Health Care Reform In California
Why You Need To Understand Key Parts Of ObamaCare
The roll-out of Health Care Reform is set to begin on January 1st, 2014. This change in the health care system of the United States will affect every American. In California, our politicians have decided to put our state at the vanguard of these changes. So California is creating it’s own health exchange, increased the benefits our Obamacare health plans must provide, and tightened regulations in selected areas.
To prepare for California health care reform, you need to know what the changes are, how they will affect you, and what you can do to position yourself and minimize the impact.
We’ll identify how health care reform will impact individuals and families in the private health insurance marketplace, seniors in the Medicare marketplace, and small businesses owners. Since many of the regulations are unique to each of these marketplaces, we’ve created separate areas that will cover each market below.
We’ll break health care reform into smaller bites that are easier to digest. We’ll leave out the politics and pros/cons discussion and just focus on what you need to know to understand how ObamaCare will impact you, and what you can do to navigate successfully through these changes.
Move your cursor over the images below to preview what’s covered in each topic. Click on the title to go to that page.
What Is Health Care Reform?
To see the full page click here
Health Care Reform is the new name for what health insurance will look like in America starting in 2014. Also known as Obamacare, the Patient Protection and Affordable Care Act was signed into law on March 23, 2010.
Most people are confused about what health care reform is. What it will do to your current health insurance. How it will effect you. In this section we will begin to answer those questions.
We'll cover the purpose of Obamacare, what mandates are, how the subsidies will work, when the California Exchange will be available and what to expect from it, and a timeline showing when everything takes effect over the next several years.
To make it a little more fun, we'll highlight key items in "Jeopardy" answer and question format.
To understand Obamacare you need to know why it was created and what its purpose or goals are. From the earliest speaches Obama made regarding health care reform, he said the primary reasons he was creating it were:
So Obamacare throws out almost everything we have today, and creates a completely new system. The new health care reform program will be rolled out over the next 4 years starting in October 2013 when the health insurance exchanges will begin operating. At that point, the uninsured will be able to enroll to get coverage that will start on January 1st, 2014.
What is health care reform made up of, is kind of complicated. Health care reform is trying to accomplish several different things at the same time. So let's tackle the biggest items first.
How can health care reform provide health protection for everyone when some people have pre-existing health conditions that are expensive and other people don't want health protection because they are young and "invincible"?
The first step is to require that everyone have health care coverage so that premiums from all the healthy people help pay the costs of the few people that have expensive health conditions. Jeopardy Alert: The federal government requires everyone to have health coverage? What is a health care reform mandate?
There are two Obamacare mandates. One for individuals and families, and one for businesses. The mandate says that everyone must have health insurance. If you don't get coverage, then you owe a penalty.
The penalty will be paid to the IRS when you file your income taxes each year. Are you curious how the IRS will know if you don't have health insurance?
Businesses and health insurance companies will report the social security numbers of their members with health insurance. So if your social security doesn't show up, you don't have health insurance.
During 2014, the mandate penalty for individuals and families will be 1% of your Modified Adjusted Gross Income (MAGI), or $95 for an individual and $285 for a family, whichever is greater. Media outlets typically quote the $95 mandate penalty, even though the majority of people will pay 1% instead.
For businesses with 50+ employees, the mandate and penalty have been postponed until 2015. At that point employers with 50 or more full-time employees will be required to offer affordable health benefits to their employees and their families. If not, then the business will have to pay a tax called the Employer Shared Responsibility Payment (ESRP). The ESRP will be either $2,000 or $3,000 per employee that gets coverage with a subsidy.
For more details about the mandate, and examples showing haw to calculate the mandate, click here.
Now that you have some idea what the mandates are and how they will work, let's move on to the next part of Obamacare.
We have to buy coverage starting in 2014, but where are we going to get this coverage from? The Obamacare bill created exchanges where you can comparison shop between plans to find the best plan for your needs. So how are these health care exchanges going to work? And for that matter, what is an Exchange?
The Obamacare health exchanges were created to simplify the process of shopping for health plans. Congress believed that the current process of getting quote online and comparing plans was too complicated. So they decided to create a brand new marketplace and limit the choices to just the approved health care reform plans.
In California, the state government decided to create its own exchange for individual and family plans called "Covered CA," and another to provide group health plans for businesses called the "Small Business Health Options Program (SHOP)". The state is spending $910 million to create these brand new exchanges.
