What You Need To Know About California Health Insurance

The SPF Mashup is a collection of note-worthy articles, reports, and information that have come out in the last months, and will have an impact on your health insurance and your health. The last month has been filled with health insurance changes in California that will take effect in 2016 or 2017.  Here’s what you need to know about health insurance changes in California.  Three sections are about changes that will effect the rates we see in 2016. The fith section is for those of you over the age of 65. The last section is a MUST READ piece for everyone. Quick Snapshot (click onRead More →

Qualifying Life Events For Health Insurance Changes

Now that the annual health insurance open enrollment period has closed you can not change your health plan unless you have a qualifying life event. There is a list of 12 total qualifying life events, but many of them occur very infrequently. Of the remainder, some are more common, and we’ll show how you can use these to create a special enrollment period that allows you to change or get new health insurance coverage. The 3 easiest qualifying events to use are: Involuntary loss of Minimum Essential Coverage New resident of California due to permanent move, or a resident moving to a location where newRead More →

cigna health insurance california 2015

  In 2013, Cigna Health Insurance enabled you to sign up for their non-Obamacare plans and avoid having to sign up for a Health Care Reform health insurance plan until 2015. This was a great strategy to keep your health insurance costs lower in 2014. Unfortunately, we are nearing the end of 2014, and your Cigna health insurance plan is ending December 31. Here’s the best alternative health plans to replace your Cigna coverage. Where do you go to get answers? How do you make the decision? Which is the right plan for you? The answer to those questions are based on three specific things.Read More →

Open Enrollment In California Lasts until Feb 15 2015

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

Anthem Blue Cross logo - Open Enrollment 2015

By now, you’ve received your letters from Anthem Blue Cross telling you what your 2015 rates are going to be. Depending on your experience this year, and the rate change you got, you may be asking yourself, “is there a better plan for me?” We’ll show you what steps to take to make sure you get through the California open enrollment period with the least amount of hassle. As a starting point, some of the information in the letters was incorrect. The subsidy income qualification levels should have been, “modified adjusted gross income of $16,105 to $46,680 or $32,913 to $95,400 for a family ofRead More →

Don't Be Puzzled By The 2015 Open Enrollment Period

The next open enrollment period begins on November 15th and ends on February 15th, 2015. During this period you can choose to stay on your current plan, move to another plan, or enroll in health insurance for the first time. For the 2015 Open Enrollment Period in California there are many changes taking place, and you need to be aware of the following: Changes to health plans. a. Health plan benefit changes. b. Standardization of all health plan names. c. Health plans that are going away. d. Rate Changes. Timeline for open enrollment changes. Covered California renewal process. a. Required income verification authorization. b. RequiredRead More →

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

Your new Obamacare health insurance plan is now in place, congratulations. Do you know if you choose a good plan? Are your prescriptions covered? Does your doctor take your plan? Now is the time to find out, because you won’t be able to change your plan after March 31, 2014. Make Sure Your Doctor Takes Your Obamacare Plan The simplest way to test your Health Care Reform insurance plan is to get an annual physical and refill an existing prescription. The annual checkup will require setting an appointment to see your physician, so you will be able to determine if the doctor is in yourRead More →

Covered CA Cancelled Your Policy

  By now, everyone in California has received a letter telling them that their health insurance plan is being cancelled on December 31st. However, the Affordable Care Act (ACA) does not say that all these plans have to be cancelled at the end of December. Why then is your health insurance plan being stopped? President Obama has said many times, “If you like the plan you currently have, you can keep it.” After the cancellation letters arrived, the administration changed the story and justified the cancellations because the cancelled plans offered “poor coverage.” In many states this may be true, but in California our healthRead More →

Covered CA Exchange Home Page

  On Tuesday October 1st, the Obamacare enrollment period began. Health insurance exchanges across the US opened their doors and begin accepting applications for coverage to start on January 1st, 2014. In California, the exchange, called Covered CA, has spent $80 million promoting itself for the last month and encouraging consumers to enroll once it opens. Is it really going to be that easy? Probably not. There are a number of key things that are missing on day one of health care reform. Some are critical for the success of Obamacare. The missing pieces are: Only a limited number of insurance company plans have beenRead More →

