San 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…
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.
There’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.
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.
Conclusion
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.
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 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…
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.
Looking To The Future
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.
Finding Affordable or No Cost Insurance For Your Child
Happy Baby © coloniera2
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
Medi-Cal
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: http://ca.db101.org/ca/programs/health_coverage/medi_cal/program.htm
Healthy Families
The 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: http://www.healthyfamilies.ca.gov/HFProgram/Income_Guidelines.aspx
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: http://www.dhcs.ca.gov/services/chdp/Pages/ProgramOverview.aspx
Children’s Health Initiative (CHI)
Coverage Map 2012
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: http://www.ihps-ca.org/localcovsol/cov_initiatives.html
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: http://www.dhcs.ca.gov/services/ccs/Pages/default.aspx
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.
- 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.
- 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.
- If neither of the steps above works, then you should contact your local Medi-Cal office from the list provided here: http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx. Medi-Cal will be your lowest cost solution, so start with this program
- 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
http://www.healthyfamilies.ca.gov/HFProgram/Income_Guidelines.aspx Medi-Cal/Healthy Families Income Guidelines
http://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx Medi-Cal Program
http://www.ihps-ca.org/localcovsol/_pdfs/WebsiteTableDocument_040607.pdf 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?
What Do We Do About Health Insurance After Having A Baby?
Mom & Baby @Boetter
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
Small 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.
Time to Ponder
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.
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.
Thanks,
7 Keys To Caring For Your Newborn
Baby examines Doctor
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
Well Baby Visit
- 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.
Thanks,
New Series Of Six Articles Discussing California Baby Health Insurance
Happy Baby © coloniera2
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:
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.
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.
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.
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.
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.
The 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.
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 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.
Summary
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.
The 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.
Summary
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.
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 StateHealthFacts.org, Californians have the 2nd lowest monthly cost for health insurance at $157, and Massachusetts has the highest premium at $437.
http://www.statehealthfacts.org/comparemaptable.jsp?ind=976&cat=5
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.
When 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
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. 
My 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.
http://health.usnews.com/health-insurance/california
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 healthcare.gov.
All 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 Healthcare.gov 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.
If 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
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.
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.
CoreGuard
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.
ClearProtection
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.
SmartSense
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.
Premier
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.
Summary
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
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 20 | 6-7:30pm |
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…
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
http://www.marchofdimes.com/pregnancy/complications.html
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
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
- Adds a “fee” on health insurance companies to pay for reform costs – this will get passed on to consumers
- Adds a tax on the sale of any medical device to pay for reform costs – this will raise consumer costs
- Adds a “fee” on pharmacuetical companies to pay for reform costs – this will increase drug prices
- 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
- Reduces plan choices to only 5 options, each of which requires more benefits than today’s low cost plans – thus increasing premiums consumers pay
- 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
- Greatly expands Medicaid* enrollment by 17 million people – thus increasing federal and state spending, and therefore the taxes we pay
- 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
- 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
- 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 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
- Allow families to keep children on their health insurance plan until age 26
- It reduces the price difference in plans for younger people and older people – thereby reducing the costs for older people
- It encourages businesses to create employee wellness programs to improve employee health
- No Cap on the medical benefits that can use if needed
- It reduces the Medicare prescription donut hole for drug costs
- The number of health plans to choose from is reduced to 5 – fewer choices should make it easier to choose
- Government will help lower income families pay for health insurance – through subsidies and credits (more about this in an upcoming post)
- All preventive services are free – promotes taking care of ourselves by getting annual checkups
- It forces the health care industry to shift from “caring for the sick”, to “keeping people healthy”
- 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.
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:
College students or recent graduates
Individuals not yet eligible for Medicare coverage
Individuals waiting on approval of major medical coverage
Individuals no longer eligible on parents’ plan due to age or status
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.
of 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 Plan Overview
The new replacement plans are the Shield Secure Plus PPO, Shield Secure PPO, Shield Wise PPO, 
and 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?
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
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.
(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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
To 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.