The primary purpose of the Covered CA exchange is to enable people that qualify for subsidies to get lower-cost coverage. The only way to get a subsidy is to sign up for a plan using the exchange. If you get coverage outside of the exchange, then you won't get a subsidy, but you will find additional plans to choose from.
Another thing to be aware of is that the California carriers will only offer policies with a limited network inside the exchange. If you have a doctor you want to keep, you may not be able to use the exchange, and will have to shop outside the exchange to get a policy with the full carrier network.
For more details about how the Covered CA and SHOP exchanges work and how to use them, click here.
Okay, so inside the California exchange there will only be a small set of health plans that the carriers will be offering. What are these plans? What benefits do they offer? How much will they cost?
While crafting the Affordable Care Act, legislators decided that every plan provided by health care reform would need to be more full featured that the majority of plans available prior to the start of the Affordable Care Act. As a result, each of the plans offered after the beginning of 2014 must provide at least the 10 Essential Health Benefits:
Here in California, the state politicians decided to add even more benefits, so all the California plans will also provide coverage for acupuncture.
There will be 5 plans offered in the California exchange:
Actuarial value means that the insurance will pay for that amount of the expected health care costs. For example, buying the Gold coverage means that your policy should cover 80% of all your medical expenses.
Each carrier that participates in the California exchange will offer these plans. However they are allowed to "tweak" their offerings to meet the actuarial value (i.e. for Silver they can offer a policy that provides an actuarial value between 68 - 72%). So not all Silver plans will be identical.
For more details about the health care reform plans, what the benefits look like, and the best use of each metal type, click here.
At this point we now know that there is a penalty next year if we don't get coverage. We know that there will be 5 plans offered in the exchanges. And we know that the exchanges are set up to provide a shopping place for people who can qualify for subsidies.
Jeopardy alert: Answer - Premium reductions in the form of tax credits. Question: What are the Obamacare subsidies? Who qualifies for a subsidy? How much are the subsidies? In the next section we'll explore these details.
The Obamacare subsidy is a tax-credit that will be used to reduce the monthly premium cost of the health care reform metal policies. To qualify for a subsidy, your income must be less than 4 times the federal poverty level.
If you are single, then as long as your modified adjusted gross income (MAGI) is less than $44,280, AND the cost of the metal policy is more than 9.5% of your income, you could qualify for a subsidy. For a California family of 4, as long as your MAGI is less than $92,400, and the cost of your family coverage is more than 9.5% of your MAGI, then you too could qualify for a subsidy.
These subsidies will reduce the monthly premiums you pay for your health coverage. At tax time in 2015, the you and the IRS will verify that the MAGI number you used to qualify for a subsidy was valid. If your actual MAGI on your 2014 tax return was higher than you expected, then you will be penalized and have to pay back part or all of the subsidy you received.
Knowing how to predict your income during 2014, and correctly claiming a subsidy is important. For more details about how to determine your eligibility, tables showing the MAGI income levels, and how to claim a subsidy, click here.
We now have a better understanding of what Obamacare is, what the "metal" policies are, what the penalty is for not having coverage, and how to determine if you qualify for a subsidy. All of this will take effect on January 1st, 2014 so how will the transition from today to 2014 take place?
How will you transition from the policy to have today, to the new Obamacare policies in 2014? When will this take place? Will you need to do anything? What if you currently don't have health insurance?
We'll answer those questions in this next section.
The transition into 2014 is almost ready to be rolled out. The initial open enrollment period for Obamacare will start on October 1st, 2013, and end on March 31st, 2014. For a total of 6 months you will have the ability to enroll in Obamacare.
This 6 month health care reform initial open enrollment period will happen only once. Next fall, in 2014, the annual open enrollment period will last from October 15th to December 7th.
This first enrollment period is primarily for people that don't have health insurance, and for people that have individual or family health insurance that started after March 23 of 2010.
If you are uninsured, you will be able to shop for a policy during the Oct-Dec time-frame. During this time you can choose between policies offered in the California exchange (if you qualify for a subsidy), and policies offered outside the exchange. When you enroll to get a policy, the policy will take effect on January 1st, 2014.
Jeopardy Alert: Answer - A tax penalty for not having health insurance. Question - What is Obamacare Mandates?
For individuals and families that currently have coverage, your current plan will be mapped into one of the new health care reform metal policies. Your existing coverage will end on December 31, 2013, and your new Obamacare metal policy will start on January 1st, 2014. You will then have until the end of March 2014 to decide if you want to stay in the mapped policy, or if you want to move to another metal policy. You will be able to make only a single change.
