are “too short” (okay…a little over-weight), or have a rated plan with Aetna, then you should definitely talk to a broker before you apply with another health insurance company. You’ll want to have the broker do Pre-Screen Requests for you to see how the other insurance companies will treat your application.

It’s important to do the pre-screen step first, because if you just pick a health plan, apply for it, and then get declined or rated even higher, it will be very hard to get other insurance companies to consider your application.

Let’s start mapping replacement plans…

Aetna Open Access MC Value Plan Alternatives

The Aetna Open Access Value plans are Aetna’s low-cost option. The Value plans offer a number of different deductibles, $8,000, $5,000, $2,500, and provide 3 office visits for a simple copay, and coverage for Generic prescriptions.

This plan description matches very closely to what is offered in the Anthem Blue Cross SmartSense plans. If you only need two office visits rather than three, then the best choices are the Health Net PPO Advantage plans and the ClearProtection plan from Anthem Blue Cross.

If cost of the plan is one of your major factors, then here is how the alternative plans above should be used.

  1. Health Net PPO Advantage 3500 – offers the best overall value (cost vs benefits)
  2. Health Net PPO Advantage 6500 – is usually the lowest cost option
  3. Anthem Blue Cross ClearProtection 3300 – Anthem’s lowest cost solution
  4. Anthem Blue Cross SmartSense 6000 – closest match to Aetna’s Open Access Value 8000, but lower cost
  5. Anthem Blue Cross SmartSense 3500, 2000, 1000 – if you feel more comfortable with lower deductibles

In the majority of cases, the alternative plans from Anthem and Health Net will be lower cost than the comparable Aetna Value plans. You’ll need to review health insurance quotes to see how the pricing looks for your location in California. Just click on the “Get Rates” button below to see.

 Aetna alternative plans from all major health insurance companies in California. The best plans!

Aetna Open Access MC Plan Alternatives

The Open Access plans are Aetna’s high-end offerings. These plans offered unlimited office visits for just a copay, provided both Generic and Brand name prescription coverage, and offered deductibles of 5,000, 3,500, 2,750, and 1,750.

The best mappings of the Open Access plans are the following:

  1. Cigna Open Access Value plans – Cigna’s entry plans, but very similar to the Aetna plans but without brand name prescription coverage
  2. Anthem Blue Cross Premier plans – these plans are the top of the line from Anthem
  3. Cigna Open Access plans – the high-end Cigna plans
  4. Blue Shield Shield Secure Plus plans – Blue Shield’s top end plans

Health Net does not have any plans that provide unlimited office visits and coverage of brand name prescriptions, so there are no options listed.

Aetna Open Access MC High Deductible Plan (HSA Compatible) Alternatives

These are Aetna’s entry in the Health Savings Account (HSA) compatible market. Like all HSA plans, they provide no benefits except zero-cost preventive care until after you reach the deductible. The plans come with two deductibles, either 5,500 or $3,500.

The mappings for these HSA plans is the following:

  1. Health Net CFB HSA 4500 plan – this is the best value HSA plan in the market
  2. Health Net CFB HSA 6000 plan – this is the overall lowest cost HSA plan
  3. Blue Shield Saver HSA plans – these are lower cost than the other non-Health Net HSA plans
  4. Cigna Health Savings 4900 plan – good general purpose plan
  5. Anthem Blue Cross Lumenos 5950 plan – Anthem’s last remaining HSA plan

Are You Looking For Lower Out Of Pocket Risk?

Some shoppers may be looking to lower premiums AND lower the OOPM’s they have had in the past. If this is your wish, then here are a couple of options you should explore:

  1. Health Net CFB PPO Standard plans – the OOPM in these plans is equal to the deductible, and 2 office visits for a copay
  2. Cigna Open Access Value 5000/100% – the OOPM is the same as the deductible, and the plan offers unlimited office visits

These alternative plans will cost a little more than the direct replacement options listed in the sections above. However, the attractiveness of having lower risk if an accident or a medical condition starts is very compelling.

Silver Linings In The California Aetna Health Insurance Decision

I believe that Aetna is just the first in a line of large and small health insurance companies that will leave the California individual and family health insurance marketplace over the next 3-5 years. Aetna had a very small market share, and would have a hard time competing with the insurance companies that dominate the California market. So having Aetna leave now will reduce the turbulence we see during the Health Care Reform roll-out later this fall.

The first silver lining in all of this is that Aetna plans tend to have very high Out-Of-Pocket Maximums (OOPM). As an example, for a family, the Open Access Value 8000 plan has an OOPM of $25,000, while the Anthem Blue Cross SmartSense 6000 plan and the ealth Net PPO Advantage 6500 have a $19,000 OOPM.

This is one of the reasons people have stayed away from new Aetna plans unless no other health insurance company would accept them. There are plenty of plans from Health Net, Anthem Blue Cross, Cigna, and Blue Shield that will have lower OOPM’s than the Aetna plans.

The last silver lining of this change at Aetna, is that Aetna plans have not been very competitive the last couple of years. So changing to comparable plans will give you a reduction in premiums. To find out how much your rates will will be reduced, get an instant quote using the “Get Rates” button below.

 Aetna alternative plans from all major health insurance companies in California. The best plans!

To get answers to any questions, or to see if you need to get Pre-Screen Requests done, just call us at 858-613-3628, or send an email to info (at)

San Diego Midwife Interview With Jamin Sylvada – Natural Birth Options

by Tim Thompson

This is the first in a series of interviews with health professionals regarding natural birth options. We previously outlined a number of childbirth choices that included midwives, birthing centers, water births, home births, and hospital midwife births.

natural childbirth - MidwifeSan Diego women have many choices when it comes to alternative birth options. A simple Google local search for a midwife shows over 50 local businesses that provide midwife care.

In this interview with Jamin Sylvada of San Diego Midwife we discuss what a midwife does, how to select a midwife, is using a midwife right for you, how they work with health insurance companies, and what the costs look like.

Listen to the interview here:

Natural Birth – San Diego Midwife 2-28-13

Interview Transcript

TIM THOMPSON: Hi everybody, it’s Tim Thompson with SPF Insurance, and today we’re going to get some great information regarding alternative birthing options, and in particular, using a midwife for the prenatal and delivery process. With me today is Jamin Sylvada, and she’s an owner of San Diego Midwife. Jamin has been a midwife for over 10 years, after spending almost six years delivering babies in a hospital setting. Thank you for taking some time to talk with me today, Jamin.

JAMIN SYLVADA: Hello. Nice to be here.

THOMPSON: Great. Can you give us a brief overview of what a midwife does?

SYLVADA: I’m a homebirth midwife. So what a homebirth midwife does is clients will come and see us from 8 weeks pregnant, 8 to 12 weeks, and we’ll do read more…

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Health Care Reform – Busting The 3 Biggest Myths Of ObamaCare

by Tim Thompson


In the last few months we’ve seen a lot of Health Care Reform rules and regulations being introduced by the Health and Human Services Department. Every time that happens, the media gets hold of it and all kinds of articles are written in the Wall Street Journal, the New York Times, and the TV network news programs talk about it. All the analysts start talking about the pros and cons, and what it means to businesses and individuals.

The problem with this is, many times one writer looked at the regulation, and wrote a piece about it. Then other writers start using pieces from that first article and rewriting parts to fit their article. By the time the information gets widely distributed, the actual regulations and rules get twisted and distorted, and what actually shows up in the media sometimes just doesn’t truly represent the reality of what the regulations say.

Health Care Reform Is ConfusingThere’s a lot of misunderstanding about what is going on with ObamaCare, and one of the things that I’ve noticed in discussions with clients, is that there’s an underlying set of myths that people have picked up about health care reform that just aren’t true. But because of all they’ve heard in the media, people believe these myths are actually true.

Today we’re going to talk about three myths I hear most commonly. Not everybody believes these myths, but enough do, and others are unsure what to believe, so it warrants dispelling these myths now.

The first one is that health care reform only affects uninsured people. The second one is that Medicare benefits and the Medicare program isn’t going to be affected by health care reform. And then the last one is that health care reform is going to reduce the costs of healthcare.

Health Care Reform Only Affects Uninsured

Let’s look at the first myth about health care reform only affecting uninsured people. In a lot of the discussions I have with clients, there are several expressions they use: “I already have coverage, so I won’t be affected by ObamaCare,” or “I’ll just keep my grandfathered health insurance plan,” and the last one – and this one I can give them a little bit of leeway, because part of what they’re saying is true — is “I have group health insurance, so I won’t be affected by health care reform.”

Well, the reality is that health care reform is actually going to affect everybody. Starting in 2014, we’re going to have a whole new set of health plans, and those plans have very rich benefits with lots of extra features that the existing plans today don’t offer. So these new plans are going to be higher cost.

Health Care Reform’s Effect On People With Health Insurance

People that currently have health insurance are going to be transitioned into these new plans sometime in 2014. So the insured will be directly affected by this because the health plans they have today are going away, and they will be mapped into a new ObamaCare plan in 2014.

Health Care Reform Effect On The Uninsured

The uninsured have an additional issue in that if they don’t get health insurance in 2014, they face a mandate penalty. Some of the healthy uninsured are going to look at that penalty and say, “Well, the penalty is 1% of my adjusted gross income; I make $50,000, so I’ll pay a $500 penalty or $1,000 for health insurance. In that case I’ll just take the penalty.” But either way, they will be directly affected by health care reform. Through the mandate it affects the insured as well as the uninsured.

Health Care Reform Effect On People With Grandfathered Health Plans

People that have grandfathered health insurance plans are not going to be directly affected by health care reform. But because of the life cycle of their grandfathered health plan, it’s going to make those plans more costly as they discover that there are plans available now that they can easily transfer to that have a richer set of benefits that would be more beneficial for any chronic health issues they may have.

For people that stay in those grandfathered plans, the pool of subscribers in the plan are going to start to shrink, and as that happens, the cost of those grandfathered health insurance plans will increase even faster than they are now. Therefore, people in grandfathered health plans will also be impacted by ObamaCare.

Health Care Reform Effect On People With Group Health Insurance

The last one, the small group marketplace, is going to be the most notably affected by health care reform. Even though the health care reform regulations predominantly affect large and medium sized companies, and companies that have 50 or more employees, smaller companies will also be affected, even though they’re exempt from ObamaCare itself.

What many surveys and polls are starting to show is that some of the businesses that have 10 or fewer employees are going to look seriously at their option to drop health insurance coverage altogether, and no longer have it as an expense of the company. Instead, they will have their employees get health insurance through the health insurance exchanges.

In fact, some of the carriers are now saying they anticipate that up to 50% of small groups with 10 or fewer employees are going to drop their health insurance plan sometime between 2014 and 2016. That will have a very large effect on all people that have group health insurance, especially if they’re in one of those small companies that drop health insurance coverage.

It’s not just uninsured that are going to be affected by health care reform, everybody is going to be impacted.

Health Care Reform Will Not Affect Medicare

The next myth was that health care reform would not affect Medicare. This one is kind of funny because right from the very get-go, the most notable cuts were specifically targeting the Medicare program. When you look at Medicare’s portion of the overall federal, you can see that in 1970, Medicare was 4% of the U.S. federal budget, and by 2011, it had grown to 16% of the federal budget.

Medicare spending a growing share of the federal budget modified

If we look at it over the last 10 years, from 2002 to 2012, Medicare is the fastest growing part of the major entitlement programs in the federal government, and it’s grown by almost 70% during that period of time.

Because of how large Medicare is and how fast it’s growing, it’s one of the key programs that ObamaCare is trying to get a handle on, so it doesn’t bankrupts the U.S. Medicare is going to be impacted, and in fact the initial cuts to Medicare have already been set at about $716 billion.

Medicare Advantage Cuts And The Effects

Of that $716 billion cut, the Medicare Advantage program gets cut the most, and will see the bulk of the effects. What that’s going to do is increase the premiums people pay for their Medicare Advantage plans, and reduce the benefits of those plans.

Increased Medicare Advantage Costs

Right now, many people choose Medicare Advantage plans because they have zero premium. When given a choice on Medicare plans, they view it as an easy choice because it’s a free program for them, “Sure, I get Medicare benefits, I don’t pay anything for it; why not.” Now they’re going to see Medicare premiums start to climb, and go from zero to $70, $80, $90, $100. We’ve already seen that with some of the Blue Cross Medicare Advantage plans this year. It’s going to get worse as we go forward in the future.

Reduced Medicare Advantage Benefits

In order to minimize the premium increases, what many Medicare Advantage plans will do is increase the co-payments, increase the deductibles, and change the co-insurance rates. In order to keep the premiums down, they’ll just push more of the costs onto the Medicare Advantage recipients. Increased premiums and reduced benefits are what we’re going to see coming in Medicare Advantage plan.

Fewer Medicare Physicians

And then if that wasn’t bad enough, as Medicare doctors begin receiving lower and lower reimbursements for Medicare Advantage people, they’re going to stop taking new Medicare Advantage recipients. We’re going to see the pool of doctors to support people in Medicare starting to shrink as well, unless changes are made over the course of the next five years. So Medicare is going to be affected, and it’s going to be affected dramatically by health care reform. Everybody’s kind of on pins and needles, waiting to see what’s going to happen there.

Health Care Reform Will Reduce Healthcare Costs

The last one, and probably the biggest myth about health care reform, is everybody thinking that ObamaCare will reduce healthcare costs. That’s completely hogwash. Early on in the process, when they were trying to come up with the rules and regulations, the emphasis and one of the goals for reform was to reduce healthcare costs.

But somewhere along the line, the goal actually shifted from cost reduction to regulation of the health insurance industry. Once they made that transition, they pushed cost reductions to the back burner. There are some small cost reduction components in ObamaCare, but the real emphasis is on regulating health insurance. The new plans, for example, have much richer benefits than many plans today: richer benefits means richer prices.

Health Care Reform Subsidies: Will They Make Plans Affordable?

A lot of people hope, “The subsidies are going to make health insurance plans more affordable, won’t they?” Yes, in some cases the subsidies will help to make the plans affordable for people. But if you make $1 too much, the affordable plans are suddenly going to become very expensive and can cost thousands of dollars more over the course of a year. Will a subsidy make it affordable or not affordable is really subject to debate at this point in time. We’re going to have to actually see what the rates look like for these plans.