In the search to find good maternity insurance California mothers have found fewer options to choose from over the last few years. However, new mandates in 2012 will require that all health insurance plans in California provide maternity health coverage. Both the Individual/Family plans as well as the Group plans will be affected by these new rules, which take effect on July 1st, 2012.
Senate Bill SB222 by state Senator Noreen Evans, and Assembly Bill AB210 by Assemblyman Roger Hernandez, were both signed by Governor Jerry Brown on Oct 6th. These two bills require that every health insurance plan offered in California must provide maternity insurance coverage. This change will reshape the maternity health insurance marketplace in California by expanding the health insurance options that are available.
Forced To Provide Maternity Insurance California Could Lose Insurance Companies?
Currently there are 23 California maternity health insurance plans offered by the major insurance companies. That’s out of a total of 164 individual & family health insurance plans, so only 14% of the individual health insurance plans offer maternity coverage. Anthem Blue Cross, Blue Shield of California, Health Net, and Kaiser Permanente, and PacifiCare/UHC are the primary insurance companies that offer a few individual maternity plans. Aetna and CIGNA do not offer any maternity insurance California plans, so it will be interesting to see whether they leave the market in this state, or put maternity coverage into their plans.
Adding maternity coverage to all health insurance plans is also part of the Health Care Reform package that is scheduled to take effect in 2014, so California is simply accelerating the time schedule. Blue Shield of California and Kaiser Permanente supported the legislative change. Blue Shield believes that maternity coverage should be a core benefit of health insurance, so the costs of prenatal care and delivery are spread across everyone, instead of just families wanting children.
So far there has been no word on how this change will effect the rates of health insurance plans in 2012. However legislative analysis of the provisions show an average increase of just under $7 per policy. This projection does not come from the insurance industry, so the actual increase is still unkown.
The state government will probably be the biggest beneficiary of these new rules, and should save millions on reduced expenses in the Medi-Cal and Access For Infants and Mothers (AIM) programs. These joint federal and state programs are the insurer of last resort for many California mothers that have no maternity health insurance. It is expected that more un-insured mothers will be able to afford maternity care after SB222 takes effect next year.
All this being said, there is still one glaring hole still left unfilled. The insurance companies do not have to provide health insurance for pregnant women in individual health insurance plans, and SB222 and AB210 do not change this. So planning to have a baby is still important. That way the family can get the necessary maternity coverage before the pregnancy happens. If not, then the California Pre-existing Condition Insurance Plan will continue to be the only insurance option for a self employed pregnant woman.
Find an update to the best California Maternity Health Insurance plans, with the most recent price changes from the major Insurance Companies on the California Maternity Health Insurance page.
Notable changes were a price increase for the Blue Cross Select HMO and a price reduction for the Kaiser Permanente 0/1500 Deductible (HSA) plan. Overall the order stayed the same, but the Kaiser plan is now even further ahead of the rest of the California maternity health insurance plans.
The end result of the analysis is that the difference in total cost between the best California maternity health insurance plan and the fifth best plan has grown to $4498.
The Featured Class in October is :
Breast Health 101
Tuesday, October 25
| 5-6pm | Exhibits and Screenings |
| 6-7:30pm | Class |
Jean McLaughlin Women’s Center
15611 Pomerado Road
Poway, CA 92064
October is Breast Cancer Awareness Month, are you up to date on the latest prevention, detection and treatment options? Join us for refreshments, exhibits and FREE health screenings followed by an informative class led by breast cancer surgeon Elizabeth Revesz, M.D. Don’t miss this opportunity to learn what’s best for your breasts!
FEE: Free-registration required
To register, call 800-628-2880 or visit Class Registration where you can see all the classes offered in October
Between 2007 and 2009 the number of uninsured women increased by 12.8%, and the March of Dimes PeriStats database shows that 22.3% of women in their child bearing years are uninsured. So it’s not uncommon to be pregnant without health insurance in the US, and the situation has been getting worse each year. For women who are pregnant, no insurance means they have to bear the full cost of prenatal care and delivery, which can total $12,000 to $20,000 depending upon where you live and the
type of delivery you have. These costs make getting health insurance for pregnant women a priority.