Once the Obamacare initial open enrollment period ends, on March 31st, 2014, you will no longer be able to sign up for any health policies unless you have a qualifying event. Let me repeat that one more time, because this is very important. AFTER March 31, 2014, IF YOU DON'T HAVE INSURANCE YOU WILL NOT BE ABLE TO ENROLL IN A HEALTH POLICY.
You will be forced to wait until the next annual enrollment period in October of 2014.
For more details about the initial open enrollment period, along with description of the qualifying events, and the timelines for this transition period, click here.
So there you have it, Health Care Reform in a nutshell. There are many more details about every aspect of Obamacare, but the time and effort to document everything is enormous. If there is something specific you would like to know or find out about, put it in a comment below, and we'll get the information to you pretty quickly, or call us and we'll help you out.
If you have a
Health Care Reform is the new name for what health insurance will look like in America starting in 2014. Also known as Obamacare, the Patient Protection and Affordable Care Act was signed into law on March 23, 2010. Most people are confused about what health care reform is. What it will do to your current health insurance. How it will effect you. In this section we will begin to answer those questions.
We'll cover the purpose of Obamacare, what mandates are, how the subsidies will work, when the California Exchange will be available and what to expect from it, and a timeline showing when everything takes effect over the next several years.
To make it a little more fun, we'll highlight key items in "Jeopardy" answer and question format.
What Is the Purpose Of Health Care Reform? Why?
To understand Obamacare you need to know why it was created and what its purpose or goals are. From the earliest speaches Obama made regarding health care reform, he said the primary reasons he was creating it were:
- Health insurance For Everyone, so no one would be declined
- Reduce health care waste, so health care would not cost a dime more
- Increased medical benefits - so medical bills associated with accidents and illnesses wouldn't cause bankruptcy
So Obamacare throws out almost everything we have today, and creates a completely new system. The new health care reform program will be rolled out over the next 4 years starting in October 2013 when the health insurance exchanges will begin operating. At that point, the uninsured will be able to enroll to get coverage that will start on January 1st, 2014.
What Is Health Care Reform Made Up Of?
What is health care reform made up of, is kind of complicated. Health care reform is trying to accomplish several different things at the same time. So let's tackle the biggest items first.
How can health care reform provide health protection for everyone when some people have pre-existing health conditions that are expensive and other people don't want health protection because they are young and "invincible"?
The first step is to require that everyone have health care coverage so that premiums from all the healthy people help pay the costs of the few people that have expensive health conditions. Jeopardy Alert: The federal government requires everyone to have health coverage? What is a health care reform mandate?
What is the Health Care Reform Mandate?
There are two Obamacare mandates. One for individuals and families, and one for businesses. The mandate says that everyone must have health insurance. If you don't get coverage, then you owe a penalty. The penalty will be paid to the IRS when you file your income taxes each year. Are you curious how the IRS will know if you don't have health insurance?
Businesses and health insurance companies will report the social security numbers of their members with health insurance. So if your social security doesn't show up, you don't have health insurance.
During 2014, the mandate penalty for individuals and families will be 1% of your Modified Adjusted Gross Income (MAGI), or $95 for an individual and $285 for a family, whichever is greater. Media outlets typically quote the $95 mandate penalty, even though the majority of people will pay 1% instead.
For businesses with 50+ employees, the mandate and penalty have been postponed until 2015. At that point employers with 50 or more full-time employees will be required to offer affordable health benefits to their employees and their families. If not, then the business will have to pay a tax called the Employer Shared Responsibility Payment (ESRP). The ESRP will be either $2,000 or $3,000 per employee that gets coverage with a subsidy.
For more details about the mandate, and examples showing haw to calculate the mandate, click here.
Now that you have some idea what the mandates are and how they will work, let's move on to the next part of Obamacare.
We have to buy coverage starting in 2014, but where are we going to get this coverage from? The Obamacare bill created exchanges where you can comparison shop between plans to find the best plan for your needs. So how are these health care exchanges going to work? And for that matter, what is an Exchange?
What Is A Health Care Reform Exchange?