New Health Care Reform Taxes Passed On To Consumers

Then there’s a whole ton of new health care reform taxes that have been added into the system to help pay for ObamaCare. That means everybody who has a health insurance plan, whether it’s in a large group, a small group, or just as an individual, is going to be taxed in order to pay for the cost of reform. Health care reform adds various taxes on health care that insurance companies will have to collect and pay, but they’re just going to pass it right through to us, the consumer.

Mandate Won’t Reduce Uninsured Very Much

During the initial years of health care reform, the mandate is actually pretty weak. The mandate says that everyone must get health insurance or pay a penalty (a tax). What that’s going to do is make healthy people just sit on the sidelines and wait for the mandate to get to the point where it finally forces them to buy health insurance. People with chronic health conditions that couldn’t get health insurance previously, are all going to jump into healthcare at the beginning of 2014.

At the end of that year, the cost for the plans is going to go up in 2015. I can guarantee that that’s going to happen, because the young healthy people are not going to be motivated to get into the plans. They won’t see the benefit of joining an expensive plan, whereas the chronically ill people are going to get into the plans and drive the costs up.

Health Care Reform’s Purpose Is Just A Matter Of Semantics

The last portion of this is, one of the key things – and it’s funny, I saw it for the first two years, 2010, and ’11 – one of the key things that was listed in the documentation from the Obama administration was: Health Care Reform would help reduce the cost that we would see in the future if we do nothing today. That was emphasized over and over again. That was how they presented health care cost reduction, that it would reduce the future costs. Not today, but it would reduce what we would pay in the future if we did nothing about it now.

Well, that’s great, 10 years from now we’re going to pay less then than we might have paid. And we all know how accurate future projections usually are. In the meantime, we’re all paying more today, and we’re going to pay even more in 2014 and more in 2015 and 2016. People are going to be pretty upset about that.


Those three myths, that health care reform is only going to affect the uninsured, that it won’t affect Medicare beneficiaries, and that ObamaCare is going to reduce healthcare costs, are just that. They are myths. There’s nothing to them.

It’s really important that you pay attention to what’s happening with health care reform, because there are more changes that are coming as we go through this year, 2013. Knowing how to position yourself so that you’re in the right spot to be able to make the best decision at the beginning of 2014 is going to be really important for everybody.

At SPF Insurance we are your Health Care Reform experts in California. Sign up for our newsletter at the SPF Insurance website to stay updated on changes, or you can subscribe to the SPFInsurance YouTube channel to get our video updates, or you can sign up for our podcasts and hear the new information through iTunes. Any of these will keep you up-to-date on what’s happening, and in particular, how it will affect you.

At SPF Insurance, we don’t just give you “here’s the news that happened,” we tell you what you can do to to make your situation better despite all of the changes taking place.

Health Insurance Rate Increases – What To Do About Grandfathered Health Plans?

by Tim Thompson
Barry asks about grandfathered health insurance plans


Recently we’ve been speaking to a number of you that have old health insurance plans that you’ve stayed with for ten or more years.  These older plans are known as “GrandFathered Health Plans” by the Affordable Care Act (ACA), and have special exemptions with respect to ObamaCare.  

The dilemma you are currently facing is what to do about the large price increases you’re about to experience.  Should you stick with the grandfathered health plan or change to a lower cost health insurance plan?  We’ll cover the tradeoffs between staying or switching plans, review the changes that have occurred, and give you our recommendations in this post.

Barry’s Grandfathered Health Plan Story

Barry asks about grandfathered health insurance plans

Barry asks about grandfathered health insurance plans

We got a call from Barry the other day, and he was very concerned because their Anthem Blue Cross plan was going up over 20% and he was going to be looking at a $1389 bill each month for he (age 62) and his wife (age 52) and their two daughters (ages 16 & 21). He said they had been in the PPO Share plans for years, and had been seeing steady premium increases during that time, and they switched to a higher deductible 5000 plan four years earlier to help keep the premium costs down.

Barry said he had phoned his agent and also called Anthem Blue Cross and both had told him he should just “ride it out” and see what happened after 2014. Barry didn’t like that idea, because the costs had finally reached the breaking point for his family. That was when a friend suggested he call us at SPF Insurance.

I had a short discussion with Barry in which I asked about the health characteristics of his family, and shared some of the reasons why the rates on his old PPO Share plan were going up so fast. Then we started looking for alternative plan options that would reduce his costs.

Barry’s Story
Barry’s family was healthy and did the usual preventive care and maybe one or two office visits if someone had a bad cold. So using those parameters, I ran the quotes and found that one of the better options for Barry’s family was the Health Net Advantage PPO 3500 plan for $480/mo. That was a savings of $909/mo or $10,908 for a year. Then I selected a plan that was closer to the benefit level they had in their current plan and described the Cigna Open Access Value 5000/100% plan for $928/mo (a savings of $461/mo or $5,532 each year). Barry was obviously relieved to hear that there were lower cost solutions for his family, however, he wanted to make sure he was not overlooking something.

So Barry asked me about what he would be giving up if he switched from his grandfathered health insurance plan. Here’s what I shared with him.

Click on page 2 below to find out what I told him…

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Health Insurance Rate Increases: A Regulatory Tsunami!

by Tim Thompson


The First Wave Of Increases Rolls In

Were you stunned when you opened the letter from your health insurance company and saw what your plan is going to cost in 2013. You probably thought to yourself, “Wasn’t Healthcare Reform supposed to prevent health insurance rate increases like this?” The truth, unfortunately for you and many people, is in the details about how the federal government regulates healthcare through ObamaCare, and the management of healthcare programs at the state level.  We’ll cover these details along with SOLUTIONS you can use to escape the rate increase you face.

In the NBC Nightly News video below, Lisa Myers asks why health insurance rates are increasing at double digit rates when healthcare costs are expected to go up by 7.5% in 2013. Watch the video to learn the disturbing effects of the rate increases.

Health insurance to rise 20% or more in California

Nightly News | Aired on January 08, 2013

Several states including California, Florida and Ohio are facing double-digit health insurance rate increases. On Tuesday, the California insurance commissioner deemed one proposed group insurance increase unreasonable and accused companies of trying to maximize profits. NBC’s Lisa Myers reports.

The 20% increases that Californian’s are seeing is supposedly caused by insurance company profiteering, according to Dave Jones, California’s insurance commissioner. However the insurance industry justifies the increases due to increased medical costs, fewer healthy people in the insurance plans because of the recession, and increased costs and extra plan benefits as a result of the Affordable Care Act (ACA). Which of these positions is correct? Or could both be true?

At the beginning of 2013, new taxes take effect as a result of ObamaCare. These 2.3% taxes on medical device manufacturers are expected to be passed on to consumers through the healthcare value chain. Medical device manufacturers will raise their prices to health insurance companies, who then pass that increase on to consumers. Plus health insurance companies are increasing rates this year to compensate for the new ACA tax on insurance companies that begins in 2014.

Premiums set to rise this year in run-up to ObamaCare tax on insurance industry

The looming tax on the insurance industry will cost health-insurance providers $8 billion in 2014, then $14.3 billion in 2018 and a total $100 billion over the next 10 years, according to the congressional Joint Committee on Taxation.
Insurance companies say they can start charging the higher premiums now because some polices bought in 2013 extend into 2014.

Check out the stupid result congress created with the Medical Loss Ratio regulations on page 2 below.

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Best Maternity Insurance Plans In California Updated!

by Tim Thompson
Looking To The Future

Looking To The Future

This information is outdated now. SEE THE NEW Obamacare MATERNITY INFORMATION HERE.

It’s the beginning of the New Year, 2013, and many changes are going to happen this year. The first of the changes involves the maternity plans in California. When getting maternity insurance, California mothers want to be able to minimize the costs of the pregnancy and the delivery. But mothers also want to be able to see the doctor they are comfortable with. So most mothers-to-be will select a PPO plan before they get pregnant.

At SPF Insurance, we specialize in maternity coverage, so we spend a great deal of time analyzing all the California health insurance plans. From that analysis we can determine which health plans have the best characteristics for families wanting to have a child. We then provide a list of the top maternity plans to our readers.

Some of the insurance companies have begun announcing their 2013 rate changes, while others have modified the plans they are offering. So the effect on the top maternity plans is larger this year. To get the best maternity insurance, California women will still want to choose the Cigna Health Savings 1900 plan. This Cigna plan is still the best at this point.

Falling out of the top plans was Anthem Blue Cross. Anthem decided to stop offering their Lumenous HSA 3000 plan, which was their only top maternity plan. A new entrant to the top list is Health Net. Health Net was in the list early in 2012, but pricing changes forced their lone entry out of the top in the fall of 2012. With the changes that took effect on January 1st, 2013, Health Net reenters with a strong plan.

The other changes to the top plans are shown on the Maternity Insurance California page. Get the names and analysis behind each plan by visiting that page.

As the California insurance companies change their plans and their rates, we at SPF Insurance will continue to update the top plan lists. That way you will always be able to get independent and objective advice about the health insurance plans that fit your specific needs.

Affordable California State Child Health Insurance Plans — I Can’t Pay Much

by Tim Thompson

Finding Affordable or No Cost Insurance For Your Child

Baby Dreams

Happy Baby © coloniera2

Every child needs dependable health insurance.  However, not all parents can afford the full cost of private medical insurance.  As a result, there are a variety of programs offered by the state of California and private organizations that can provide health care to financially strapped families.  Through these programs, there should be no child in California that doesn’t have health insurance.

In the sections below we will give an overview of the child health insurance programs that are available in California.  Some of these plans provide complete coverage for children at no cost, and others provide just the basic services.  Then we’ll outline the steps parents should take to find the best program for their children.


California State Child Health Insurance Program Descriptions


This is the name for California’s Medicaid program.  The program is administered by California, and is financed equally by the Federal and State government.  Medi-Cal provides no cost health insurance to low-income families, seniors, and people with disabilities.  People that qualify for Medi-Cal can receive free preventive care, treatment for injuries and illnesses, dental care, vision screening, and mental health treatment.

This program is one of the cornerstones of the Affordable Care Act, and will expand considerably to take in new people in 2014.  .  For more details about Medi-Cal visit the following link:

Healthy Families

To get affordable child health insurance California parents need to applyThe healthy families program provides low cost health insurance to the children of low income families. This program provides a variety of services such as medical, dental, visions, and preventive care. The program requires families to meet certain income requirements which may viewed at the following link:

The Healthy Families program is being rolled into the Medi-Cal program during 2013.  The transition plan will ensure that families do not see a disruption in services, and will increase the benefits that children receive once inside of Medi-Cal.  Healthy Families is still accepting applications for new children.

Child Health and Disability Prevention Program (CHDP)

This is not an insurance program.  However, the program does assist low income families in obtaining preventive care and health assessments for their children. CHDP provides checkups, nutrition evaluations and guidance, immunizations, hearing, and vision screenings. This program is administered by the state Department of Health Care Services (DHCS).  The program helps families determine their eligibility for assistance programs, and enroll in the appropriate care program, such as Healthy Families and Medi-Cal.

More information about CHDP can be found at:

Children’s Health Initiative (CHI)

Healthy Kids health insurance

Coverage Map 2012

Children’s Health initiative is run by an independent non-profit known as The Institute For Health Policy Solutions (IHPS).  CHI works with many counties to reach the low-income families with children that don’t have health insurance.  CHI works with families whose income is less than 300% of the Federal Povery Level.  By providing technical support and guidance, programs are created in each county to create “Healthy Kids” insurance plans in a partnership with the local communities and businesses.

CHI helps families determine which state programs they qualify for, and can assist in the enrollment process.

For information about CHI in your county, see the following map of California:

California Children’s Services (CCS)

CCS is a state program that provides health care assistance to children up to age 21 with special health problems.  The program works with Medi-Cal and Healthy Families to provide case management and ensure that children receive the right care and see the right physicians for their special health needs.  Examples of special health problems are cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, and traumatic injuries.

For more details about CSS visit the following site:


Steps You Should Take To Find Affordable Child Health Insurance

If the mother of a baby is enrolled in Medi-Cal or the Aid for Infants and Mothers (AIM) program,  then the steps below will not apply for getting baby health insurance after birth.  In this situation, the baby will be transferred into Medi-Cal with the mother, or into Healthy Families or Medi-Cal if the mother is in the AIM program.  For all other situations, use the steps outlined below.

  1. The first step is to look at the coverage map for the Children’s Health Initiative above.  If CHI has an active program in your area, then this program can act as your partner in helping you get into the correct health program.
  2. If CHI is not active in your county, then contact the Child Health and Disability Prevention Program.  This office can help you through the process of finding the correct program and assist you in filling out the necessary forms, or they will put you in contact with a local office for assistance.
  3. If neither of the steps above works, then you should contact your local Medi-Cal office from the list provided here:  Medi-Cal will be your lowest cost solution, so start with this program
  4. If you do not qualify for Medi-Cal, then contact the Healthy Families program.


No child in California should be left without health insurance.  By providing the proper care and nurturing, we ensure a better future for our state.  The programs we have outlined above can provide families with financial difficulties, the health care their children need.  The first move is to follow the outlined path, taking one step at a time, and enrolling your child or children.

SPF Insurance is not allowed to provide assistance with any of the programs listed in this article.  We can try to answer any questions you have, but ultimately must refer you to these programs for further help.


Resource Links   Medi-Cal/Healthy Families Income Guidelines   Medi-Cal Program Overview of Local Children’s Health Initiative Coverage Expansions

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Should I Put My Baby On My Group Health Insurance Plan, Or A Child Health Insurance Plan?

by Tim Thompson

What Do We Do About Health Insurance After Having A Baby?

New Baby With Mom

Mom & Baby @Boetter

Bringing a new baby into the world is an honor and a joy, so first off we want to congratulate you on that. Within those first 30 days there are big decisions to be made and what we’re going to do is give you a look at how choosing the right California health insurance after having a baby can be simpler than you might expect. The key to being empowered to make the best decision for your family is understanding your options, knowing what steps to take, and that’s what SPF Insurance will help you do. Let’s clear away the confusion now, and begin clarifying how today’s California families can choose the right insurance for their infants.

Health Insurance Choices Families Face Today in California

Those who get health insurance through their employers face decisions when annual enrollment periods roll around, and when they are faced with major life events such as the birth of a new baby. The problem is deciding which plan they should select and how they should cover their family. Many companies today are increasing costs for employees who want to add their family to the company plan.  They do this by increasing deductibles and co-pays, and by increasing the amount the employee pays to cover adding dependents to the group plan.   That’s why it’s important that you understand how to make the best choice for your family.