No matter what your income level is, there are ways to get insurance for pregnant women. The 2 options to look into are your state Medicaid programs, and then the Pre-Existing Condition Insurance Plan (PCIP).
The PCIP is offered in all 50 states, and this federal program provides affordable health insurance to people that have been unable to get medical insurance. For women that are pregnant without insurance, the PCIP can be a just what you need.
The best news about the California PCIP is that it offers a rich set of benefits at affordable prices. The pre-existing condition insurance plan California has a $1500 deductible, $25 office visit copays, both generic and brand name prescription coverage, and a maximum $2500 out of pocket limit. To qualify for the PCIP California plan you need to have been declined by an insurance company within the last 12 months, and be uninsured for 6 months. For more information about the cost of the program, how to enroll, and how to get the simple application, women that are pregnant with no insurance in California should visit the PCIP California page so they can protect themselves and their baby.
Comparing the PCIP to other Maternity Health Insurance plans, shows the PCIP is the 3rd best maternity insurance plan in California. The best pregnancy health insurance plan is the Kaiser Permanente 0/1500 HSA plan with a total out of pocket (TOOP) cost of $4854, the 2nd best plan is the Kaiser $50 Copay plan with a TOOP of $5064, and the PCIP is 3rd with a TOOP of $5068. The best plan from the other 3 companies that offer maternity insurance plans is the Anthem Blue Cross Select HMO plan with a TOOP of $7570.
Visit “California Maternity Health Insurance Plans Analyzed” to learn more about the analysis mentioned above.
There is no reason to worry about getting pregnancy health insurance if you are pregnant without insurance. Medicaid and PCIP can provide the solution to get health insurance for pregnant women in California. Go ahead and get started today figuring out what plan is best for you. Call the state Medicaid office, and then get information about your state Pre-Existing Condition Insurance Plan California.
SPF Insurance is proud to announce a new resource page targeting the needs of women in California who are pregnant without insurance. This new page, “Health Insurance For Pregnant Women,” provides information on 7 ways that women who are pregnant without health insurance can find coverage to help protect themselves and their babies.
The number of uninsured pregnant women in California has continued to climb, so it’s important that solutions be created to ensure that the health of these women, and their babies, is strong and that these newest state residents start off on the right foot — happy, fit, and ready to grow and thrive.
This website focuses on providing information that visitors can use to make good decisions about their health care, and we are committed to helping Mothers-to-be get the care they need. The Health Insurance For Pregnant Women page provides background and details about group health insurance options, state government programs, discount plans, and highlights a provision of the Accountable Care Act, the Pre-Existing Condition Insurance Plan California (PCIP California).
PCIP California will enable women who are pregnant without insurance to finally have the quality of care they need to deliver healthy babies. It’s a great plan, that’s priced attractively, and should gain thousands of new enrollees in the next year.
So check it out, and be sure to leave your comments!
The federal government, which pays most of the cost for this program, just gave California permission to lower the rates on the insurance plan by up to 24%. The Pre-Existing Condition Insurance Plan California (PCIP California) was created as part of the Health Care Reform Bill last spring, and serves Californian’s that have been denied regular health insurance because of health conditions. This little known plan serves as a safety-net insurance plan for the uninsured.
The rate reduction will take effect on Oct 1st, and the hope is that this will encourage more uninsured people to enroll in the plan. The 3500 current plan participants will get 8% to 24% rate cuts depending upon their age and where they live.
My most recent PCIP California enrollee, Darren, a 24 year old in San Diego, will see his premiums drop from $181 to $149 each month, a savings of 17.6%, which is about the average savings across all ages and areas in California. Darren’s $149 premiums gets him a PPO plan with a $1500 deductible, a $25 office visit copay, and a worst case max out of pocket of $2500.
The California PCIP is a great plan for uninsured people because it provides very high benefit levels at a price point below what the major insurance companies like Aetna and Anthem Blue Cross would charge for a plan with the same benefit levels.