The Obamacare health exchanges were created to simplify the process of shopping for health plans. Congress believed that the current process of getting quote online and comparing plans was too complicated. So they decided to create a brand new marketplace and limit the choices to just the approved health care reform plans. In California, the state government decided to create its own exchange for individual and family plans called "Covered CA," and another to provide group health plans for businesses called the "Small Business Health Options Program (SHOP)". The state is spending $910 million to create these brand new exchanges.
The primary purpose of the Covered CA exchange is to enable people that qualify for subsidies to get lower-cost coverage. The only way to get a subsidy is to sign up for a plan using the exchange. If you get coverage outside of the exchange, then you won't get a subsidy, but you will find additional plans to choose from.
Another thing to be aware of is that the California carriers will only offer policies with a limited network inside the exchange. If you have a doctor you want to keep, you may not be able to use the exchange, and will have to shop outside the exchange to get a policy with the full carrier network.
For more details about how the Covered CA and SHOP exchanges work and how to use them, click here.
Okay, so inside the California exchange there will only be a small set of health plans that the carriers will be offering. What are these plans? What benefits do they offer? How much will they cost?
What Are The New Obamacare Health Plans?
While crafting the Affordable Care Act, legislators decided that every plan provided by health care reform would need to be more full featured that the majority of plans available prior to the start of the Affordable Care Act. As a result, each of the plans offered after the beginning of 2014 must provide at least the 10 Essential Health Benefits: - Ambulatory Patient Services
- Emergency Services
- Hospitalization
- Maternity and Newborn Care
- Mental Health and Substance Use Disorder Services, including behavioral health treatment
- Prescription Drugs
- Rehabilitative and Habilitative Services and Devices
- Laboratory Services
- Preventive and Wellness Services and Chronic Disease Management
- Pediatric Services, including oral and vision care
Here in California, the state politicians decided to add even more benefits, so all the California plans will also provide coverage for acupuncture.
There will be 5 plans offered in the California exchange:
- Platinum - provides 90% actuarial value
- Gold - provides 80% actuarial value
- Silver - provides 70% actuarial value
- Bronze - provides 60% actuarial value
- Catastrophic - on available for people age 30 and under
Actuarial value means that the insurance will pay for that amount of the expected health care costs. For example, buying the Gold coverage means that your policy should cover 80% of all your medical expenses.
Each carrier that participates in the California exchange will offer these plans. However they are allowed to "tweak" their offerings to meet the actuarial value (i.e. for Silver they can offer a policy that provides an actuarial value between 68 - 72%). So not all Silver plans will be identical.
For more details about the health care reform plans, what the benefits look like, and the best use of each metal type, click here.
At this point we now know that there is a penalty next year if we don't get coverage. We know that there will be 5 plans offered in the exchanges. And we know that the exchanges are set up to provide a shopping place for people who can qualify for subsidies.
Jeopardy alert: Answer - Premium reductions in the form of tax credits. Question: What are the Obamacare subsidies? Who qualifies for a subsidy? How much are the subsidies? In the next section we'll explore these details.
What Is The Health Care Reform Subsidy?
The Obamacare subsidy is a tax-credit that will be used to reduce the monthly premium cost of the health care reform metal policies. To qualify for a subsidy, your income must be less than 4 times the federal poverty level. If you are single, then as long as your modified adjusted gross income (MAGI) is less than $44,280, AND the cost of the metal policy is more than 9.5% of your income, you could qualify for a subsidy. For a California family of 4, as long as your MAGI is less than $92,400, and the cost of your family coverage is more than 9.5% of your MAGI, then you too could qualify for a subsidy.
These subsidies will reduce the monthly premiums you pay for your health coverage. At tax time in 2015, the you and the IRS will verify that the MAGI number you used to qualify for a subsidy was valid. If your actual MAGI on your 2014 tax return was higher than you expected, then you will be penalized and have to pay back part or all of the subsidy you received.
Knowing how to predict your income during 2014, and correctly claiming a subsidy is important. For more details about how to determine your eligibility, tables showing the MAGI income levels, and how to claim a subsidy, click here.
We now have a better understanding of what Obamacare is, what the "metal" policies are, what the penalty is for not having coverage, and how to determine if you qualify for a subsidy. All of this will take effect on January 1st, 2014 so how will the transition from today to 2014 take place?
How will you transition from the policy to have today, to the new Obamacare policies in 2014? When will this take place? Will you need to do anything? What if you currently don't have health insurance?
We'll answer those questions in this next section.
What Is The Health Care Reform Initial Open Enrollment Period?