Does it make sense to put your baby, or your spouse and children, onto your group health insurance plan?  Would it be smarter to get them an individual health plan instead?  These are the kinds of questions SPF Insurance is here to help you answer, and we believe you can make the best decision once you know the trade-offs of choosing either of these options.  Before we start, there are a couple of things you need to know about group health insurance plans, so we’ll cover those next.

Understanding Enrollment Periods for Group Plans

The occurrence of major life events will create special enrollment periods for employees with group benefit plans.  Aside from the annual enrollment period, group health insurance plans also recognize when a person gets married, when they get divorced, when there is a death in the family, when an adoption occurs, and when a new baby is born. At each of these points, you have the option to change portions of your group insurance benefits, but costs may rise or fall.

In this case, we are discussing the arrival of a new baby, and while the mother’s insurance will cover the cost of delivery and post-partum care for her and for the infant, within the first 30 days of the baby’s life it will be time to decide if it should be on the mother’s insurance or the father’s. Whether or not the parents are married, the birth of a baby represents a special enrollment period where they must be accepted by either insurance plan.

Four Tier Pricing in Small Group Health Insurance

Group Plan Or Add Baby Health Insurance Plan InsteadSmall group health insurance in California typically uses a 4 tier pricing system. The first tier is insurance for the individual employee only. The second tier is for adding a spouse, or sometimes a single individual such as a child or domestic partner. The third tier is for the addition of a child or children.  Most group plans have a single price for one child or multiple children, and this can be important in the decision. The fourth tier, often referred to as “family”, is the cost to add the spouse and all children to the plan.

Anthem Blue Cross PPO 30 Copay and Blue Shield Local Access+ HMO Premier 45 plans are examples of small group plans with 4 tier pricing.  We’ll use these in the examples in the next section.

How a Family Can Choose Between a Group Plan vs. an Individual Plan

Choosing between group plans and individual or family plans is crucial. To understand this, let’s use an example family. We’ll say the family is a couple living in Long Beach, California and that both are age 40. They have 2 children, one being a newborn baby within the last 30 days, and the other is a 4 year old.  One spouse has group insurance through their employer and the other does not. The employer pays 100% for the employee coverage, and 50% of the cost to add the employee’s dependents (spouse and kids).  Let’s compare the choices they could make.

A group plan such as Blue Shield of California Local Access+HMO Enhanced 45 will cost the employer $318 per month, for a single employee. If our couple adds the spouse, the total cost to add the spouse is $401 and the employer pays half, so the employee will pay $200.50.  If our couple decides to just put the children on the group plan, and not the spouse, the cost to add the kids is $274, so the employee would pay $137 of that cost.  If the couple decides to put the whole family on the group plan, then the total cost would be $662 per month, and the employee would pay $331.

Calvin & Hobbs Ponder Health Insurance Baby First Year And Thereafter

Time to Ponder

From this example you can see that the employer contribution to the dependent coverage cost is a very important piece of information in this decision.  The smaller the employer contribution is, the more our couple will have to pay to put the family onto the group health insurance plan.  This may make an individual or family plan most cost effective.

Similarly, the Anthem Blue Cross PPO $30 Copay plan costs the employer $567 per month for a single employee. Adding a spouse adds $599 per month, so the couple pays $299.50. Adding a child or children to the group plan costs $312 per month, and the couple would pay $156.  To add the whole family, the price is $926 per month, so the family would pay $463 per month.

When you compare these group examples with an individual and family health insurance plan such as the Health Net Advantage 3500 PPO, you see a sharp difference in costs. To put the spouse onto the Advantage PPO plan would cost only $85 per month, and for the spouse plus both children the cost is $201 per month. As you can see, our example family would fair far better financially by not opting for the group plan and choosing an individual and family plan instead.

For your situation, you will need to do a similar analysis.  So we outline the steps to follow next.

Steps You Can Take to Make the Best Decision for Your Family

For your new baby, there are a few steps you should take to choose the right insurance option. The first step for those with group health insurance through their employer is to speak with someone in the company’s HR department. Find out how much it will cost you to add the baby to your company insurance plan, and what forms are necessary if you make that choice.

Next, get a quote on all the individual and family health plans from the major insurance companies.  SPF Insurance can provide this to, or you can get this information from our health insurance quote engine on your own.  Next pick the individual and family plans that best fit your family’s healthcare needs, by following the Five Step Process outlined on the SPF home page.  Compare the costs and the benefits between these options and your group health plan.  Make sure you determine if the group plan fits your needs adequately, or if it is much richer in benefits.  The last step is to decide what is most important, price or benefits.  This will help you determine which is the best for you and your family.

 Baby health insurance plans from all major insurance companies in California. The best deals!

Health Insurance You Choose for Your Baby Makes a Lifetime of Difference

The first 18 months of your child’s life will involve many Wellness visits to the doctor to monitor the early stages of their growth. This is a crucial period and is generally the most costly, too. However the quality of care they receive can set them on a good course and help keep them in good health. That’s why it’s important to find the right health insurance plan to give them the best care while also meeting your family’s budget guidelines.

SPF Insurance is here to help you navigate the health insurance maze in California, and if you would like to speak with someone about your specific situation, we would be happy to offer our expert advice. Get in touch with one of our advisers who can personally assist you determining the best fit for your family.

Leave a comment below to let us know if this helped you, or if we need to add something else.


Does My Baby Health Insurance In California Cover Well Baby Visits?

by Tim Thompson

7 Keys To Caring For Your Newborn

For well baby visits it's important to have baby health insurance california

Baby examines Doctor

If you are a parent, or a soon-to-be parent, you understand the all-consuming desire to have a healthy baby and child.  By adding new baby health insurance in California immediately after the birth of your child, you are taking one of the most valuable steps towards promoting your infant’s well-being. The baby health insurance covers all the costs of routine well-baby checkups, making it affordable to provide the best health care for your baby. These well-baby checkups are the basis for starting your child off on the path to being healthy their entire lifetime.

Well-baby checkups are an integral part of ensuring baby’s first year is a healthy one. They provide a way for parents and pediatricians to assess your child’s health and development. Well-baby office visits offer a chance for parents to ask important questions, and receive informative answers regarding daily nutrition, developmental milestones, behavior, and potential health risks and hazards.

Importance Of Well-baby Checkups

As medical science continues to reveal fascinating information about pre- and post-natal human development, doctors and psychologists have recognized the significance of baby’s first year in establishing a healthy foundation for the rest of his/her life.  Studies show that healthy children perform better in school, and are more likely to graduate from high school according to an Advisory Report for the California Department of Education.

A Blueprint For Great Schools


Health Care Access and Nutrition. Rigorous research confirms the clear connection between health status and academic achievement. We know that:

  • Healthy children miss fewer days of school, are more attentive, and are better behaved.29
  • Healthy children are more successful in school, and are more likely to graduate from high school and go to college.30
  • Children with health insurance are more likely to get the health care they need.32 The result is healthier, more attentive, and higher-performing students in the classroom.

In a report from the Centers For Disease Control, they show that kids graduating from high school have a greater likelihood of living longer.

School Dropout as a Public Health Issue


Education is one of the strongest predictors of health: the more schooling people have the better their health is likely to be. Although education is highly correlated with income and occupation, evidence suggests that education exerts the strongest influence on health (1-4). More formal education is consistently associated with lower death rates (4), while less education predicts earlier death. The less schooling people have, the higher their levels of risky health behaviors such as smoking, being overweight, or having a low level of physical activity (5). High school completion is a useful measure of educational attainment because its influence on health is well studied, and it is widely recognized as the minimum entry requirement for higher education and well-paid employment.

So clearly, keeping your child healthy gives them the best chance to succeed in school and have a long healthy life.

Having California Health Insurance For Children Makes Routine Well-baby Checkups Free

Because well-baby care is an important part of baby health insurance California companies provide these services for free. This makes it easy for parents to stick to the well-baby Checkup Schedule suggested by the American Academy of Pediatrics (AAP).

In order to make sure your baby is thriving, the AAP recommends a total of nine visits during the first three years. These visits are timed in accordance with baby’s first year development and AAP immunization schedules. The first six occur during baby’s first year:

  • 1 Month
  • 2 Month
  • 4 Month
  • 6 Month
  • 9 Month
  • 12 Month

Seven Key Parts to a Well-baby Visit

Pediatrician examining Baby shows importance of baby health insurance california

Well Baby Visit

There are seven key components to your well-baby visits. These seven parts, highlighted by the March of Dimes, evaluate every aspect of your child’s health – physical, mental, and emotional. They are also a good chance to assess your parenting skills. Parenting isn’t easy so establishing a positive relationship with your child’s pediatrician and staff allows you become a part of a team which is invested in nurturing and protecting the health of your family. These seven components include:

  • Growth. Similar to your own physical checkups, the first thing that happens at a baby’s wellness visit is an assessment of his/her length, weight, and head circumference. The doctor will chart your child’s figures and compare them with the national average. This information lets everyone know how your baby is doing on the general physical level.
  • Physical Examination. During the exam, your child’s pediatrician will look at the eyes, in the ears, and in the mouth and throat. S/he will also manipulate the child’s limbs and examine the diaper area to ensure all is normal.
  • Developmental Milestones. While all babies develop at their own speed, your answers to the pediatrician’s questions will help to paint a more well-rounded portrait of how your baby/child is doing developmentally. Things like rotating the head independently, rolling over, scooting, crawling, walking, speaking, etc., are all a normal part of baby/toddler development.
  • Nutrition. The first several months can seem easy. Whether you are breast feeding or bottle feeding, if your baby is a healthy eater you can usually be sure s/he is getting adequate nutrition. Once baby starts eating solids, it can get trickier. You will receive critical information and advice regarding your baby’s nutritional needs.
  • General Information. Your pediatrician will provide time for you to ask any questions you have about all aspects of baby and child care. You will learn about things like child safety seats, home health hazards, and baby proofing your home.
  • Lab Tests. While most visits do not involve labs, they may be recommended if something comes up during a routine baby checkup which alerts the doctor to an abnormality. The sooner any conditions are noticed, the sooner your baby can be treated and on the road to health.
  • Immunizations. Your doctor will make sure your child is up-to-date on his/her vaccinations.

You and your pediatrician will work together to provide a nurturing, healthy and safe first year for your baby by keeping to the recommended preventive well-baby visits. Just as your baby needs routine care, so do you. Use the focus of scheduling and keeping your baby’s doctor visits as a reminder to take care of yourself as well.

California Health Insurance For Children Is The First Step

Giving your new baby the best health care possible means taking your child for well-baby visits to ensure proper development physically, mentally, and emotionally.  Being prepared to ask questions and take notes will allow you to make sure your baby is healthy.  Getting health insurance when the baby is born provides a fundamental foundation for your child’s healthy growth and development. If you want to learn more about affordable health insurance policies, or if you have any questions about baby health insurance in California, contact SPF Insurance and one of our advisors will be glad to help you.

Leave a comment below to let us know what you think about this article.

First In A New Series: How To Get Baby Health Insurance

by Tim Thompson

New Series Of Six Articles Discussing California Baby Health Insurance

Baby Dreams

Happy Baby © coloniera2

Today SPF Insurance is introducing the first of six new pages and posts dealing with baby health insurance, and child health insurance. The first is a new page titled “How To Get Health Insurance For My New Baby?“. This page provides new mothers and fathers with the information they need to be able to transition their newborn from being covered on the mother’s plan to having it’s own plan. We cover the various options that are available, and the time frames in which decisions have to be made. The purpose of the page is to provide a detailed overview of the nuances that surround getting health insurance for children and the strategies that parents should use, especially right after birth.

The other five pages and posts will provide additional details on the cost of baby health insurance, identify the best plans for children, show the importance of well baby care, provide help for parents that can not afford health insurance for their children, and help families determine if company insurance plans are a better value than individual health insurance.

Below is a quick summary of the planned articles:

  1. Does My Baby Health Insurance In California Cover Well Baby Visits?

    This article covers the importance of giving your new baby the best care by doing the Well Baby checkups as scheduled by your pediatrician. It covers the benefits to child, not just as an infant, but continuing on through out the child’s full life. There is also discussion about what the well baby visit schedule, what will be covered in each visit, and how you can be prepared to ask any questions you have about your baby’s development and growth.

  2. What Is The Cost Of Child Health Insurance In California?

    Although parents will do anything to protect their children, cost is still an issue in many cases due to simple economics. Can I afford to get the best plan, or should I look for a plan that will be good enough. This article aims to help with that decision. We provide an overview of what baby health insurance costs are like in various parts of California. Then give some specific examples that parents can use to begin budgeting for the new family costs once the baby comes home from the hospital.

  3. What’s The Best Health Insurance Policy For A Baby?

    SPF Insurance is known for providing specific information and recommendations that you won’t find anywhere else. This article provides our recommendations on the best child health insurance plans in Calfornia. We show you what we’re looking for, and then give you the plans that our analysis says are the best for each situation. This is a “Don’t Miss” article.

  4. Affordable California State Child Health Insurance Plans — I Can’t Pay Much

    Not all families in California are able to afford paying an extra $200/mo for baby health insurance. So we identify the various government assistance plans and zero cost plans to help these families protect their children. This information is scattered around the internet in various places, so we bring it all together on one page, and provide steps parents can follow to get the best plan or program for their children.

  5. Should I Put My Baby On My Group Health Insurance Plan, Or A Child Health Insurance Plan?

    Lot’s of families have their health insurance provided by their employer. As the cost of health care has risen in the US, many companies are beginning to push more of the increasing costs onto the employees. Many times this takes the form of higher premiums to include the family on the employee’s group health insurance plan. This article discusses this trend and gives specific questions and answers to help you decide if it’s time to move your family or your kids onto their own health insurance.

Check back periodically over the next month to see all these new articles as they are published.

SPF Insurance is your expert in the health insurance industry. We’ve been helping families and small businesses get affordable health insurance for over 9 years. For any questions just call us and one of our advisors will be glad to help you.