United HealthGroup Leaves California

  The second domino in a linked chain has tipped over. Two weeks ago Aetna announced its departure from California’s individual and family health insurance market, and yesterday UnitedHealth Group, Inc (parent of UnitedHealthcare) announced that UnitedHealthcare (UHC) is leaving California. With UnitedHealthcare leaving California, about 8,000 members will need to get new health insurance before December 31st, when their UHC coverage ends. In this article, we’ll show you the best replacement health insurance plans from the remaining California insurance companies. In California, UHC provided individual health insurance through their Golden Rule subsidiary using the brand name UnitedHealthOne. Golden Rule was created by UHC overRead More →

natural childbirth - Midwife

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

Health Care Reform Is Confusing

  In the last few months we’ve seen a lot of Health Care Reform rules and regulations being introduced by the Health and Human Services Department. Every time that happens, the media gets hold of it and all kinds of articles are written in the Wall Street Journal, the New York Times, and the TV network news programs talk about it. All the analysts start talking about the pros and cons, and what it means to businesses and individuals. The problem with this is, many times one writer looked at the regulation, and wrote a piece about it. Then other writers start using pieces fromRead More →

Barry asks about grandfathered health insurance plans

Recently we’ve been speaking to a number of you that have old health insurance plans that you’ve stayed with for ten or more years.  These older plans are known as “GrandFathered Health Plans” by the Affordable Care Act (ACA), and have special exemptions with respect to ObamaCare.   The dilemma you are currently facing is what to do about the large price increases you’re about to experience.  Should you stick with the grandfathered health plan or change to a lower cost health insurance plan?  We’ll cover the tradeoffs between staying or switching plans, review the changes that have occurred, and give you our recommendations inRead More →

Health Plan Rate Increases Due To Health Care Reform

  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, LisaRead More →

Looking To The Future

This information is outdated now. SEE THE NEW Obamacare MATERNITY INFORMATION HERE. It’s the beginning of the New Year, 2013, and many changes are going to happen this year. The first of the changes involves the maternity plans in California. When getting maternity insurance, California mothers want to be able to minimize the costs of the pregnancy and the delivery. But mothers also want to be able to see the doctor they are comfortable with. So most mothers-to-be will select a PPO plan before they get pregnant. At SPF Insurance, we specialize in maternity coverage, so we spend a great deal of time analyzing allRead More →

Tweet Finding Affordable or No Cost Insurance For Your Child Every child needs dependable health insurance.  However, not all parents can afford the full cost of private medical insurance.  As a result, there are a variety of programs offered by the state of California and private organizations that can provide health care to financially strapped families.  Through these programs, there should be no child in California that doesn’t have health insurance. In the sections below we will give an overview of the child health insurance programs that are available in California.  Some of these plans provide complete coverage for children at no cost, and othersRead More →

Tweet What Do We Do About Health Insurance After Having A Baby? Bringing a new baby into the world is an honor and a joy, so first off we want to congratulate you on that. Within those first 30 days there are big decisions to be made and what we’re going to do is give you a look at how choosing the right California health insurance after having a baby can be simpler than you might expect. The key to being empowered to make the best decision for your family is understanding your options, knowing what steps to take, and that’s what SPF Insurance willRead More →

Tweet New Series Of Six Articles Discussing California Baby Health Insurance Today SPF Insurance is introducing the first of six new pages and posts dealing with baby health insurance, and child health insurance. The first is a new page titled “How To Get Health Insurance For My New Baby?“. This page provides new mothers and fathers with the information they need to be able to transition their newborn from being covered on the mother’s plan to having it’s own plan. We cover the various options that are available, and the time frames in which decisions have to be made. The purpose of the page isRead More →

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

Tweet Aetna was one of the major insurance companies that did not offer maternity coverage in California until July of 2012.  On July 1st, a new California mandate began and required all plans offer maternity and autism care.  As a result of this, Aetna added these benefits to their existing plans and increased the rates slightly. Aetna announced they are leaving California individual and family health insurance marketplace at the end of 2013. Go here to learn about good Aetna health plan replacements. If you are looking for maternity coverage, the Aetna plans are not a good choice because of their higher deductibles. Click thisRead More →

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

Tweet Most Californians will probably see higher prices for their health insurance.  Whether it be through their company insurance plan, or their own individual and family health insurance plans.  The price increases come in the form of a letter received just before a birthday, and potentially every quarter.  California health insurance premiums go up each year, just like the sun rises each morning.   Insurance Costs Rise, But More Slowly   Annual family health insurance premiums rose about 4 percent to $15,745 in 2012, according to the latest survey by the Kaiser Family Foundation and Health Research and Educational Trust Now that's a fairly modest increase by historical standards, andRead More →