The transition into 2014 is almost ready to be rolled out. The initial open enrollment period for Obamacare will start on October 1st, 2013, and end on March 31st, 2014. For a total of 6 months you will have the ability to enroll in Obamacare. This 6 month health care reform initial open enrollment period will happen only once. Next fall, in 2014, the annual open enrollment period will last from October 15th to December 7th.
This first enrollment period is primarily for people that don't have health insurance, and for people that have individual or family health insurance that started after March 23 of 2010.
If you are uninsured, you will be able to shop for a policy during the Oct-Dec time-frame. During this time you can choose between policies offered in the California exchange (if you qualify for a subsidy), and policies offered outside the exchange. When you enroll to get a policy, the policy will take effect on January 1st, 2014.
Jeopardy Alert: Answer - A tax penalty for not having health insurance. Question - What is Obamacare Mandates?
For individuals and families that currently have coverage, your current plan will be mapped into one of the new health care reform metal policies. Your existing coverage will end on December 31, 2013, and your new Obamacare metal policy will start on January 1st, 2014. You will then have until the end of March 2014 to decide if you want to stay in the mapped policy, or if you want to move to another metal policy. You will be able to make only a single change.
Once the Obamacare initial open enrollment period ends, on March 31st, 2014, you will no longer be able to sign up for any health policies unless you have a qualifying event. Let me repeat that one more time, because this is very important. AFTER March 31, 2014, IF YOU DON'T HAVE INSURANCE YOU WILL NOT BE ABLE TO ENROLL IN A HEALTH POLICY.
You will be forced to wait until the next annual enrollment period in October of 2014.
For more details about the initial open enrollment period, along with description of the qualifying events, and the timelines for this transition period, click here.
So there you have it, Health Care Reform in a nutshell. There are many more details about every aspect of Obamacare, but the time and effort to document everything is enormous. If there is something specific you would like to know or find out about, put it in a comment below, and we'll get the information to you pretty quickly, or call us and we'll help you out.
If you have a
Impact On Individuals & Families
To see full page click here
This page will be updated frequently. Please check back again.
Health care reform will have a dramatic effect on individuals and families. As you saw in the other sections about what Obamacare is, the effects may be positive or negative. It depends upon your specific circumstances.
During the transition period starting on October 1st 2013, there are some specific steps you can take to ensure you minimize the negative effects. What we'll cover in this section is an overview of the changes you need to be aware in the following four areas:
This page will give you a good overview of the changes, and then point you to a more detailed page for the analysis and examples.
The initial open enrollment period is six months long and starts October 1st, 2013 and ends on March 31, 2014. During this period you can apply for coverage and be guaranteed of acceptance into any plan you choose.
The primary purpose of this open enrollment period is to enroll as many uninsured people as possible. The state of California has been promoting awareness of the CoveredCA exchange since early September. Various community groups are doing outreach campaigns to educate people about health care reform.
The second purpose of the enrollment period is to enable the transitions of everyone that already has health insurance into the new Obamacare plans. These transitions are going to cause a lot of pain and worry for you.
The letters insurers are sending to you will show what the cost of the new plans looks like. Most of you won't like the new cost or the plan. For more details about the letters you've received, and a strategy you can take to delay the health care reform price increases for another year, click here.
As I just mentioned, the rates on the new health care reform plans are going up. These increases will impact almost everyone. So most of you are going to be unhappy about that. Okay, you're pissed off about that. I understand.
There are reasons why the premiums have increased by 20% to 50%. Most are embedded in the rules and regulations of Obamacare. Not because the insurance companies decided to increase profits.
The main drivers of the health care reform cost increases are:
Although this video is targeted at the North Carolina market, the concepts outlined apply everywhere, including California.
The new fees and taxes add over $20 per person to the monthly rates you see for health insurance. The biggest of those are the Health Insurance Tax which adds about 2% to your monthly premiums, and the Health Insurance Marketplace User Fee which adds $14 per month. This fee is used to pay for the operation of the state exchange in 2015.
For more details about the impact of all the cost contributors click here.
This is actually one of the most important concepts that Californians need to understand. The decision regarding where to buy health insurance can have a great impact on the cost you pay, and the cost every person in California pays.
If you or your family will qualify for a subsidy, then you will want to get health insurance INSIDE the CoveredCA exchange. The exchange is the only place you can apply for coverage and get the premium reduction subsidies.