Kaiser Permanente Plan Updates After California Maternity Mandate

by Tim Thompson

Many Kaiser health insurance plans have always offered maternity coverage.  With the July beginning of the California mandate that all health insurance plans provide maternity and autism coverage, Kaiser added these benefits to the plans in their portfolio that did not already have them. For most of its history, Kaiser has been an HMO (Health Maintenance Organization) plan provider, but in the early 2000s they added PPO plans (Preferred Provider Organization) to their portfolio.  Kaiser offers three families (groupings) of health plans: a traditional HMO family, and two PPO families.  Within each family the benefits of the plans are the same but the deductible or copayment is different.

Kaiser LogoThe unique part of Kaiser Permanente health insurance plans is that Kaiser has its own network of physicians and hospitals.  Therefore, most people that have non-Kaiser physicians don’t select Kaiser plans because they would have to change doctors.  Depending upon where you live, Kaiser may not offer plans in your area of the state.

In this Kaiser health insurance plan review we will summarize the benefits of each family of plans, describe who the plans are appropriate for, and compare the plans to the competition.

Deductible Plans

These are Kaiser’s PPO plans.  They each provide free preventive care, unlimited office visits with a simple copay, and generic and brand name prescription coverage.  The Deductible family has deductibles of 500, 1000, 1500, 2000, and 3000.

Click here to get more details about the Deductible plan benefits.

The Deductible plans are fairly high in benefits, so they will tend to be a better fit for individuals that need more regular doctor visits or brand name prescription coverage.  Families with small children will also find these plans useful.

From a price versus benefit standpoint, the Kaiser Deductible family is competitive with Cigna’s Open Access plans, the Anthem Blue Cross Premier plans, and the Aetna Open Access Managed Choice plans.  The Kaiser plans are slightly higher priced than the Cigna, Anthem, Aetna, and Blue Shield plans but they make up for that with a little better prescription benefits and lower Out-Of-Pocket maximums.

HSA Deductible Plans

The HSA Deductible plans are Kaiser’s Health Savings Account compatible offerings.  As such they offer preventive care for free, and all other medical benefits are paid by Kaiser after you reach the deductible.  The family of plans has deductibles of 0/1500, 0/2700, 30/2700, 40/4000, and 50/5000.  With the 0/1500 and the 0/2700, Kaiser pays 100% for all medical benefits once you reach the deductible amount.  For the other HSA plans, you begin sharing costs with Kaiser once you reach the deductible, with Kaiser paying 70% and you paying 30%.

Click here for a more detailed description of the plan benefits.

Like all Kaiser health insurance plans, the HSA Deductible plans offer free prenatal office visits.  This can be a great cost savings since a normal pregnancy has 12-14 prenatal office visits.  Over the last couple years, the 0/1500 HSA Deductible plan has been one of the top 2 maternity insurance plans in California.  The remainder of the Kaiser HSA plans are not very competitive with the HSA plans offered by the other carriers so we don’t recommend them.

Kaiser Copayment Plans

The Kaiser Copayment plans are HMO plans with rich benefits.  This family of HMOs offers free preventive care, unlimited office visits for a simple copay, and generic and brand name prescription coverage.  As the name implies, these plans provide all benefits with just a copay.  There is no coinsurance in these plans.  The family has 3 separate copayment options.  The $50 Copayment has $50 office visit copays and a $500/day hospital copay.  The $40 Copayment plan has $40 office visit copays and a $350/day hospital copay.  The $25 Copayment plans has $25 office visit copays and a $200/day hospital copay.

Click here for more details about the Copayment plan benefits.

The Copayment plans are a good option for someone that has an active injury prone lifestyle.  These plans are the most benefit rich options available in the California marketplace.  The other situation the Copayment plans are good for are women that are planning to get pregnant.  The $50 copayment plan has been one of the top five maternity insurance plans in California for the last several years.

The Kaiser Copayment plans are the best HMO plans in California.  They have richer benefits and lower monthly premiums than all but the Health Net HMO Value 50 plan.  Comparing the Kaiser HMO plans to the Health Net HMO Value plan, the main difference is that the Kaiser inpatient and outpatient benefits are copays where the Health Net HMO plan has a 50% coinsurance cost.  If a large medical event were to occur the Kaiser plans would give you better protection cost-wise.

Summary of Kaiser Permanente Review

Most people either love Kaiser or hate Kaiser.  People that have recently moved to California tend to stay away from Kaiser once they learn that their choice of doctors and hospitals are limited to only Kaiser facilities.  That being said, Kaiser Permanente health insurance plans are good values in the situations outlined above.

With Health Care Reform just around the corner, Kaiser Permanente is at the crossroad of being a major player or being left behind.  The lack of facilities across the whole country may limit Kaiser’s ability to get a large enough customer base in order to compete with the larger competitors that do have a country wide footprint.  If that occurs, then Kaiser could be limited to a lesser role in 2014 and beyond.

See the recent analysis for the other major insurance companies by clicking on these links:
Health Net Analysis
Blue Shield Analysis
Anthem Blue Cross Analysis
Cigna Analysis
Aetna Analysis

If you would like to discuss your specific needs with one of our advisors please call us.  If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.

New Aetna Health Insurance Plans Offer Maternity Coverage

by Tim Thompson

Aetna was one of the major insurance companies that did not offer maternity coverage in California until July of 2012.  On July 1st, a new California mandate began and required all plans offer maternity and autism care.  As a result of this, Aetna added these benefits to their existing plans and increased the rates slightly.

Aetna announced they are leaving California individual and family health insurance marketplace at the end of 2013. Go here to learn about good Aetna health plan replacements.

If you are looking for maternity coverage, the Aetna plans are not a good choice because of their higher deductibles. Click this link to see the California plans that are currently the best maternity insurance plans.

The Aetna portfolio of plans is easy to understand and is composed of four primary plan types. Within each plan type, or family of plans, the benefits are the same with the main difference being the deductible of the plans in the family. Aetna’s portfolio covers the full spectrum of benefit levels, from low-end plans with basic benefits, to high-end plans with low deductibles and extensive benefits.

Aetna LogoAetna was the first health insurance company to provide free preventive care to customers.  This free care was in their plans long before Health Care Reform required this coverage.

In this review we’ll describe the benefits of each Aetna plan, and tell what kind of situations and people the plans are a good fit for. Then we’ll look at how the Aetna plans compare to the plans of the competition.

Open Access Managed Choice Value Plans

The Open Access Managed Choice (OAMC) Value family of plans is the lower benefit level plans that Aetna offers.  The OAMC Value plans provide 3 office visits for a simple copay of $50 , free preventive care, and coverage for generic prescriptions.  The family offers deductibles of 2500, 5000, and 8000.

To see more details about the benefits of these plans, click on the deductible links above.

The OAMC Value plans are a good fit for healthy individuals and families that don’t need brand name prescription coverage.

Aetna Open Access Managed Choice Plans

The Open Access Managed Choice family of plans is the highest benefit level that Aetna offers.  These plans offer unlimited office visits for a simple $40 copay ($50 copay for specialists), free preventive care, and both generic and brand name prescription coverage.  For brand name prescriptions the OAMC plans have a $750 prescription deductible that must be met before you have copays.  The family offers deductibles of 1750, 2750, 3500, and 5000.

To see more details about the benefits of these plans, click on the deductible links above.

The OAMC plans are a good fit for families with small children that need more office visits than the Value plans provide.  Aetna has more lenient underwriting requirement to qualify for their health insurance plans.  So these OAMC plans are good choice for people with existing conditions that other insurance companies might not accept.  For more help with this contact our office and an advisor will help you determine how the carriers will treat your existing medical conditions.

Open Access Managed Choice High Deductible Plans (HSA Compatible)

The Open Access Managed Choice High Deductible (OAMCHD) plans are Aetna’s Health Savings Account (HSA) compatible plans.  These plans provide free preventive screenings and all other benefits are part of your deductible costs.  The OAMCHD plans have deductible levels of 3500 and 5500.  Once you reach the deductible on the 5500 Aetna will pay 100% thereafter.  When you reach the deductible on the 3500, you begin sharing costs with Aetna paying 90% and you paying 10% until your out-of-pocket costs equal 5950.  At that point, Aetna pays for all further expenses

To see more details about the benefits of these plans, click on the deductible links above.

These plans are a good fit for individuals and families that want to “self-insure,” but have a safety net to protect them against loss, and can make use of the tax deductibility of contributions to a Health Savings Account.

Preventive & Hospital Care (HSA Compatible)

The Preventive & Hospital Care 2750 plan is the last remaining member of this family.  The plan provides free preventive care and all other benefits require that you meet the deductible first.  After reaching the deductible you begin sharing costs with Aetna paying 80% and you paying 20% until you reach the out-of-pocket maximum of $5950.  This plan does not provide coverage for office visits, lab tests, or prescription coverage.  This plan is also HSA compatible.

Click here to see more details about the benefits of these plans.

The Preventive & Hospital Care plan is not really a good fit for anybody.  The plan costs more than other plans with greater benefits, and the lack of office visits and lab tests means there is a fair amount of risk if you have this plan.  Therefore, we don’t recommend this plan for anybody.

Dental PPO Plan

Each Aetna health insurance subscriber can opt to add a dental PPO plan to their health coverage.  This dental plan has a $25 deductible and no limit to the yearly benefits.  The plan provides free annual checkups, x-rays, and cleanings.  Simple 1 and 2 surface cavity filings are also provided after you meet the deductible.  The Aetna Dental PPO plan does not provide any benefits for other restorative work such as root canals and crowns.

This plan is priced like an HMO plan, but has a PPO network of dentists, and covers 100% of the services it provides except for the $25 deductible.  For people wanting basic preventive coverage to have their teeth health maintained, this plan is a good fit.  If you know that you will periodically need dental work, then another dental plan is going to be a better fit.  See the Dental Information page of the website for more details, or get a dental insurance quote here.

Click here and look at the 2nd page to see more details about the benefits of the Aetna Dental PPO plan.


Three years ago, Aetna was one of the most competitive health insurance companies in California.  Their portfolio of plans provided preventive care for free at a time when other carriers were not, and was priced to be the best option for most people depending upon age and location in the state.

Today the Aetna plans are not very competitive.  They tend to have higher prices than their competitors, and the plan OOPMs are also higher.  Aetna provides no rate guarantee period, so the rates you start out with can be changed at any time.

For these reasons, the Aetna plans are not a good fit for most people.  The price versus benefits of the Aetna plans makes the competition a better option.  The main situation where Aetna’s plans can still fit are for people with existing health conditions that other carriers would decline, and for older individuals looking for high benefit plans like the Open Access Managed Choice family.

Aetna is one of the largest nationwide health insurance companies and should fare well during the changes that Health Care Reform will bring.  Their large customer base gives them the advantage of “large numbers” that will be critical to survival for insurance companies after 2014.  We expect to see changes from Aetna over the next couple years that will bring Aetna back in line with their competitors, so don’t count them out just yet.

To see the reviews for the other major insurance companies, click on these links:

Health Net Analysis
Blue Shield Analysis
Anthem Blue Cross Analysis
Cigna Analysis

If you would like to discuss your specific needs with one of our advisors please call us. If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.


Cigna Adds Maternity Insurance To Their California Health Plans

by Tim Thompson

Prior to July 1st 2012, Cigna did not offer any maternity insurance plans in California, and their plans were not competitive.  On July 1st they added maternity and autism care to all existing plans and made slight pricing adjustments to position their plans to gain market share in the California marketplace.

Cigna LogoThe Cigna portfolio of health insurance plans is simple to understand, and is composed of only 3 plan families.  The plans are mainly targeting the middle and upper benefit levels, and the pricing is competitive for people age 35 and higher.  Cigna decided not to target the low-cost portion of the market.

One of the major differences between Cigna and other insurance companies is that Cigna still provides a 12 month rate guarantee.  Other companies offer either 6 months or no guarantee at all.

We’ll describe the Cigna portfolio of plans and tell what situations they fit into, along with an analysis of how each of the 3 families of plans compares to the competition.

Open Access Value Plans

These are Cigna’s lowest benefit plans.  The plans provide free preventive care, unlimited office visits for a $40 copay ($60 for specialist), and coverage for generic prescriptions.  The plans do offer brand name prescription coverage, but have a $3500 brand deductible that must be met before any brand prescription coverage begins.  So the Open Access Value plans are primarily generic only coverage.  The plan offers deductibles of 1000, 1500, 2000, 3000, 5000, and 5000/100%.  There is a PPO dental plan that can be added to each of these health plans.

Click here for more details about the Open Access Value plans.

The most popular plan in this family is the 5000/100%.  This plan is virtually identical to the rest of the plans, but the out-of-pocket maximum is equal to the deductible.  The price difference between the 5000 and the 5000/100% is pretty small so the 5000/100% is usually the better value.

The Open Access Value plans are a great fit for families with young children that want the ability to see the doctor more than just a couple times each year.

Cigna Open Access Plans

This is Cigna’s primary full benefit health insurance family.  The Open Access plans offer unlimited office visits for a $30 copay ($40 for specialist), along with both generic and brand name prescription coverage.  The family has deductibles of 1000, 1500, 2000, 3000, 5000, and 5000/100%.  The brand name prescription deductible for this family is $250 for the 1000 and 1500 plans and $500 for all other plans.  There is a PPO dental plan that can be added to each of these health plans.

Click here to get more details about the benefits of each plan.

The Open Access plans are a good fit for individuals and families that need brand prescription coverage or the ability to see a doctor multiple times per year.  Depending upon your age and where you live, these plans are very competitive with the comparable plans from Aetna, Anthem Blue Cross, and Blue Shield of California, and will tend to be lower cost than most of the competition.

Cigna Health Savings Plans

The Health Savings plans are Health Savings Account (HSA) compatible.  These plans offer free preventive care and all other care is covered after you reach the plan deductible.  Office visits, lab tests, prescription coverage, and hospital coverage is subject to meeting the deductible.  The family offers deductibles of 1900, 3400, and 4900.  With the 3400 and 4900 plans when you meet the deductible Cigna then pays 100% of all additional expenses.  The 1900 plan has an additional $600 cost sharing period until you reach the plan’s out-of-pocket maximum (OOPM) of 2500. Once you reach the OOPM, Cigna pays 100% of all additional expenses.

Click here to get more details on the benefits of each plan.

The Health Savings plans are ideal for women that are planning to have a baby, or people that anticipate having medical expenses that are greater than the plan deductibles.  The Cigna Health Savings 1900 plan is the best maternity insurance plan in California as of July 1st. The combination of the out-of-pocket limit and tax savings offered by the HSA can make these plans very cost effective relative to traditional PPO or HMO plans.