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

Tweet 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.Read More →

Impact on families and individuals

Tweet     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, UCRead More →

Tweet   The state of California required all health insurance companies to include coverage for maternity and autism beginning July 1st.  Anthem Blue Cross offered these benefits in only a handful of their plans, so they made changes to the rest of their health insurance plans to include these new benefits.  The net effect of these changes is that Blue Cross raised the rates on most plans in May to account for the July benefit changes, and dropped a few plans. The Anthem Blue Cross portfolio of plans is very diverse and includes lower cost plans for rate conscious consumers as well as full featured plansRead More →

SPF Insurance provides information to our clients to solve health problems and insurance problems. The classes offered by Palomar Health can help you understand what your options are and help you maintain your health. We encourage you to explore their upcoming classes and sign up for those that appeal to your needs. If this is helpful, tell your friends about it! Tweet   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 :Read More →

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

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

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 TopRead More →

Our newest resource page with information and reviews about Short Term Health Insurance (or Temporary Health Insurance) plans has been officially launched this morning and is now live and ready for use. Short term plans are typically used when someone knows there will be a gap in insurance coverage of less than 12 months.  A typical example of this is when someone changes jobs and their new company insurance plan doesn’t start until after they have been with the company for 3-6 months.  These new employees can set up a short term plan that will last until the day the new company plan starts. SomeRead More →

Health Net has introduced a new family 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 seeRead More →

Blue Shield of California this week disclosed the new health insurance plans they will offer beginning on July 1st. These plans will replace all but 4 of the company’s current plans, and will add maternity care and mental health therapy for Autism. The only existing plans that will continue to be offered after July 1st are the Spectrum PPO 5000, Spectrum PPO 5500, Access+ HMO, and the Access+ Value HMO. Blue Shield of California Plan Overview The new replacement plans are the Shield Secure Plus PPO, Shield Secure PPO, Shield Wise PPO, and the Shield Saver plans. Each of these plans offers similar benefits withRead More →

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

A new study, by Medicare Trustee Charles Blahous, shows that the original projections by the Congressional Budget Office (CBO) and the Medicare Trustees compared the Affordable Care Act (ACA) cost and savings projections to a baseline scenario that is different from what we actually face. This new analysis caused a great deal of criticism, but some experts argue that the report projects a distressingly accurate snapshot of the effects from the ACA. Over the first 10 years of the ACA, government spending would be increased by over $1.15 Trillion, and this initial increase in federal deficit spending was hinted at by the CBO during theRead More →

Governor Jerry Brown’s administration is planning to implement some parts of the Affordable Care Act (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.Read More →

Consumer Watchdog, a special interest group with strong ties to trial lawyers, is gathering signatures to put a health insurance rate regulation measure on the November 2012 ballot. The measure seeks to create a new bureaucracy, funded by insurance companies, to create a new layer of regulations on top of existing state and federal regulations to control health insurance rates. Physician groups, hospitals, doctors, and small businesses announced the launch of Californians Against Higher Health Care Costs (CAHHCC) to combat the Consumer Watchdog efforts. C. Duane Dauner, president/CEO of the California Hospital Association says that “Consumer Watchdog’s ballot measure is full of false promises andRead More →

According to the California Endowment, a private foundation concentrating on health issues, the average California family pays an additional $1400 in yearly premiums in order to cover the costs of uninsured Californians. And because the Federal Supreme Court may throw out the mandate provision of the Affordable Care Act, the state of California is preparing to go it alone on some parts of health care reform. The new child health insurance laws and the required California maternity insurance coverage mandate will stay in place, while work on the California Health Benefit Exchange — a website to help consumers find and purchase health insurance once 2014Read More →

With the beginning of April it becomes time to start running quotes for individual and family health insurance rates with a May 1st effective start date. The new rates and changes that Anthem Blue Cross of California announced in March now become very evident. Many Anthem customers that have older health insurance plans have seen their rates finally reach the “pain threshold” and as a result they are looking for lower cost alternatives. My quick assessment, from the first half dozen quotes I’ve run, is that Anthem has given up a huge chunk of their lead over the other individual and family health insurance companiesRead 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 AffordableRead 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 SupremeRead 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.Read 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 strainedRead 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 wouldRead More →