If you do not qualify for a subsidy, then you should get health insurance OUTSIDE the exchange. All of the plans that are available inside the exchange are also available outside the exchange. Along with those plans, the carriers have added a number of other insurance plans tailored for specific people.
Another difference is that some plans inside the exchange have very limited networks. So your physician may not be in that plans' network. Outside the exchange there may an identical plan, but with a much larger network. Because of this, wanting to keep your current physicians might mean that you have to look for plans outside the exchange.
Whether you shop inside or outside the CoveredCA exchange, finding a plan with the right benefits, that your doctor accepts, and at an affordable price, is not going to be easy because of the Obamacare impact on families and individuals. If you would like assistance, or have questions, please call us and one of our advisors will make sure you get the answers you need.
So how are you supposed to navigate this new health care reform system? We'll give you a simple 3 step process and outline some key things to do in each step. Then we'll give you some specific plan recommendations based on the plans and pricing that is currently available.
SPOILER Alert!! ---> Only a few carriers have their plans approved yet (10/14/13). Stay tuned for updates once they happen.
Because rates on the new metal plans are a lot higher than the plan you currently have, there is a potential solution to bypass Obamacare in 2014. Cigna is not participating in the CoveredCA exchange so they are not required to cancel all their existing plans on December 31st, 2013, like all the other major insurance companies in California.
As a result of this, you might find a lower priced plan from Cigna prior to Jan 1st, that would be lower cost than the metal plans. The Cigna Open Access Value 5000/100% plan has better benefits than the "Bronze" plans and tends to have a lower cost.
As we go through the 3 step process, you will want to compare the health care reform plan to what Cigna has available today.
Here is the 3-Step process:
For more details about the selection process, click here.
The CoveredCA exchange does not allow you to easily compare plans BETWEEN the metal levels. You can only compare Bronze plans to Bronze plans, Silver plans with Silver plans. You can compare plans across all the metal levels by getting quotes from SPF Insurance. To see these comparisons run a quote by clicking on the Get Health Insurance Quotes link in the Quote Center at the top or on the button below.
This page will be updated frequently. Please check back again.
Health care reform will have a dramatic effect on individuals and families. As you saw in the other sections about what Obamacare is, the effects may be positive or negative. It depends upon your specific circumstances. During the transition period starting on October 1st 2013, there are some specific steps you can take to ensure you minimize the negative effects. What we'll cover in this section is an overview of the changes you need to be aware in the following four areas:
- Initial Open Enrollment Period
- Health Insurance Cost Increases
- Inside The Exchange Or Outside The Exchange
- Solutions & Recommendations
This page will give you a good overview of the changes, and then point you to a more detailed page for the analysis and examples.
Initial Open Enrollment Period
The initial open enrollment period is six months long and starts October 1st, 2013 and ends on March 31, 2014. During this period you can apply for coverage and be guaranteed of acceptance into any plan you choose. The primary purpose of this open enrollment period is to enroll as many uninsured people as possible. The state of California has been promoting awareness of the CoveredCA exchange since early September. Various community groups are doing outreach campaigns to educate people about health care reform.
The second purpose of the enrollment period is to enable the transitions of everyone that already has health insurance into the new Obamacare plans. These transitions are going to cause a lot of pain and worry for you.
The letters insurers are sending to you will show what the cost of the new plans looks like. Most of you won't like the new cost or the plan. For more details about the letters you've received, and a strategy you can take to delay the health care reform price increases for another year, click here.
Health Insurance Cost Increases
As I just mentioned, the rates on the new health care reform plans are going up. These increases will impact almost everyone. So most of you are going to be unhappy about that. Okay, you're pissed off about that. I understand.
There are reasons why the premiums have increased by 20% to 50%. Most are embedded in the rules and regulations of Obamacare. Not because the insurance companies decided to increase profits.
The main drivers of the health care reform cost increases are:
- Guaranteed issue - meaning you can't be turned down or charged more
- Mandatory Essential Health Benefits required in all plans
- The new 3:1 Price Ratio limit
- Multiple fees and taxes that get passed on to us
Although this video is targeted at the North Carolina market, the concepts outlined apply everywhere, including California.
The new fees and taxes add over $20 per person to the monthly rates you see for health insurance. The biggest of those are the Health Insurance Tax which adds about 2% to your monthly premiums, and the Health Insurance Marketplace User Fee which adds $14 per month. This fee is used to pay for the operation of the state exchange in 2015.