Dental PPO Option

The Cigna PPO dental plan can be added to any health insurance plan Cigna offers.  This dental plan is not offered to individuals and families that have health insurance from other companies.

The dental plan has a $50 deductible, a $1000 maximum benefit per year, and provides free preventive care, while covering basic or minor restorative care at 80%, and major restorative care at 50%.  The plan has a 6 month waiting period for minor care and a 12 month waiting period for major care.

Look at the last 2 pages of a plan brochure link above to get more details about the Dental PPO 50 plan benefits.

This dental plan is a great value for a PPO plan and offers an extensive network of dentists in California.  If your dentist is in the Cigna network then add this option to your health insurance.


Cigna decided to become a larger player in California in July and has made the changes to enable that to happen.  After a few months of results it is clear to us that Cigna’s plans will continue to do well in the maternity insurance market as well as the family and early retiree markets.

With health care reform looming around the corner it’s good to see another nationwide insurance company decide to be a factor in California.  Health care reform will favor the large companies at the expense of the smaller insurance companies that don’t have a large enough customer base to enable them to survive.

See the recent analysis for the other major insurance companies by clicking on these links:
Health Net Analysis
Blue Shield Analysis
Anthem Blue Cross Analysis

If you would like to discuss your specific needs with one of our advisors please call us.  If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.

California Health Insurance Premiums Increasing Now And In 2014

by Tim Thompson

Most Californians will probably see higher prices for their health insurance.  Whether it be through their company insurance plan, or their own individual and family health insurance plans.  The price increases come in the form of a letter received just before a birthday, and potentially every quarter.  California health insurance premiums go up each year, just like the sun rises each morning.  

Insurance Costs Rise, But More Slowly


Annual family health insurance premiums rose about 4 percent to $15,745 in 2012, according to the latest survey by the Kaiser Family Foundation and Health Research and Educational Trust

Now that's a fairly modest increase by historical standards, and well down from last year's 9 percent. Still, it's more than double the 1.7 percent increase in average wages and way above the 2.3 percent rate of general inflation this year.

In terms of employee insurance costs, this year's 4 percent increase qualifies as a good year, but it still takes a growing bit out of middle-class workers' wages, which have been flat or falling in real terms," said Kaiser President and CEO Drew Altman.

This 4 percent increase is the average increase across the entire US for employer sponsored health plans.  In California the average change for individuals and families purchasing their own health insurance is more like 12-13 percent (this comes from the average rate increase received by clients renewing their policies after July 1st).

For families this increase is significantly higher than the rate of inflation and any pay increases they received this year.  However, California families pay significantly less than what people in other states pay.  According to, Californians have the 2nd lowest monthly cost for health insurance at $157, and Massachusetts has the highest premium at $437.

Currently, Massachusetts requires that everyone in the state have health insurance, so only 5 percent of the population does not have coverage.  Weren't rates supposed to go down if everyone was covered?  

According to most pundits, things will only get worse between now and 2014 when the Affordable Care Act kicks in.  In 2014 there are many new benefits that all health plans must offer, so that will increase premiums.  Nobody is sure how much the rates will go up, but some projections are the increases will be 20-30%.

President Obama’s claim that insurance premiums ‘will go down’


A nationwide study conducted by Milliman Inc. for the Society of Actuaries found that nationwide the premiums in the individual market would increase from 8 to 37 percent in 2014 — with a cumulative increase of as much as 122 percent between 2013 and 2017.

Other studies have shown similar types of cost increases.  However, the key to understanding the difference between the cost increases shown in studies and the cost savings claimed by administration officials, is to pay close attention to the wording.  Obama and his administration are careful to describe the savings as being lower than they would have been without the Affordable Care Act (ACA) at some point in the future.  Whereas the studies show price increases relative to today's health insurance rates.  

These two diverging claims are not mutually exclusive.  Meaning they can both be true.  The cost of health insurance can go up by 8 to 37 percent in 2014, and still be lower in cost 10 years from now than it would have been for the same coverage without health care reform.  So let's take a look at the reasons why this can occur.

Many of the cost increases associated with health care reform are due to the new "Essential Health Benefits" that all health insurance plans must cover in 2014.  Many of these new benefits must be added to the plans that businesses and individual have today, so the cost for these new plans will increase in the short term.  

The two next largest cost factors for the new 2014 health insurance changes are the inclusion of people that have health problems and the addition of new taxes and fees to help pay for ACA.  These new insurance company taxes and medical device fees will be passed through to consumers, and the added healthcare costs for people with existing conditions will also be paid for with increased premiums.

Ten years down the road, we may find that the whole of ACA health care reform could in fact slow down the cost increases for healthcare such that what we pay for these rich benefit plans in 10 years may be less than what we would have paid for these plans had health care reform not taken place.  Projections about what the future 10 years from now will look like are always fraught with error, even looking 1 year out is questionable, but usually more accurate than long range predictions.

The initial whispers coming from health insurance companies is that the new plans and rates will be a shock to consumers next fall during the initial enrollment period that starts in October of 2013.  The letters telling existing health insurance consumers that they are being transferred into the new exchanges and mapped to new metal plans – Bronze, Silver, Gold, and Platinum – will be a surprise, and the rate increases they see in the letter will be shocking.  

Stay tuned for more details on this in the next post.

Introducing A New HSA Health Insurance Page!

by Tim Thompson

We’ve just published a new page on the website that covers all the information you want to know about Health Savings Account (HSA) health insurance plans. We cover what they are, how they work, who they’re good for, what their pros and cons are, and we analyze all the California HSA plans to determine which plans are the best for you.

Stethoscope & Piggy BankWhen HSA’s were introduced in 2004, they were really popular because they were the lowest cost health insurance plan available. Over time, the costs of HSA’s has changed, and they aren’t usually the lowest cost anymore. However, for people in some situations they can be a great solution. Find out if your situation is a good candidate for one of these plans.

The best part about the page is the analysis of the California HSA health insurance plans. We show the results visually in a graph, and walk you through the process of how we decided on the top 6 HSA plans:

Top 6 California HSA Plans

Aetna Preventive and Hospital Care 2750
Health Net CFB HSA 4500
Kaiser 30/2700 HSA
Cigna Health Savings 4900
Health Net CFB HSA 6000
Kaiser 50/5000 HSA

These six plans had the best combination of price and benefits, and were obviously (visually) better than the remainder of the plans (you’ll love the graphic that shows how all the plans compare to each other visually). Then we narrow down the options to identify the single BEST HSA PLAN in California. Which one of these do you think is the best plan?

So check out the information at Best HSA Health Insurance Plans In California. Then tell us what you think in the comments section. Is there other information you were looking for, or something that didn’t make sense? If so, tell us and we’ll add it.

Other Recent Articles:
Anthem Blue Cross July 1st Plan Updates
Health Net Rolls Out New Insurance Plans With Maternity Coverage
New Analysis Shows The Best Maternity Insurance In California Is…”
Blue Shield Of California Introduces New Plans For July 2012

US News Report On Best California Health Insurance Plans Is Misleading

by Tim Thompson

I always watch for reports that rate things I'm interested in.  Especially when it's related to my profession as a health insurance broker in California.  The August 7th report from US News regarding the "Best California Health Insurance Plans" caught my eye because they are a large well known organization with a huge audience.  US News LogoMy first glance at the report made my stomach clench into a knot, and I knew there was a problem with what they were showing.  Their results could mislead people into picking plans that are too expensive, or simply scare them away from trying to get health insurance at all.  So I dug in to find out what went wrong.

Best California Health Insurance Plans – US News

Using government data, U.S. News has rated 59 health insurance plans marketed to individuals living in California. Of these, 14 earned the top rating of five stars in the U.S. News analysis.


The overall look of the page made me a little nervous about the potential content because there were 4 "Get Quotes" ads that eHealthInsurance paid for all around the US News health insurance report.  Next, the first 10 plans listed as 5 Stars by US News were mostly HMO plans by an insurance company named Chinese Community Health Plan.  I've never heard of that company so they can't be a big player in the California market.  

The opening text of the report says they rated 59 plans in California, but I know that there are over 120 plans offered by the major insurance companies.  The last straw was that the second plan on the five Star list was the Blue Shield Saver 6000 HSA plan.  Now I was sure that there was something terribly wrong with the report, because the new Blue Shield plans are not very competitive in California as of July 1st.  So how could this one be listed as the 2nd best plan?

It became clearer when I noticed the little "+ Read More" under the first 2 lines shown above.  Once I clicked on that and saw the rest of the text I understood more about what I was seeing.

Using government data, U.S. News has rated 59 health insurance plans marketed to individuals living in California. Of these, 14 earned the top rating of five stars in the U.S. News analysis. A plan's star rating reflects how much coverage it provides for an array of healthcare services. (For an explanation of our star ratings, see How We Rate Health Plans.) A plan's star rating does not take into account its monthly premium. Average monthly premiums for all rated individual plans in California range from $252 for healthy 30-year-old nonsmokers to $586 for healthy 60-year-old nonsmokers.
To find ratings and premiums for plans available to you specifically, please fill out the blue form below.

The top plans, according to US News are those that offer the most benefits for the least amount of out-of-pocket cost.  So HMO plans that have $10-$40 copayments for every benefit end up being the top rated plans.  HMOs, however, have significantly higher monthly premiums than most people can afford, so how are these 5 star plans a good choice for consumers?  

Looking at the US News "How We Rate Health Plans" page gave me some more clues about what went wrong. 

We obtained data from information collected by the Centers for Medicare and Medicaid Services (CMS) for the purpose of offering details about such plans on

Pencil and PaperAll the data for EVERY health insurance plan is publicly available inside most large health insurance quote engines, so why did US News choose to use only the 5 insurance companies that reported their data to CMS, even though the site shows plans from all the major insurance companies. With some more effort, US News could have collected the data from the main insurance companies and made the results much more complete.


As it is, the US News report claims to have been created to help people shop for health insurance:

Our goal in evaluating these health plans—as it has been for decades in ranking hospitals, colleges, and more—is to help consumers to make important life decisions, in this case to find health insurance that provides the coverage they need at a price they can afford.

But their data excludes the cost of the medical plans from the analysis, which makes the resulting star ratings useless to anyone that is shopping for health insurance.  How can a person know if they need two star or three star benefits from their insurance plan?  The star system does not provide a way for someone to know what kind of benefits are available in two star or three star plans without looking at each plan.  

Woman Pondering Health PlansIf someone has to look at each plan to figure out if it has the benefits they need, then the US News star ratings are not useful and could be misleading.  Misleading because someone could look at only the four and five star plans in order to get a "good" plan.  Then discover that those plans are not affordable and give up the search thinking that health insurance is too expensive.  

I applaud the efforts US News used in their analysis of the plans they did review.  Their breakdown of the point scoring system they used to rate the plans was good.  However they needed to do something more with the information to make it useful to their readers.  They were SO CLOSE to having something really good, and they stopped one step short.  The simple addition of plan premiums as a 2nd axis along with the stars on the 1st axis would have made the analysis much more valuable.  With that addition a user could have answered the question "How can I get the most value (plan benefits) for the least cost?"  As it currently stands, the report is more of a curiosity and a time waste than a resource for someone shopping for health insurance.  

So, if anyone from US News reads this, I'd love to get a copy of your data and add the extra information to make the data useful.  To all my SPF Insurance fans and clients, stay tuned for an upcoming graphic that will show how all the California health insurance plans rate from a price and benefit standpoint.

Other Recent Articles:
Anthem Blue Cross July 1st Plan Updates
Health Net Rolls Out New Insurance Plans With Maternity Coverage
New Analysis Shows The Best Maternity Insurance In California Is…”
What Is The Best HSA Plan In California?
Blue Shield Of California Introduces New Plans For July 2012


Take The Floor Tonight : Voices For Pelvic Floor Disorders (PFD) – Class

by Tim Thompson
Impact on families and individuals



Incontinence and prolapse: You don’t have to live with it!

Do you or a loved one suffer from pelvic floor disorders? Join us for light fare and girl talk to find out what options you have and how to prevent incontinence and prolapse from developing.   Come hear the experts speak on common, but underreported conditions that millions of women suffer from. Find out what options you have and how to prevent these conditions from developing at this free event.


Join us for light fare and girl talk

  • When: Wednesday, Aug. 15, 2012, 5:30 p.m. — 7:30 p.m. Register by Aug. 8.
  • Where: Goldberg Auditorium, UC San Diego Moores Cancer Center (map and directions)
  • Cost: Free



Topics and speakers

  • Pelvic Floor Disorders 101: Overview of Prolapse and Incontinence
    Emily Lukacz, MD
  • What Every Woman Needs to Know About Bladder Control
    Michael Albo, MD
  • Prevention and Treatment
    Charles Nager, MD

FEE: Free – registration required


SPF Insurance provides information to our clients to solve health problems and insurance problems. The classes offered by UCSD Health System can help you understand what your options are and help you maintain your health. We encourage you to explore their upcoming classes and sign up for those that appeal to your needs.

Anthem Blue Cross July 1st 2012 Plan Updates

by Tim Thompson


The state of California required all health insurance companies to include coverage for maternity and autism beginning July 1st.  Anthem Blue Cross offered these benefits in only a handful of their plans, so they made changes to the rest of their health insurance plans to include these new benefits.  The net effect of these changes is that Blue Cross raised the rates on most plans in May to account for the July benefit changes, and dropped a few plans.

The Anthem Blue Cross portfolio of plans is very diverse and includes lower cost plans for rate conscious consumers as well as full featured plans for those willing to spend more to get the higher benefits.  The primary plans in the portfolio, along with a description of each, recommendations as to who the plans are good for, and a simple competitive analysis are outlined below.

Anthem Blue Cross Logo


The CoreGuard family of plans remains an enigma to me because it has never fit what the majority of people need in benefits or price.  The plans offer only free preventive services and then require that you meet the plan deductible before any further benefits are paid for by Anthem Blue Cross.  The family of plans offers the following deductible choices, 5000, 3500, 2500, 1500, and 750.

Click here to see more details about CoreGuard plans.

Because of limited benefits the CoreGuard family serves a small niche in the market. The Coreguard plans can be a good choice for someone that wants to have a low deductible and doesn’t need a full featured plan (typically using either the 750, 1500, or 2500).  The higher deductible versions of the CoreGuard family (3500 & 5000) really have no purpose because the ClearProtection 3300 plan is similar in price, yet offers more benefits.  Therefore the ClearProtection 3300 plan is a better choice.