The plan is especially attractive for pregnant women that don’t have health insurance. When compared to all the other individual maternity health insurance plans, the PCIP California plan is the 3rd best option. Easily beating out the best plans from Anthem Blue Cross and Blue Shield.
See the California Pre-Existing Condition Insurance Plan page for more details about the plan, pricing, and how to sign up.
Rogue health insurance websites are set up to capture personal information from people trying to get instant quotes, and then the websites sell that information to agents. In the results from 2 Google searches for “Pregnancy Health Insurance” and “Maternity Insurance Plans,” almost 50% of the top 20 results were rogue websites. There are plenty of legitimate health insurance websites to choose from, but you need to be able to distinguish the good from the bad. By hitting the “Get Quote” button on rogue websites, we tell them, “Please have 5-10 medical insurance agents call me for the next 8 weeks trying to sell me a policy”, and “Please sell my email address to other list services and health insurance agents so I can receive their unwanted emails”. I’ll share some easy ways you can recognize these websites before they deceive you.
About 10 years ago, I left the corporate world to start my own business. I needed to set up health insurance for my family so I went online and searched for San Diego Medical Insurance. I figured the top links should be the best ones to visit so I did. I read a little bit of information on the first website, and it said I would receive instant San Diego health insurance quotes by filling out the website’s quote request form, so I filled out the form. When I hit the “Get Quote” button I was sent to a page that told me I would be contacted by 5-8 agents that would provide me with quotes. About 20 seconds later my phone started ringing, and for the next 2 months I received daily phone calls from agents wanting to sell me health insurance. The email barrage was even worse because I don’t think it ever stopped. I eventually had to get a new email address (this was before spam filtering).
What I’ve learned since then are the telltale signs of fake quote websites and how to recognize them quickly. Here is the list of red flags to watch for:;
- The website has Google Ads for insurance – No legitimate California health insurance broker would allow ads for competitive websites to be displayed.
- The website has a link for “Agents” or “Brokers” (scan through all the links including the ones on the top and bottom of the page) – This typically means the site is going to sell your information to the agents/brokers that sign up to use the website’s service.
- Quickly scan the privacy policy, especially the first few paragraphs, to see if they will provide your information to third parties – If so, they plan to sell your information to agents or email list services.
- In California, check to see that the website has an insurance license number (many times this is placed at the bottom of the page) – if not it could be a rogue website or a national company that might not know the specific details of the California health insurance market.
- Look for something similar to the following wording “this website provides a free service and is not an insurer or agent/broker” – this means it is a marketing website that will sell your information to agents or refer you to a national broker for a referral commission (affiliates).
If you don’t see any of the above red flags, and you entered your zip code and pushed the button to get a San Diego Medical Insurance quote, you still need to look out for 3 more red flags on the quote request form:
- Check the Disclaimer at the bottom of the quote request page to see if the website is going to have agents call you.
- The quote request form requires your home address – This is not necessary to provide you with a quote, but will result in you getting junk in your mail box.
- The form asks for the best time to contact you – this definitely means agents will be calling you.
If one of the above 3 red flags occurs you should close that page. As long as you don’t hit the final “Submit” button on the request page, your information should not be saved.
Rogue San Diego health insurance websites are pretty common on the internet, and tend to show up in longer keyword searches. To avoid becoming a phone and email spam victim you need to be careful to ensure you are working with a legitimate San Diego Medical Insurance website. Signs to look for are websites that have Google Insurance Ads, Agent/Broker links, no insurance license, bad privacy policies, or text that says the website is not an insurer or a broker. Following these simple precautions will make your online search stress free.
Since you are already here at SPF Insurance, go ahead and run a comparison quote now by clicking on this Health Insurance Quote link. Your information will be protected and not sold or given to any other company.
Let us know how we can help you.
Maternity Health Insurance Plans Anayzed: What Are Your Out Of Pocket Costs Going to Look Like?
We just added new information on the California Maternity Health Insurance page that will answer all your questions about how much your costs will be during the prenatal care and baby birthing process!