For more details about the impact of all the cost contributors click here.
Inside The Exchange Or Outside The Exchange
This is actually one of the most important concepts that Californians need to understand. The decision regarding where to buy health insurance can have a great impact on the cost you pay, and the cost every person in California pays.
If you or your family will qualify for a subsidy, then you will want to get health insurance INSIDE the CoveredCA exchange. The exchange is the only place you can apply for coverage and get the premium reduction subsidies.
If you do not qualify for a subsidy, then you should get health insurance OUTSIDE the exchange. All of the plans that are available inside the exchange are also available outside the exchange. Along with those plans, the carriers have added a number of other insurance plans tailored for specific people.
Another difference is that some plans inside the exchange have very limited networks. So your physician may not be in that plans' network. Outside the exchange there may an identical plan, but with a much larger network. Because of this, wanting to keep your current physicians might mean that you have to look for plans outside the exchange.
Whether you shop inside or outside the CoveredCA exchange, finding a plan with the right benefits, that your doctor accepts, and at an affordable price, is not going to be easy because of the Obamacare impact on families and individuals. If you would like assistance, or have questions, please call us and one of our advisors will make sure you get the answers you need.
Solutions & Recommendations
So how are you supposed to navigate this new health care reform system? We'll give you a simple 3 step process and outline some key things to do in each step. Then we'll give you some specific plan recommendations based on the plans and pricing that is currently available. SPOILER Alert!! ---> Only a few carriers have their plans approved yet (10/14/13). Stay tuned for updates once they happen.
Escape Health Care Reform In 2014 With Cigna
Because rates on the new metal plans are a lot higher than the plan you currently have, there is a potential solution to bypass Obamacare in 2014. Cigna is not participating in the CoveredCA exchange so they are not required to cancel all their existing plans on December 31st, 2013, like all the other major insurance companies in California.
As a result of this, you might find a lower priced plan from Cigna prior to Jan 1st, that would be lower cost than the metal plans. The Cigna Open Access Value 5000/100% plan has better benefits than the "Bronze" plans and tends to have a lower cost.
As we go through the 3 step process, you will want to compare the health care reform plan to what Cigna has available today.
Simple 3-Step Process To Find The Right Metal Plan
Here is the 3-Step process:
- The first step in this process is to determine if you will qualify for a Premium Tax Credet (aka Subsidy)
- Get a quote to compare benefits and prices to choose the best plan
- Apply for the plan Off-Exchange or On-Exchange
For more details about the selection process, click here.
The CoveredCA exchange does not allow you to easily compare plans BETWEEN the metal levels. You can only compare Bronze plans to Bronze plans, Silver plans with Silver plans. You can compare plans across all the metal levels by getting quotes from SPF Insurance. To see these comparisons run a quote by clicking on the Get Health Insurance Quotes link in the Quote Center at the top or on the button below.
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InfoGraphics
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SPF Health Care Reform News
SPF Health Care Reform News
To see the full page click here
This page will be updated frequently. Please check back again.
Here is a summary of the SPF Health Care Reform News and Posts. Just the information you need to be able to select the right plan for your situation.
Go back to the Health Care Reform California page using this link.
This page will be updated frequently. Please check back again.
Here is a summary of the SPF Health Care Reform News and Posts. Just the information you need to be able to select the right plan for your situation. Go back to the Health Care Reform California page using this link.
Obamacare News Feeds
Obamacare News Feeds
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There is new ObamaCare news everyday, but many stories are full of errors or omissions. These are the sources we feel provide the most accurate news about health care reform. We've got feeds from sources that are both pro and con on ObamaCare, so you can see what both sides think.
Do you know about a good source that you like to read? If so share with us in a comment below. We'll select some of the best health care reform news suggestions and add them here.
These are the sources we pull from. Unfortunately they don't work in the preview window, so click on the link above to view the feed page.
Thanks,
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There is new ObamaCare news everyday, but many stories are full of errors or omissions. These are the sources we feel provide the most accurate news about health care reform. We've got feeds from sources that are both pro and con on ObamaCare, so you can see what both sides think. Do you know about a good source that you like to read? If so share with us in a comment below. We'll select some of the best health care reform news suggestions and add them here.
These are the sources we pull from. Unfortunately they don't work in the preview window, so click on the link above to view the feed page.
Thanks,
Forbes - Apothecary by Avik Roy
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NPR - Prescriptions For Change
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Kaiser Health News
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Health Care Reform Resources
Resources
This Resource page will be updated regularly when new information is available.