The ClearProtection 3300 plan is one of the most popular plans in the California marketplace.  The plan offers 2 office visits for a $40 copay and generic prescription coverage.  The 3300 deductible is the only remaining member of this proud family of plans.

Click here to see more details about ClearProtection plans.

For healthy individuals and families with teenagers this plan is usually a good choice, and it’s almost always lower cost than the CoreGuard family.


The SmartSense family of plans offer 3 office visits for copays, and provide generic prescription coverage.  The plan offers deductibles of 6000, 5000, 3500, 2500, and 1500.  There is an option to upgrade the prescription benefit to provide brand name coverage, and with this combination the SmartSense family is pretty competitive in the California marketplace.

Click here to see more details about SmartSense plans.

These plans are usually a good choice for families with children between the ages of 8-19, or for individuals that want to have lower costs and Brand name prescription coverage.


The Premier family of plans offer unlimited office visits for a copay, and provide both generic and brand name prescription coverage.  These are the Cadillac plans in the Blue Cross portfolio.   Within the family, you can choose deductibles of 6000, 5000, 3500, 2500, 1500, or 1000.

Click here to see more details about Premier plans.

These plans are a good fit for young children that need more office visits or are accident prone. Another group is people that have some medical conditions that require more frequent office visits and/or brand name prescription coverage.

PPO Share

The PPO Share family of plans is the granddaddy of the Anthem Blue Cross plans.  The family plan deductibles are 7500, 5000, and 3500.  These plans offer unlimited office visits for a copay, and provide both generic and brand name prescription benefits.  These plans changed very little because they have been the primary maternity plans for Blue Cross for many years.

Click here to see more details about PPO Share plans.

These plans are not really a good fit for anyone looking to get new insurance coverage, because the Premier plans tend to be lower cost and offer similar benefits.  These plans are commonly held by people that don’t want to deal with changing their health insurance, or have medical conditions, and they originally signed up for these plans many years ago.

Lumenos HSA

The Lumenos plans are the Blue Cross Health Savings Account (HSA) compatible plans.  These plans offer free preventive care just like the rest of the Blue Cross health insurance plans, but for all other benefits you must pay the plan deductible first.  Once you meet the deductible, Anthem pays 100% of all additional costs.  The Lumenos family offers the following deductibles 5950, 4500, and 3000 for individuals, and 11900, 7500, 5500, and 3500 for families.

Click here to see more details about Lumenos plans.

These plans are perfect for someone that wants to “self-insure” but make sure that there is a safety net in case something major happens.  The tax savings benefit is another reason people select HSA compatible plans (more details about HSA plans will be available soon).

Comparing Anthem Blue Cross Plans To The Marketplace

From a price and benefit standpoint, Anthem Blue Cross plans are still competitive in California.  In general, they are not the cheapest plans, nor are they the most expensive.  For most people, if they ask me to give them the 3 best plans for their needs, a Blue Cross plan would probably make it into that short list.

For maternity coverage, the best plan from Blue Cross is the Lumenos 3500 HSA with an expected total out of pocket maximum of $4900.  The remainder of the Blue Cross plans don’t really compare well against the top maternity insurance plans from their competition.  The Lumenos plan is the 5th best maternity plan in California.

The ClearProtection 3300 plan has its hands full trying to compete with the new Health Net plans in the low price end of the market.  The benefits of the Health Net plans are very similar to the ClearProtection plan, however they do have higher deductibles than the 3300 offered by Blue Cross and are much lower priced (see the analysis of the new Health Net plans).

The middle and high end of the market is where Anthem Blue Cross is very competitive at this point.  The SmartSense and Premier plans tend to offer a little bit better pricing than their competitors, Kaiser, Cigna, Blue Shield, and Aetna.


Earlier this year I raised the alarm that Anthem Blue Cross was becoming less competitive in the California marketplace based upon the price and benefit changes they made early in 2012.  The maternity and autism mandate appears to have evened out the playing field again, and Blue Cross is now one of the better positioned health insurance companies.

I expect that Blue Cross will maintain their market share lead, and will move further ahead of Aetna, Blue Shield, and Kaiser, while giving up some ground to Health Net and Cigna in certain parts of the market.

As we get closer to 2014 and the potential beginning of Health Care Reform’s “no underwriting” period, I expect we will see a surge of enrollments in the lower cost and medium cost plans, so Anthem Blue Cross should capture a good portion of those new applications.

Overall Anthem Blue Cross has a strong and broad portfolio of health insurance plans in California.  Their plans are priced competitively in most of the state and should be good solutions for many people.

See the recent analysis for the other major insurance companies by clicking on these links:
Health Net Analysis
Blue Shield Analysis

If you would like to discuss your specific needs with one of our advisors please call us.  If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.

Other Related Articles:

Health Net Rolls Out New Insurance Plans With Maternity Coverage
New Analysis Shows The Best Maternity Insurance In California Is…”
What Is The Best HSA Plan In California?
Blue Shield Of California Introduces New Plans For July 2012

Nourish Your Mind and Body : Free Your Knees

by Tim Thompson
SPF Insurance provides information to our clients to solve health problems and insurance problems. The classes offered by Palomar Health can help you understand what your options are and help you maintain your health. We encourage you to explore their upcoming classes and sign up for those that appeal to your needs.

Palomar Health provides a large variety of free and low-cost health education classes. The classes are led by physicians and other professionals, and in some cases also provide free screenings depending upon the class topic.

The Featured Class in August is :

Free Your Knees


Monday, August 206-7:30pm

Pomerado Hospital
Conference Room C/D
15615 Pomerado Road
Poway, CA 92064

Knees, the workhorses of weight-bearing joint, can wear ouit over time due to osteoarthritis or injury. Join Orthopedic Surgeon Kevin Metros, M.D., as he discusses the latest advances in treatment, including minimally invasive total knee and partial knee replacement.

FEE: Free – registration required


To register, call 800-628-2880 or visit Class Registration where you can see all the classes offered in August.

    Other Classes In August:

  • Diabetes: Guide to Health Living
  • Take Shape for Life – Medifast
  • Healthy Foods for Health Skin
  • CPR for Family & Friends
  • Body Composition Screening
  • Alternative Treatments for Menopause
  • and many more…

New Analysis Shows The Best Maternity Insurance In California Is…

by Tim Thompson
After a lot of analysis and data crunching, we’ve finally gotten all the new California maternity plans analyzed. The state of California mandated that all health insurance plans offered in the state after July 1st, 2012 had to provide coverage for maternity care. As a result, every insurance company adjusted their plans and their pricing to include this benefit. The result of this analysis is a ranking of the best maternity insurance in California.

Baby Holding Finger Prior to July 1st, there were only 27 plans that provided benefits for pregnancy costs. Now there are up to 120 plans to choose from (depending upon which county you live in there may be fewer options). These new options mean that women can get any health insurance plan and know that maternity coverage is provided.

The key to picking the best maternity insurance plan is to find one that will minimize the total out of pocket cost of the prenatal office visits and lab tests, during the 9 month pregnancy, and the delivery costs of having the baby. These costs can reach up to $20,000 for an uncomplicated pregnancy, and can be well over $100,000 if the baby is premature.

March of Dimes – Pregnancy Complications
For some women, labor starts too early, before 37 completed weeks of pregnancy. One out of eight babies in the United States is born too soon. This can lead to serious health problems for the baby. So it’s important to know the signs of preterm labor.

For the last couple of years the top pregnancy insurance in California has been the Kaiser $0/$1500 HSA Deductible plan, with an expected Total Out Of Pocket cost (plan premiums plus all costs for prenatal care and delivery) of $4438. As of July 1st, the new leader is the Cigna Health Savings 1900 plan, with a Total Out Of Pocket cost of $4381. Prior to July Cigna did not offer pregnancy plans in California, but their decision to begin offering it will probably result in a surge of new female subscribers.

For more information about the other top maternity insurance plans, go to the Maternity Insurance California page. We’ve outlined what to look for in a good pregnancy plan and summarized the total cost breakdown for each of the top plans.

Other Related Articles:
Anthem Blue Cross July 1st Plan Updates
Health Net Rolls Out New Insurance Plans With Maternity Coverage
What Is The Best HSA Plan In California?
Blue Shield Of California Introduces New Plans For July 2012

Health Care Reform Pros And Cons – Top 10 Reasons To Dislike It

by Tim Thompson
There’s so much to like about the Affordable Care Act (ACA), and there’s so much to dislike it for.  As a type I diabetic I applaud the idea of enabling everyone to buy regular health insurance without the fear of rejection.  I eagerly await the ability to buy the same insurance plan as someone who is healthy.  But as a citizen of the USA, I worry that we’ve bitten off way more than we can chew on, and we’re hiding the true enormity of that bite under a tablecloth (a napkin seemed too small for this analogy). So here’s my take on the worse parts of Health Care Reform plan.

Here’s the Top 10 Things to Dislike About Health Care Reform

  1. Adds a “fee” on health insurance companies to pay for reform costs – this will get passed on to consumers
  2. Adds a tax on the sale of any medical device to pay for reform costs – this will raise consumer costs
  3. Adds a “fee” on pharmacuetical companies to pay for reform costs – this will increase drug prices
  4. Reduces the maximum amount that can be put into a Flexible Spending Account (FSA) to pay for medical expenses from $5000 to $2500 – effectively increasing taxes on many employees using an FSA
  5. Reduces plan choices to only 5 options, each of which requires more benefits than today’s low cost plans – thus increasing premiums consumers pay
  6. Does little to fight the root cause of health care inflation – Americans have poor health habits – but creates various committees and panels to figure out what to do in the future
  7. Greatly expands Medicaid* enrollment by 17 million people – thus increasing federal and state spending, and therefore the taxes we pay
  8. Requires pharmacuetical companies provide up to 50% discounts to seniors in the Medicare Part D donut hole – these discounts will be made up for by charging higher rates to insurance companies, which will result in higher premiums for non-Medicare consumers
  9. Requires companies with 50 or more employees to offer health insurance or pay a penalty – because the penalty is lower cost than a health insurance plan, it will encourage companies to drop coverage to save money
  10. It greatly expands government spending, regardless of what politicians say

* Medicaid is a federal and state government program that provides free health insurance to low income and disabled Americans.

Other items that did not make the top 10

These didn’t make the top 10, but definitely contribute to the difficulties we face with the implementation of the Affordable Care Act.

  • Does not address the Medicare physician reimbursement rate problems that are pushed to the next year each fall
  • Does not change the grossly inadequate Medicaid payment schedule for physicians which leaves them unable to afford to care for medicaid patients – this reduces the number of Medicaid accepting doctors during a time when enrollment will be surging
  • Does not adequately address an upcoming shortage of primary care physicians
  • Increases the unreimbursed medical expense tax threshold from 7.5% of income to 10% – thereby increasing taxes on people with the greatest medical needs
  • Impose a tax on health insurance companies that allow employers to select rich benefit health plans exceeding a specific threshold – effectively causing insurance companies to stop offering rich benefit plans
  • It reduces the premium difference between young and old consumers to 3:1 – so younger people end up paying for older people
  • Tax indoor tanning salons to pay for reform costs
  • Requiring laid off people who are unable to afford COBRA coverage to wait for 6 months without insurance before accepting them into the current Pre-Existing Condition Insurance Plans (PCIP)

As you can see, this list contains some large issues that must be corrected for Health Care Reform to have any chance of success. This does not mean that we should throw out the Affordable Care Act.  Rather we should fix the flaws in order to keep the many good things included in the bill — see the previous post “Top 10 Reasons To Like It” for more details.

The Biggest Drawback of Health Care Reform

The biggest drawback of Health Care Reform is that it will expand the US budget deficits greatly. This increase can not be sustained without cutting other programs or raising taxes (aka increased costs for us).  The various “fees” and taxes that are imposed on companies and products don’t ultimately get paid for by the companies.  They get passed to us through higher premiums and product costs.  So in the end, the politicians have crafted a plan that they can say does not raise taxes on citizens.  But the reality is that it does, and they know that.

The false hope in this reform package is that it does virtually nothing to reduce health care costs, but imposes numerous “fees,” taxes, additional benefit, and administrative costs that will simply be passed on to the consumer in increased premiums. So with no further changes in the reform bill, we will get increased government spending and increased costs for every person in the US. This was not the goal of health care reform, but is what we will get if ACA is not modified.

The expansion of Medicaid enrollment is potentially the biggest ticking bomb in the ACA.  The network of physicians that will accept Medicaid patients is getting smaller each year.  This is primarily because the reimbursement rates paid to the doctors is not keeping up with the costs of caring for these Medicaid patients.  So doctors stop taking new Medicaid patients to enable their practice to survive.  With millions of new Mediaid patients joining the system, where will they find doctors?  How much more will the Medicaid system cost if the doctors were paid the same amount as Medicare doctors?  How can we afford that extra expense, given the budget deficits the US currently has? These are the questions our elected officials need to answer.  The dilemma they face is that Medicaid enrollment is expected to increase by over 14 million people in 2014, at a cost of almost $95 billion according to the CMS 2011 Actuarial Report On The Financial Outlook For Medicaid

For a good resource about what the Affordable Care Act does, visit The Kaiser Family Foundation piece : Summary Of New Health Reform Law.

The pros and cons of health care reform will take several years to work through. Until then we have to adjust to the changes that are coming. SPF Insurance will keep you informed about these new adjustments as they occur, and before they start to affect your life.

So stay tuned for more.

If you liked this “Top 10 List,” then LIKE this post over there to the right and a little bit above here.

Health Care Reform Pros And Cons – Top 10 Reasons To Like It

by Tim Thompson
Top 10 Reasons To Like Health Care ReformHealth Care Reform got a big lift from the Federal Supreme Court ruling that the individual mandate could be considered a tax, and therefore, the Affordable Care Act (ACA) could remain intact. This means that the reform plan will continue to roll out, with a January 1st, 2014 start date. Many provisions have already been phased in, but the removal of health condition underwriting, allowing people with existing health conditions to enroll in regular health insurance plans, starts in 2014. Even though this reform bill has flaws, there are plenty of good things and positive changes that it contains.

