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 on item to go to that piece)

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

Bill Would Make Pregnancy a Qualifying Event for Covered California

pregnancy as qualifying event in California“California lawmakers are advancing legislation to add pregnancy to the list of so-called 'life-qualifying events' allowing people to buy health insurance outside the regular open enrollment period.” http://www.californiahealthline.org/articles/2015/6/5/bill-would-make-pregnancy-a-qualifying-event-under-covered-calif

Read more here: http://www.sacbee.com/entertainment/living/health-fitness/article23124087.html#storylink=cpy

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

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

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

New Preventive Services Are Added To 2016 Health Plans


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

Read more here: http://www.npr.org/sections/health-shots/2015/06/05/412257783/more-preventive-health-services-approved-for-no-cost-coverage#storylink=cpy

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

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

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

Covered California Prescription Drug Cap Changes 2016“A new decision by Covered California to adopt a policy that helps customers pay for high-cost speciality drugs sparked hope for an expanded state law that could assist thousands with HIV, diabetes, multiple sclerosis and other chronic illnesses, health advocates say. Under last week’s policy change, a first in the nation, those who bought health plans through Covered California, the state’s health insurance plan exchange, will see their specialty drugs capped at $250 per month per prescription. Overall, the caps will range from $150 to $500 and were crafted to help reduce the monthly out-of-pocket costs for enrollees.”  http://www.dailybreeze.com/health/20150524/covered-californias-prescription-drug-price-cap-may-open-doors-for-thousands

Read more here: http://www.dailybreeze.com/health/20150524/covered-californias-prescription-drug-price-cap-may-open-doors-for-thousands#storylink=cpy

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

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

“Of the estimated 575,000 Americans who used at least $50,000 in prescription medicines last year, about 139,000 used at least $100,000 worth of medication, nearly triple the 47,000 who hit that mark in 2013, the report said. The total cost to health plans for U.S. patients with prescription drug expenses in excess of $50,000 was $52 billion in 2014, Express Scripts said in its report: “Super Spending: Trends in High-Cost Medication Use.” http://www.reuters.com/article/2015/05/13/usa-pharmaceuticals-costs-idUSL1N0Y22WY20150513

Read more here: http://www.reuters.com/article/2015/05/13/usa-pharmaceuticals-costs-idUSL1N0Y22WY20150513″ target=”_blank”>http://www.reuters.com/article/2015/05/13/usa-pharmaceuticals-costs-idUSL1N0Y22WY20150513#storylink=cpy

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

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

California May Allow Undocumented Immigrants To Enroll In Covered CA

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

Read more here: http://www.sacbee.com/news/politics-government/capitol-alert/article22904433.html#storylink=cpy

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

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

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

Will Your Medicare Advantage Plan Survive?

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

Read more here: http://healthaffairs.org/blog/2015/06/04/how-medicare-advantage-plans-can-thrive-in-a-winner-take-all-market/”>Credits: How Medicare Advantage Plans Can Thrive In A Winner-Take-All Market#storylink=cpy

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

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

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


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

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

How to be a good California health insurance shopper“We’ve assumed, he says, that cancers are all like rabbits that you want to catch before they escape the barnyard pen. But some are more like birds—the most aggressive cancers have already taken flight before you can discover them, which is why some people still die from cancer, despite early detection. And lots are more like turtles. They aren’t going anywhere. Removing them won’t make any difference.
We’ve learned these lessons the hard way. Over the past two decades, we’ve tripled the number of thyroid cancers we detect and remove in the United States, but we haven’t reduced the death rate at all. …(Meanwhile, the number of people with permanent complications from thyroid surgery has skyrocketed.) It’s all over-diagnosis. We’re just catching turtles.” http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

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

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

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