One of the common questions we get from couples planning to have a baby is, “What will our costs be if we use Pregnancy Health Insurance plan ABC?” This new article, Analysis of Best California Maternity Health Insurance Plans covers the detailed cost break down of the five recommended maternity health insurance plans. One of the key parts of the analysis is showing the tradeoffs between paying more for the prenatal and delivery costs out of pocket and less for the insurance premiums, versus paying less for the prenatal/delivery costs and more for the monthly premiums.
One of the surprises is that an HSA plan jumped into the lead as the best maternity health insurance plan. This happened because the updated plan pricing for Kaiser Permanente increased the premium costs of the HMO plans more so than the HSA plans, and enabled the Kaiser 0/1500 HSA plan to take the lead with the lowest total out of pocket costs.
Using the outline of the analysis for the 5 plans that were shown, it is possible to determine what the total out of pocket costs would be for any of the other 18 maternity health insurance plans that are offered in California. If you have any questions about the information, please give us a call and one of our advisors would love to help you.
After a lot of work, We’ve compiled all the California Maternity Health Insurance information into one page on the website. This way it will be easier to find the information you’re looking for and simplify applying for maternity coverage.
While we were compiling the information and adding new content, we realized that there was more information that’s needed to really provide a complete picture for maternity medical insurance, so we’ve put in little notices about the upcoming content to check back for. If you need something that was missed, please post a comment and we’ll respond (and thank you!).
The new California Maternity Health Insurance page link can be found under the “San Diego Insurance Featured Articles” section on the right side of the webpage, or the link above. Let me know if you find the information useful.
Ask someone in San Diego if they should have Medical Insurance, and they’ll likely agree that it’s a good idea. But ask that same person if they’re confident about shopping for insurance and picking out the best San Diego Medical insurance plan and they always say “no”. They say they “don’t understand” health insurance or they “don’t have the time” to find the information, and there’s always something else that needs to be done first.
It could be much easier if they knew 3 simple keys to make shopping for San Diego Medical Insurance a snap. Use an informative website with the tools you need, ask an expert San Diego Medical Insurance broker to get answers to your questions instead of searching, and the most important key, know what benefits you will actually use in a Medical Insurance plan.
There are a myriad of Medical Insurance websites to choose between, but not all of them will be useful in the insurance shopping process. The Insurance Company websites provide good information about their own plans, but nothing about competitors, so they are not useful when shopping for Medical Insurance. In the last few years, thousands of “Affiliate Marketing” websites have been created targeting the Medical Insurance market, and these sites trick the unsuspecting consumer into providing their contact information in order to get a quote, only to then sell that contact information to multiple insurance agents who begin phoning to provide the quotes. To avoid these affiliate sites, look for an insurance license number somewhere on the home page of the website. If you don’t see one, then leave the website. Medical Insurance brokers make up the rest of the websites to choose from. What you want is a website that is located near you (at least within your state), so the information and tools are specific to what is available to you here in San Diego.
Ideally you want the website to be staffed by knowledgeable, independent brokers that can help you if you have questions. If you call a medical insurance company hotline, the support people will know about the companies’ plans and features, but not about plans from other companies. If you call one of the large nationwide brokers you’ll get a person that probably doesn’t know the answer to your local questions and you’ll get bounced from one person to the next. An independent San Diego broker knows what all the major Medical Insurance companies have to offer in your area, and can help you choose between the available health insurance options to get the one that best fits your needs. Use the broker to get answers to your questions, and let his or her experience simplify your effort.
The last key to making it easy to shop for San Diego Medical Insurance is to know what benefits you will use during an average year. So ask yourself how many times you typically go see a doctor, and if it’s only once or twice you can then look in the quote for plans that offer that many office visits and exclude all the plans that offer unlimited visits (the more office visits the plan offers, the higher the monthly premium). Similar questions are do you take brand name prescriptions, do you have a doctor you want to continue seeing, and what is your budget for Medical Insurance costs. Knowing this information makes finding a plan with those benefits much easier.