Here Are The Top 10 Reasons To Like Health Care Reform

  1. Allow families to keep children on their health insurance plan until age 26
  2. It reduces the price difference in plans for younger people and older people – thereby reducing the costs for older people
  3. It encourages businesses to create employee wellness programs to improve employee health
  4. No Cap on the medical benefits that can use if needed
  5. It reduces the Medicare prescription donut hole for drug costs
  6. The number of health plans to choose from is reduced to 5 – fewer choices should make it easier to choose
  7. Government will help lower income families pay for health insurance – through subsidies and credits (more about this in an upcoming post)
  8. All preventive services are free – promotes taking care of ourselves by getting annual checkups
  9. It forces the health care industry to shift from “caring for the sick”, to “keeping people healthy”
  10. Nobody can be declined for health insurance

The last item in the list is the most far-reaching change of the Affordable Care Act.  Enabling everyone to get health insurance regardless of their health condition is an important step in improving the health of Americans.  Once everyone has insurance, we need them to see a doctor to begin taking preventive steps to ensure their ongoing health.  These preventive care services will now be free, so cost should not keep people from taking care of themselves.

Changing the mindset of the health care industry from being sentries on the lookout for danger, to architects overseeing the fortification of a castle to protect it from disease will be a slow process. The transition to keeping people healthy and rewarding medical professionals for preventing illness, will be a major shift for the industry, and for consumers as well. This new focus will help us change the health habits of America, and prevent us from becoming a country of couch potatoes.

Some other good things that did not make the top ten are:

    • Small Business tax credit for providing health insurance to employees
    • Creation of the Pre-Existing Condition Insurance Plan for people with health conditions prior to 2014 when nobody can be declined
    • Enabling insurance companies to offer policies across state lines
    • (If I forgot any, put them in the comments section below.)

As a healthy type I diabetic, I look forward to these changes, and the day that I too can get regular health insurance. But I know that there are dark clouds on the horizon, and not everything about ACA is perfect (for more on the Top 10 Reasons To DISLIKE ACA). With the election coming up this fall there will be a lot of mud slinging regarding health care, and promises by the Republicans to repeal ACA. Although I support the Republican cause, I think there’s enough good in version of Health Care Reform, so I think we need to fix the holes and problems with ACA, not start over again.

So as we go through the next 18 months until 2014, there will probably be a lot of news and comments about health care reform. At SPF Insurance we’ll cut through the clutter and post about those changes that will impact you, and let you know what you can do to protect yourself, and benefit the most.

Stay tuned for more.

If you liked this list, then “LIKE” us over there to your right and slightly above here.

SPF Insurance Introduces A New Resource Page About Short Term Health Insurance Plans

by Tim Thompson
Our newest resource page with information and reviews about Short Term Health Insurance (or Temporary Health Insurance) plans has been officially launched this morning and is now live and ready for use.

Short term plans are typically used when someone knows there will be a gap in insurance coverage of less than 12 months.  A typical example of this is when someone changes jobs and their new company insurance plan doesn’t start until after they have been with the company for 3-6 months.  These new employees can set up a short term plan that will last until the day the new company plan starts.

Some other situations where these plans can work, are:

  1. College students or recent graduates

  2. Individuals not yet eligible for Medicare coverage

  3. Individuals waiting on approval of major medical coverage

  4. Individuals no longer eligible on parents’ plan due to age or status

  5. Individuals looking for an affordable substitute for COBRA

These temporary health plans are easy to qualify for.  Typically just four to eleven Yes or No questions.  Pls the plans can start as quickly as the day after the application is submitted.

Most of the major insurance companies (Aetna, Blue Cross, Blue Shield, etc.) don’t offer short term plans, so the selection of the company that provides the plan is very important.  At SPF Insurance we have carefully screened the companies and selected four of the top temporary health insurance carriers.  These carriers offer plans with 2 to 8 options, so knowing how to compare the plans and pick the one that is best for your needs is important.

On the new Short Term Health Insurance page we’ve done a lot of that work for you and provided our analysis of the plans, and recommending the plans we think offer the best value for the price.

So go ahead and stop by to check out this new short term health insurance resource page, and be sure to comment at the bottom and tell us what you think, then “Like” us.

Health Net Rolls Out New Insurance Plans With Maternity Coverage

by Tim Thompson
Health Net has introduced a new family Health Netof plans to replace their existing health insurance plans starting July 1st. The plans are divided into two portfolios, one for Health Net’s Individual and Family Plans (IFP) and the other for their California Farm Bureau Plans.

Health Net Individual and Family Plans

This family offers 2 sets of benefits, from the mid-range benefit level of the “Value” plans, to the budget benefits of the “Advantage” level. Providing these benefit options and prices should simplify finding a plan that fits anyone’s needs.

Value Plans
These plans offer a good set of benefits including 2 office visits to see a doctor for a $35 copay, 40% coinsurance after you meet the plan deductible, two deductible levels at $4500 and $7500, and a $2500 brand name prescription deductible.

The Value plans provide a unique and expensive hospital care benefit, in that you pay a copay of $500 and then your deductible, and then you pay 40% of the costs (Health Net pays the other 60%) until you reach your out of pocket maximum.

the Value plans are only a good fit for small families in which most of the medical expenses are for a single family member, yet the family wants to have the same set of benefits for all family members. The Value plans do not offer “family” deductibles and max-out-of-pocket limits, each member of the family has their own plan, with their own deductible, etc.. Other than this situation, you will be better off in the Advantage plans outlined below

Advantage Plans
The Advantage plans are slightly different from the Value plans in that they provide 2 office visits for a $40 copay, 50% coinsurance after the deductible, and two deductibles at $3500 and $6500, along with a $2500 brand name prescription deductible that is separate from the plan deductible. The major difference between the Value and Advantage plans is that for care in a hospital, the Advantage plans require you to meet your deductible first and then pay the 50% coinsurance until you reach your maximum out of pocket limit.

These plans are a good fit for individuals and families that want a full set of standard benefits at the lowest price.

California Farm Bureau Plans

California Farm Bureau (CFB) is an organization established over 75 years ago to protect and promote agricultural interests throughout the state. The Farm Bureau offers a set of health insurance plans to the members through Health Net of California. Besides the health insurance plans, membership in the Farm Bureau provides a variety of discounts for travel, rental cars, and theme parks, and others as part of the annual membership. The annual membership cost varies depending upon which county you live in, and can be paid annually or on a monthly basis (in San Diego county the annual cost is $85/year or $8/month).

There are two types of CFB health plans available to members. The “Standard” plans and the “Health Savings Account” (HSA) compatible plans.

Standard Plans
These plans are for individuals and provide 2 office visits for a $50 copay, 0% coinsurance after the deductible (once you reach the deductible Health Net pays 100%), three deductible options of $4000, $6000, and $7500, and a $2500 brand name prescription deductible that is separate from the plan deductible. The Standard plans also offer the ability to get unlimited care at CVS MinuteClinic locations for a $50 copay.

These plans can be a good option for individuals that want a plan that is easy to understand and has a full set of standard benefits at reasonable prices. The $4000 deductible plan looks like a good option for women who are planning to have children (check back later in June to see the full analysis on Best Maternity Insurance Plans For California Couples).

HSA Plans
The CFB HSA plans have historically been some of the best in the marketplace, and these new plans keep that characteristic. The plans are traditional HSA plans that provide preventive services for free, and all other benefits are paid after you reach the plan deductible. The plans have two deductible options at $4500 and $6000.

The nice feature of these HSA plans is that the deductible and the maximum out-of-pocket (OOP) limit are the same number. Once you meet the deductible, you have also met the max OOP and Health Net pays 100% of all additional costs.

The CFB HSA plans are great for healthy people that want to “self insure” and can benefit from the tax savings of the HSA, but want to have a safety net in case something happens.

Health Net Cost Comparisons

These new Health Net health insurance plans are very competitively priced compared to the other carrier’s plans. In fact, these 9 plans are lower priced than any other plan in California right now. For a 30 year old woman in San Diego county, the Health Net Advantage 6500 plan is lowest priced plan at $66/mo, and the next closest competitor is the Anthem Blue Cross SmartSense 6000 StandardRx plan at $112/mo which has similar benefits, or the Anthem Blue Cross CoreGuard 5000 plan at $102 with less benefits than the Advantage plans.

Even adding the $8/mo membership to the CFB plans, makes the HSA 4500 plan cost $92/mo while the next lowest cost HSA plan is the Kaiser %50/5000 HSA plan at $102/mo.

Based upon these price comparisons, I expect Health Net will begin to gain market share from the other carriers over the next 6 months. Price is not be-all-end-all for everything, but if you can get the same kind of benefits at a much lower cost, most people will opt for the lower cost solution. This same transition is happening in the small group health insurance market because of a new set of plans that Health Net introduced in April. It looks like Health Net is planning to become a much bigger player in the California health insurance marketplace.

The new July pricing for all the carriers is available in the SPF Insurance quote engine now, so stop by and see what plan options fit your needs best. If you have any questions at all, please call us and we’ll make sure you get the answers you need.

Other Related Articles:
Anthem Blue Cross July 1st Plan Updates
New Analysis Shows The Best Maternity Insurance In California Is…”
What Is The Best HSA Plan In California?
Blue Shield Of California Introduces New Plans For July 2012

Blue Shield Of California Introduces New Plans For July 2012

by Tim Thompson
Blue Shield of California this week disclosed the new health insurance plans they will offer beginning on July 1st. These plans will replace all but 4 of the company’s current plans, and will add maternity care and mental health therapy for Autism. The only existing plans that will continue to be offered after July 1st are the Spectrum PPO 5000, Spectrum PPO 5500, Access+ HMO, and the Access+ Value HMO.

Blue Shield of California Plan Overview

The new replacement plans are the Shield Secure Plus PPO, Shield Secure PPO, Shield Wise PPO, Blue Shield of Californiaand the Shield Saver plans. Each of these plans offers similar benefits with the main difference being the number of office visits and copays, the deductibles, the coinsurance percentage, the maximum out of pocket limit, and the prescription benefits. Each of the Shield plans offer two or three deductible levels so the benefits a person needs can be better matched by one of the new offerings.

The Shield Secure Plus PPO plans offer unlimited office visits for a $30 copay along with a 30% coinsurance and a $500 brand prescription deductible, while the Shield Secure PPO plans offer the same unlimited office visit copay with a 40% coinsurance and a $3000 brand prescription deductible. The Shield Wise PPO plans offer 2 office visits for a copay ($25, $35, or $45 depending upon the plan) along with a coinsurance (25%, 35%, or 45% depending upon the plan), and a $3000 brand prescription deductible. The Shield Saver plans are Health Savings Account (HSA) compatible and offer no benefits until the deductible is reached.

Blue Shield Cost Comparisons

Looking at how these new Blue Shield plans compare to the other California health insurance company plans that will be available in July, shows that the new Shield plans may not be very price competitive in some age groups and regions of the state. In San Diego county, the price for a 30 year old woman in the Shield Wise 4500 plan is $154/mo. This compares to a $104/mo cost for the Anthem Blue Cross ClearProtection 3300 plan with “somewhat comparable” benefits, and a $143/mo cost for the CIGNA Open Access Value 3000 plan with slightly better benefits than the Blue Shield plan.

Comparing the new HSA plans from Blue Shield shows that the Shield Saver 6000 plan costs $220 for a 45 year old woman in San Diego. At Anthem Blue Cross the Lumenos HSA 5950 Plus plan costs $202 and at CIGNA the Health Savings 4900 costs $207/mo. Both the Anthem and CIGNA plans actually offer lower deductibles and a lower cost that the Blue Shield plans.

If we compare plans with greater benefit levels and across a couple of age groups (30 and 45 year), the results are pretty similar. Therefore, it looks like the new Blue Shield of California plans are simple to understand, and give consumers an ability to select the level of benefits they want, but these conveniences will require that the buyer be willing to pay more for the plans. This doesn’t look good for market acceptance and I expect we’ll see changes next year to correct this problem. It wasn’t that long ago I was saying that Anthem Blue Cross had lost it’s competitive edge (see Anthem Blue Cross Slipping Out of Top Spot in California Health Insurance) and was giving up the lead to the other insurance companies in California, now Blue Shield appears to be taking that role.

The SPF Insurance Services health quote engine currently has the prices for new Blue Shield of California plans, so stop by and check out the rates!

Other Related Articles:
Anthem Blue Cross July 1st Plan Updates
Health Net Rolls Out New Insurance Plans With Maternity Coverage
New Analysis Shows The Best Maternity Insurance In California Is…”
What Is The Best HSA Plan In California?

Will Companies Drop Health Coverage Because Of Health Reform Law

by Tim Thompson
If you were a business owner, and knew that you could save a lot of money by dropping your company health insurance plan and put your employees into the health insurance exchange where they could get similar coverage, would you do it? That’s the question that the House Ways and Means Committee was trying to answer in a new report they released recently. Their analysis showed that businesses could save $28 billion in the first year of health care reform (2014) by dropping the company benefit plan and paying a small penalty for ending the employee coverage.

From a company perspective, the employees will still get coverage, and potentially at lower cost, especially if they qualify for US government subsidies. While the company saves thousands if not millions of dollars, which then flows to the bottom line as increased profits. This will be a very tempting test for smaller companies that are struggling to make ends meet in a tight economy.

The Congressional Budget Office says that employers won’t drop health coverage because they use the benefit plans to retain and attract their employees. However, both reports only talk about the largest companies in the US, and forget about the small business that is offering benefits to it’s employees as a nicety. In the small business group health insurance marketplace, the cost of health plans is typically much higher than the cost of plans in the individual & family health insurance market. So it is possible that businesses could split the cost savings with employees and let the employees get health insurance through the exchange that is comparable to what they had through work. Both sides would win and health care reform would take a potential financial hit in increased subsidies.

Stay tuned for more.

New Study Shows Health Care Reform Will Cost The Government $1.15 Trillion Over First Ten Years

by Tim Thompson
A new study, by Medicare Trustee Charles Blahous, shows that the original projections by the Congressional Budget Office (CBO) and the Medicare Trustees compared the Affordable Care Act (ACA) cost and savings projections to a baseline scenario that is different from what we actually face. This new analysis caused a great deal of criticism, but some experts argue that the report projects a distressingly accurate snapshot of the effects from the ACA.

Over the first 10 years of the ACA, government spending would be increased by over $1.15 Trillion, and this initial increase in federal deficit spending was hinted at by the CBO during the debate leading up to the passage of the ACA. According to Blahous, the savings within the health care reform bill would likely be delayed or ultimately become non-existant, while the cost increases are built into the law.