Here are the health care reform resources we have checked out and can recommend to you.
To make this easier we have organized the resources into the following sections:
- Subsidy Calculators
- Provider Networks
- Affordable Care Act Documents
If you need information on specific health care reform topics, refer to the detailed pages we've created. At the bottom of each page, we've listed specific health care reform resources that relate to that topic.
Subsidy Calculators
There are a few subsidy calculators that are available before the beginning of October. Each of these calculators uses "estimates" of what the health plan premiums are in order to provide basic information about how much of a subsidy you could qualify for. When we get to October, these tools should become more accurate once the actual plan costs are loaded into them.
Until then know that the results are just guesses.
- Subsidy Calculator | The Henry J. Kaiser Family Foundation - This is one of the more detailed calculators. It includes employer health plan information, and the ages of each individual in a family along with their smoker status (California does not increase the rates for people that smoke).
- National Health Care Calculator - UC Berkeley Labor Center - This is a simpler calculator but just as accurate.
Provider Networks
One of the biggest changes for the new health care reform metal plans is the new provider networks that some of the health insurance companies introduced. These networks are smaller, but still in the growth stage as the carriers attempt to establish new contracts with individual doctors instead of the medical groups.
There are two insurance companies that maintained their pre-Obamacare networks. Health Net and Blue Shield both keep their PPO networks intact. Therefore, they will offer the most extensive networks during most of 2014.
If you have a physician you want to keep seeing, then it is important to verify which networks the doctor is in. Sometimes this can be accomplished by calling the doctor's office and asking. However, these network changes are new to the doctor's office personnel, so you will to emphasize that you mean the new 2014 networks. Even with a positive response from the physician's office, I would still recommend verifying that by using the provider network links below.
Provider Network Links:
- Anthem Blue Cross Provider Directories - Anthem's network search is not publicly available yet, but they have provided directory listings for each region in California.
- Blue Shield of California Provider Network - Blue Shield's network is not going to change. If your doctor is in the network today, they will also be in the provider network in 2014. This is the largest doctor network in California.
To search in the 2014 network, make sure you "select a plan" in the upper right (next to the image of the 3 doctors). The 2014 networks are clearly identified, and should be easy to find. Then you'll need to select a plan name (Bronze, Silver, Gold, or Platinum). Finally, to search for your physician by name, click the "advanced search" link underneath the green icon for Doctors. - Cigna Provider Network - Cigna does not currently have their 2014 network available. Check back later for updates.
This current link allows you to search in their 2013 network for physicians that accept their current Open Access PPO plans. - Health Net Provider Network - Health Net's provider search tool is a little bit awkward until you get used to it. I've found the easiest way to search is to select the "Search by City and/or State" option on the first page. Then type in the city and state, and click continue.
After that you will be asked to select the type of provider search you want to run, using the colored icons on the page. To search for Doctors, click the blue icon, and you will be taken to a page which asks you to select the Plan and/or Hospital Affiliation for your doctor.
Inside the Plan drop down menu, you will find that the new health care reform networks (Plans Available As Of 1/1/14) and the older networks (Currently Available Plans) are clearly separated. The plans listed under the Covered California label are the exchange plans, and the Standard Medical Plans are the off exchange plans. - Sharp Healthcare - The Sharp network is primarily composed of Sharp physician groups. The following medical groups are in the Sharp network:
- Sharp Community Medical Group (SCMG)
- Sharp Rees-Stealy (SRS)
- Children's Physicians Medical Group (CPMG)
- Primary Care Associates Medical Group (PCAMG)
- Greater Tri-Cities IPA (GTC)
- Arch Health Partners
- Kaiser Permanente
- Western Health Advantage
- Molina
Patient Protection and Affordable Care Act Documents And Analysis
This section is for the curious and the people that want to know the details of Obamacare. These are the rules and regulations of the ACA. The creation of this website is based on reading a lot of this material.
We've also included websites that write great analyses of the ACA and how it works. These are all sources we feel are the best and most authoritative.
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm Entitled The Patient Protection and Affordable Care Act. {NOTE: Mar. 23, 2010 - [H.R. 3590]}. From the U.S. Government Printing Office
http://www.gpo.gov/fdsys/pkg/FR-2013-02-25/pdf/2013-04084.pdf Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation; Final Rule. From the Federal Register dated February 25, 2013
