Supreme Court decides to keep ACA subsidy.

A big decision was made last week by the Supreme Court, which could have negatively impacted millions of Americans receiving health insurance subsidies in states where the federally run exchange is used.

Known as the King v. Burwell case, the Court ruled against the lawsuit, which would have effectively ended health care subsidies for nearly 6 million people in the 34 states that did not set up their own health insurance exchange. It was originally expected that each state would implement their own insurance marketplace, such as the California run exchange (called CoveredCA). Instead, many states did not set up a state run marketplace and deferred to the federally run exchange, thus creating this policy debate.

Although those with subsidies through CoveredCA would not have been directly impacted, the repercussions of removing the subsidy for people in federally run exchanges could indeed have affected the insurance industry overall. Now that the Court has ruled, will struggling state exchanges opt to move to the federally run exchange? Stay tuned.

Phil Dougherty


Covered California (CoveredCA) Alert

Any one insured under CoveredCA, and receiving subsidies, should be aware of a recent development that may impact them.

CoveredCA subsidy eligibility is based on the household’s Modified Adjusted Gross Income (MAGI) and is available for those whose annual income meets certain Federal Poverty Level (FPL) criteria. For 2015, the Federal Poverty Level Guidelines from 2014 are being used to determine subsidy levels.  However, Medi-Cal eligibility is based on the new 2015 Federal Poverty Level Guidelines and the income threshold was increased. Continue reading

What to do while “locked-in”.

Many of us in individual health plans are unable to make a plan change outside of open enrollment.  Unless you have a qualifying event, such as a change in family status, a move, or the loss of group health insurance, you may have to wait until open enrollment (November 1, 2015 – January 31, 2016) to make a plan change.  While “locked-in” here are some tips on how to improve your health, stay informed and save money: Continue reading

A Case of the Flu.

2015 started with a bang…actually with a cough.  Like many in my circle of friends and acquaintances, I got the flu.  After a few days of suffering, I found myself on a Saturday morning in mid-January with a choice to make. Do I continue with my Nyquil binge and wait till Monday to see my doctor or head out now to visit an Urgent Care center?   Continue reading

Blue Shield and Sutter Health, a love story.

It was touch and go there for a bit, but Blue Shield of California and Sutter Health resolved their differences and signed a new two-year agreement that will keep Sutter hospitals and medical centers in Blue Shield’s provider network.  The public jousting was palpable and thankfully short-lived.  Coming to an agreement before the end of the open enrollment (February 15) means many can check insurance off their to-do list, for a while anyway. Continue reading

Deadline approaching…

There are just five days left to renew your health insurance for 2015 if you want it effective on January 1, 2015. 

In both Covered CA and the private marketplace, you have through December 15, 2014 to explore your options and make any changes to your health insurance for a January 1, 2015 effective date. Please read the specifics below to understand your options based on the market in which you obtained your current health insurance. Continue reading

Open Enrollment is here!

The first annual open enrollment period since the implementation of health care reform has started and it’s time to evaluate plan options for 2015.  For those who have existing individual or family coverage and want to consider a change, are enrolled in group or COBRA insurance and want to compare their current plan with 2015 marketplace plans, or are without health insurance and entering the market for the first time, now is the time to consider a change. Continue reading

Commissioner Jones: Superhero or Opportunist?

BAM! POW! WHAM! Insurance Companies take cover. CA Insurance Commissioner Dave Jones has changed into his spandex and cape! (Play superhero theme music.)  And, with the help of his sidekick (Proposition 45), he’s ready to challenge his arch nemesis (aka insurance companies) and protect the good people of Gotham (California) from their tentacles and stinging rate increases. (Aside: Isn’t anyone concerned that there are no more phone booths for Superman to change in?) Continue reading

It’s not just what’s on the ballot that matters; it’s when the vote is held.

There is no better example of this than the upcoming November election.

Originally set for October 15 – December 7, this year’s annual open enrollment period, when consumers can enroll in ACA compliant coverage for the first time or change plans for the next plan year, was pushed out to November 15 – February 15.  CoveredCA, California’s version of ObamaCare, has followed suit and will match the new open enrollment schedule.

Continue reading