A large portion of the ObamaCare deficit reduction strategy relied upon double counting the Medicare savings. The ACA provisions cut Medicare spending by $500 Billion to improve the government’s ability to pay for future Medicare benefits, but those same Medicare savings were also used to pay for health care reform.

To enable the ACA to be budget neutral, two thirds of the health exchange subsidies will have to be eliminated, and all of their costs removed from the health care system. Otherwise the government will be plagued by worsening budget deficits. This is a core piece of the health care reform bill, which attempts to make health insurance affordable for lower income families.

The Blahous study has shown that the original deficit reduction benefits of the ACA were false promises, and that mounting deficits will be the result of implementing the current health care reform bill. So now we have a dilemma, do we make changes to a flawed bill, or do we start over now that the real truths are known, and create a better solution.

Stay tuned for more.

Image: Stuart Miles /

California to Push On With Health Care Reform Regardless of Supreme Court Decision

by Tim Thompson
Governor Jerry Brown’s administration is planning to implement some parts of the Affordable Care Act Health Care Reform
(Health Care Reform) even if the Federal Supreme Court overturns part or all of the reform bill. State Health and Human Services Secretary Diana Dooley said that California should implement it’s own version of Health Care Reform, and require that all California residents have health insurance, similar to the requirement that everyone have car insurance.

I applaud the intent to “do good deeds” for California, but Governor Brown is facing continuous budget deficits as things are, and needs voter approval of tax increases in order to maintain the status quo. How will he propose to add more taxes to pay for a new program with potentially escalating costs over the next decade?

Health Care Reform is not about Health Insurance Reform, it needs to first focus on health care costs and reducing the health care inflation rate by eliminating duplicated tests, increasing access to electronic medical records, prevention and maintaining the wellness of individuals, and rewarding health habits both within the health care community and in individuals. Then Health Care Reform can increase coverage to all people, and the government costs will be supported by existing tax revenues. The current system is trying accomplish this in reverse order.

Stay tuned for more.

Image: dream designs /

Consumer Watchdog Group Starting New Boon-Doggle In California

by Tim Thompson
Consumer Watchdog, a special interest group with strong ties to trial lawyers, is gathering signatures to put a health insurance rate regulation measure on the November 2012 ballot. The measure seeks to create a new bureaucracy, funded by insurance companies, to create a new layer of regulations on top of existing state and federal regulations to control health insurance rates.

Physician groups, hospitals, doctors, and small businesses announced the launch of Californians Against Higher Health Care Costs (CAHHCC) to combat the Consumer Watchdog efforts. C. Duane Dauner, president/CEO of the California Hospital Association says that “Consumer Watchdog’s ballot measure is full of false promises and devoid of real solutions. Regulating health insurance rates does not address the underlying demand and utilization forces that drive health care costs. One of the biggest drivers of increasing insurance premiums stems from the chronic underfunding of the Medicare and Medi-Cal programs. When government programs fail to pay the actual cost of caring for their beneficiaries, hospitals and other providers must shift these un-reimbursed costs to private insurers, which drives up premiums. This initiative does not address governmental payment shortfalls.”

Consumer Watchdog is using the initiative precess to open up California medical insurance in the same way that allowed trial lawyers to make millions of dollars off homeowners and auto insurance following successful ballots in the past.

Stay tuned for more.

California Families Pay For The Uninsured

by Tim Thompson
According to the California Endowment, a private foundation concentrating on health issues, the average California family pays an additional $1400 in yearly premiums in order to cover the costs of uninsured Californians. And because the Federal Supreme Court may throw out the mandate provision of the Affordable Care Act, the state of California is preparing to go it alone on some parts of health care reform.

The new child health insurance laws and the required California maternity insurance coverage mandate will stay in place, while work on the California Health Benefit Exchange — a website to help consumers find and purchase health insurance once 2014 rolls around — is continuing to proceed. Many consumer advocates are urging state lawmakers to forge ahead with a California mandate requiring everyone to have health insurance, just like the requirement to have car insurance. Further discussions are required before before any changes happen in this area. However, a number of bills are in the development process specifically targeting health care reform in California.

Stay tuned for more.

Anthem Blue Cross Slipping Out of Top Spot in California Health Insurance

by Tim Thompson
With the beginning of April it becomes time to start running quotes for individual and family health insurance rates with a May 1st effective start date. The new rates and changes that Anthem Blue Cross of California announced in March now become very evident. Many Anthem customers that have older health insurance plans have seen their rates finally reach the “pain threshold” and as a result they are looking for lower cost alternatives.

My quick assessment, from the first half dozen quotes I’ve run, is that Anthem has given up a huge chunk of their lead over the other individual and family health insurance companies in California. Several of their lowest cost plans no longer exist (ClearProtection 5000, CoreGuard 10000), and the remaining plans are now similarly priced to Aetna, Blue Shield, Cigna, and Health Net plans. Going into the remainder of the year, I expect to see more new clients opting for Blue Shield of California and Cigna because they offer richer benefits at lower costs.

Stay tuned for more.

Health Care Reform Individual Mandate In Jeopardy

by Tim Thompson

The initial arguments in the Supreme Court hearings about the individual mandate seem to indicate that the mandate will not be accepted. The general tone of the discussions had the 4 liberal Justices supporting the mandate, and the 4 conservative Justices against the mandate. Judge Clarence Thomas sat quietly and listened to the proceedings but did not ask any questions or make any comments. It is believed that Judge Thomas will not support the mandate, thus giving a 5 to 4 advantage to overturning the mandate.

The next step is to determine if the individual mandate can be severed from the remainder of the Affordable Care Act, and those discussions are underway. Without the mandate the ability to provide health insurance to everyone will not happen.

Stay tuned for more.

Supreme Court Begins Hearing Health Care Reform Arguments

by Tim Thompson

Yesterday the legal boxing began with the first round being about the Anti-Injunction Act (AIA) of 1867, and whether or not the court could actually hear arguments about the health care reform individual mandate if no penalties (paid to the IRS) had been paid yet. The AIA is the legal basis of all tax collections, and says that you have to pay the tax before you can challenge the tax in court. From the sounds of the arguments in the Supreme Court hearing yesterday, it appears the AIA is a non issue for the rest of the week’s health care reform arguments.

Today the Supreme Court will be hearing the first arguments about the ability of the federal government to impose an individual mandate to buy health insurance on all citizens.

Stay tuned for more.

California Hospitals Taking Action Before Health Care Reform Kicks In

by Tim Thompson

Hospitals all across America are struggling to find ways to reduce costs and eliminate duplication of efforts. These cost cutting measures are part of the hospitals preparation to survive once health care reform fully begins in 2014.

In California, hospitals are trying to figure out how to make due with fewer patients, because the amount hospitals will be paid for providing medical services will be based upon keeping patients from returning to the hospital. This is a whole new world for hospital administrators, and on top of that they face significant cuts to Medicare and Medicaid, which make up over 50% of California hospital revenues.

Let’s hope the hospitals figure this all out, because it would be a shame to only have a couple of hospitals left a few years after health care reform starts. That would cause the ultimate access to health care restriction horror scenario.

Stay tuned for more.

New Health Care Reform Tax Will Raise Costs For Everyone

by Tim Thompson

A new report by the actuarial firm Millman Inc. says that a new tax on health insurers’ premium revenues will be passed on to consumers, and will cause problems for state Medicaid programs.

The health care reform premium tax, which starts in 2014, was intended to help pay for coverage of the 32 million uninsured Americans, and will be paid by all health insurance companies. But under federal law, the state and federal governments have to pay the tab for their Medicaid programs. States typically pay about 36% of the Medicaid costs, and this new tax will be paid out of each States’ already strained budget.  The Medicaid program provides medical coverage for about 60 million low-income families.

So let’s see, there’s a new tax on health insurance that we will have to pay because insurance companies will pass the tax on to us in increased premiums, AND, the tax that is paid on the Medicaid program expenses (which we already pay through our state and federal income taxes) will have to be paid by state and federal government revenues (aka our taxes).   Hmm….Sounds like we get hit with the full cost of the “health care tax”.   Who’s bright idea was that!   Oh yeah…our government.   Brilliant!

The insurance industry trade group (AHIP) said that they believe consumers should be exempt from this tax that increases health care coverage costs. I agree.  Especially since the goal of health care reform was to keep health costs from climbing out of control.

Stay tuned for more.

The Feds Slap California’s Hand Over Medi-Cal Copays

by Tim Thompson

Governor Brown’s plans to charge low-income patients for medical care they receive through the Medi-Cal program were rejected by Federal health officials. The copays were part of Governor Brown’s budget balancing “act”, and it was hoped that the state would save $296 Million by having poor people make co-payments. Over 8 million are in the Medi-Cal program, and many are children or elderly people.

The budgetary plan was to have physicians and hospitals collect the copays, and make the decision to deny coverage if the copays were not made. Medical providers complained that this was a “back-door” cut in reimbursement rates, because the providers would not want to “refuse” coverage for people that could not afford the copays.

Legislative advocates applauded the Federal health officials, and warned that imposing copays on poor people would worsen the problem by making them avoid the health care system entirely, until an emergency occurred. Thereby driving up costs.

Stay tuned for more details.

To Get Affordable Health Insurance Californian’s Have Choices

How much someone, or a company, is willing to spend is what determines how easy it is to find an affordable health insurance plan. A few individuals might just buy an expensive comprehensive plan that costs hundreds of dollars a month, but most would prefer to find a plan that costs a lot less. The more benefits you want a plan to have, the more the plan will cost. Therefore, someone wanting the most benefits would buy a comprehensive plan at high cost, while another would opt to get a high deductible plan at much lower expense. As luck would have it, the San Diego health insurance industry has a multitude of options that will appeal to consumers of every income level. So there is an affordable health insurance plan available that will fit the need and finances of every person.

When looking for affordable health insurance San Diego citizens must first do a little research to determine what their plan options are. A few Google searches should provide the necessary information. Using the new found information, and combining it with a good picture of what medical benefits are needed, will help people pick the right plan.

Care must be used during the search process to prevent falling into the lair of affiliate marketers. Usually affiliate marketers won’t tell an out and out lie. But they can leave out important information about plans that people should know, and they can sell people’s contact information to multiple agents if they’re not careful. Therefore it’s a good idea to request written information, or brochures from an insurance company, before buying a health insurance policy. As a lawyer would say, “the devil is in the details”, so reviewing the plan information is an important step. At the same time, you should look for any hidden meanings in the plan documentation and the website privacy policy, to prevent surprises later on.

Is a cheap plan always an affordable health insurance plan? Many times it’s not. Some cheap plans are so cheap that you end up paying out of your own pocket for everything until you reach a very high deductible. As long as you never need to use the plan, it’s affordable. But if something happens, It will seem like you have no insurance at all. So weighing the pro’s and con’s of this can factor into the choice of what’s affordable to you.

Along with the affordability of the plan, most people also want the plan to offer a good value for the price. This means comparing health insurance plans with similar benefits and selecting the plan with the lowest cost, while keeping in mind what benefits you’ll actually use in a typical year. Plans that offer more benefits than you’ll use can be a better choice if they cost the same, or less than a plan with only the benefits you want.

When looking for affordable health insurance San Diego people could face a number of challenges. One of those is that health insurance plans can be confusing with all the options and benefits. Relying on good San Diego health insurance brokers is the best way to get the necessary information and recommendations that you need in order to make a good decision. Using this information, you can then focus your efforts on just a few plans and pick the one that best fits your specific needs and budget.

San Diego Dental Insurance: 6 Tips To Find The Best Plan

by Tim Thompson

Millions оf Californian’s dо nоt hаvе аnу dental insurance, and that includes people in San Diego. That’s pretty sad. You see people every day that have some sort of dental issue that’s never been fixed. By the age of 50, the average person is missing four to five teeth, with higher numbers living in the valley, or in inner cities. Occasionally the loss is due to accidents or injuries, and for some it’s because they don’t have San Diego dental insurance. Other times it’s a result of people not taking care of their teeth.

Dental Insurance San DiegoTo maintain your overall health, taking care of your teeth is vital. After all, it’s your body and it’s the only one you’re going to get, so you’d better take care of it. When I get up in the morning I try to brush my teeth first thing because my breath tastes like road pizza. However, just before bedtime, I have a harder time remembering to brush my teeth. And just before bed is the best time to brush. Му mouth stіll tastes fine frоm dinner but іt wоn’t bе long bеfоrе thе bacteria starts tо feed оn іt аnd іt will taste awful. Nobody would want to kiss a mouth that smelled terrible, would they? Νоt mе. Therefore I make sure to brush and floss before going to bed. Іt mаkеs mе feel better аnd еvеn mоrе lіkе loving.

When shopping for dental insurance San Diego residents need to keep these five items in mind. It’ll make you happy once you’ve got a plan set up and start taking care of your teeth.

First, consider the price of the plan. Саn уоu afford thе payment? Does the plan have a monthly premium, a yearly premium, or a single payment?

The second item to consider is your location. Іs thеrе а dentist nеаr уоu thаt accepts thіs раrtісulаr San Diego dental insurance plan? Dentists usually accept only a handful of dental plans.

Third, consider what dental benefits or services would you actually use. Most people should have their teeth cleaned twice a year by a dental hygienist. Getting an annual checkup, so a Dentist can catch any issues before they become major problems, is a good idea. These are the basic services you’ll use every year. Will thе plan уоu аrе considering include thеsе fоr free? Оr аt а discount?

Number four on the list, is to check if the dental insurance plan has a cap on the maximum benefits allowed during each year?  Will your expected dental care fit within this cap during most years?

Fіfth, whаt will thіs San Diego dental insurance cover? Are there restrictions on some services? Whаt percentage will уоu hаvе tо pay up-front? How much will you have to pay up front to the Dentist?

Sixth, look to see if the dental insurance plan has a waiting period before you can receive corrective services.  Many PPO dental insurance plans will make you wait 6 months, or up to 12 months before you can get benefits for corrective issues like cavities, root canals, and crowns.  Will you be fine through the waiting period without getting major dental benefits?

These are all great points to consider when you are going to spend your money to maintain your good health. Taking care of your smile by brushing, flossing, and having regular dental checkups means you shouldn’t have to worry about cosmetic dentistry. To get dental insurance in San Diego people just need to plan ahead for their own wellbeing.

Image: digitalart /

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