Everybody in San Diego would rather do anything besides look for Medical Insurance, because it’s not a priority and they don’t know how to make it fast and easy. The keys to this are using a great local website, asking questions of a knowledgeable health insurance broker, and knowing what medical benefits you need. With this information, finding the best San Diego Medical Insurance plan can be quick, painless, and simple so you’ll have more time to spend on the beach.
For everyone that’s looking for the perfect resource to help make San Diego Medical Insurance easy to understand and apply for, the wait is over. The San Diego Medical Insurance page is now live and ready.
This page starts by having you answer 5 questions to determine what benefits you need in your medical insurance plan, then guides you through the medical insurance quote and helps you easily find and compare the insurance plans that match what you outlined in the first step, so you can make the best decision. Then it walks you through the process of applying online, and gives you tips on how to make the application painless.
This resource combines all the information on the SPF Insurance website and puts it into a step by step sequence that’s easy to follow, fast, and makes the process of finding the right medical insurance policy easy. So all the families in San Diego now have a one stop resource. Try it out now, and be sure to leave a comment to let me know how you liked the page. I use the feedback from clients to make tweaks to the website to improve it’s useability, so let me know what you liked and what you think needs improvement.
So stop by to use this page today at: http://www.spfinsurance.com/san-diego-medical-insurance.
There are usually many questions people ask me when they are filling out their health insurance applications. So I’ve created a new article that gives you tips on what to do and what not to do, so that your application is truthful and complete, and presents your health history to the insurance company in a fashion that is most favorable to you.
This should be recommended reading for everyone before they start an online medical insurance application. To see this article go to the Health Insurance Quote Information page and scroll down to the bottom. If you’d like, a shortcut the article can be found in this link: Health Insurance Application Tips. I know this will help a bunch of people that worry about what to say when they’re filling out an application.
An update to this post is now available, with more details and an additional option on the California Maternity Health Insurance page of the website.
The short answer is probably not unless you qualify for one of two exceptions. These exceptions are, join a group health insurance plan at your work or your spouse’s company, or if you have a non-maternity plan check to see if your insurance company will allow you to transfer to a plan that covers maternity care (Blue Shield of CA will allow a transfer to a maternity plan).
If the above options don’t help you, do you have other choices? Depending upon what state you live in, there are government programs to provide care for pregnant mothers to be, so check with your State Department of Insurance to determine what your local options are. In California, there is the state Medi-cal program (Medi-cal is the California version of Medicaid), and the Access for Infants and Mothers (AIM) program.
If you are pregnant and don’t have health insurance, then you should start with Medi-cal first to see if you qualify for coverage through their program. Medi-cal provides a zero-cost health plan for pregnant women that meet specific income limits. Medi-cal is intended to cover families and women that are below the federal poverty level. If you don’t qualify for Medi-cal then apply to the AIM program.
The AIM Program is low-cost health care coverage for pregnant women, and is provided for middle-income families who don’t have health insurance and whose income is too high for no-cost Medi-cal. AIM is also available to women who have private health insurance plans with a maternity-only deductible or co-payment greater than $500. To be eligible for AIM a single mother’s monthly household income must be between $2,453 to $3,679 (there is a table with income ranges for families with other children at http://www.aim.ca.gov/Costs/Income_Guidelines.aspx). The AIM program is funded by the State of California, and although funding is usually available, if the program is filled up, then no additional mothers will be enrolled.
Although health insurance is not usually available after you become pregnant, there are other options that can help. The Medi-cal and AIM programs are designed to provide maternity care to the uninsured mother, so there should be a solution for all mothers to be.
For additional information about AIM and Medi-cal see the following websites:
http://www.aim.ca.gov/AIM_Program/ Information about the AIM program
http://www.dhcs.ca.gov/services/medi-cal/Pages/MCIndividual.aspx Information about Medi-cal
http://www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE_Info_women.aspx Information about the Presumptive Eligibility program to gain access to Medi-cal.
An update to this post is now available, with more details and an additional option on the California Maternity Health Insurance page of the website.
