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.

The explanation from the White House was the delayed start would give consumers more time to evaluate plans.  It would also allow insurance carriers more time to set rates and make plan decisions for the following year.

As for more time for consumers to make good decisions, it is going to do just the opposite.  With insurance plans having a calendar year deductible, it is to a policyholder’s advantage to start a plan January 1; to make maximum use of the policy. Under the new open enrollment schedule, one needs to enroll by December 15 this year to obtain a January 1 effective date.  This gives anxious consumers 4 weeks, including a major holiday, to enroll or make a plan change instead of the 7 ½ holiday free weeks with the original schedule. 

This change isn’t helping consumers.  Enrolling on December 16 would result in a February 1 effective date leaving one month to be covered under an existing policy, or short-term insurance, or no coverage at all.   Providing more time to help carriers doesn’t wash either.  As of this date, 2015 plan rates and benefit information are not yet available; not due to carrier delays, but because they are sitting at the California Insurance Commissioner’s desk waiting for his approval.

No. Changing the open enrollment start and end dates benefits no one, except possibly politicians (Dems or Repubs) who are anxious about open enrollment.  Potentially high insurance premiums or cries of “my doctor won’t see me” make for bad publicity and angry voters (bad for Dems), but mild increases and a smooth transition could have the opposite effect for Repubs.  Not surprising Washington has gone mute on this impractical schedule change.

Next edition: “Proposition 45: Commissioner Gordon is Batman”.

Phil Dougherty

How to Choose a Carrier.

Health Care Reform has leveled the playing field as far as coverage benefits and eligibility goes. Plans are standardized and fall into four distinct benefit levels (Bronze, Silver, Gold, and Platinum) and must be actuarially equivalent. Pre- existing conditions no longer restrict your access to coverage or result in higher premiums. By removing these two critical elements, what’s left to compare? Plenty!

Continue reading

Next Open Enrollment Period Uncorked…

In addition to sizing up a turkey or sniffing a yam, you might add squeezing a health plan or two into your Thanksgiving shopping list. This year’s open enrollment period was moved from October 15 – December 7 to November 15 – February 15, 2015, and if you want to ring in the New Year with a “fresh” plan, you’ll have a shorter amount of time to act this year.  Let’s look a little closer to see what this enrollment period date change really means. Continue reading

Employers & Employees Beware.

Popular among small employers was an arrangement by which they would pay the employee’s individual insurance plan premiums on a pre-tax basis. Market reforms within our new healthcare law now prohibit this.

Starting January 1, 2014, employers who reimburse or pay premiums directly to a carrier for any employee’s individual or family health insurance policy will no longer be able to do so tax-free. This may adversely affect both employer and employee. Continue reading

Short Term Insurance still has a place.

Our new health care reform law has made it possible now for virtually anyone to obtain health insurance. Those with a pre-existing condition(s) cannot be denied insurance, charged a higher premium or have coverage restricted in any way. This is a huge step forward in our health care system and the ramifications of this step are being played out as I write this message.

But there has been another significant change that was less publicized. There are only certain times of the year when you can enroll in or change coverage, called Open Enrollment. What! Did we fix one problem in our system just to create another?

Continue reading

Special Open Enrollment Period (limited to certain life change events).

With open enrollment now over, obtaining individual or family health insurance before the next open enrollment (currently scheduled for October 15 – December 7, 2014) is only possible with certain “life change” events.  Some of these events must result in a loss of minimum essential coverage such as a divorce or legal separation, a move out of state or service area, change in employment status (i.e., reduction in hours), loss of employer coverage, or the death of a parent or spouse.  Proof of a loss in minimum essential coverage is required. 

Or, if the life change event results in gaining or becoming a new dependent such as a marriage (including domestic partners) or the birth or adoption of a child, one can also acquire new coverage outside of next open enrollment period. Proof of these changes is required as well.

Being unhappy with the coverage you obtained during the initial open enrollment period or a change in a physician’s network status* does not qualify as a special enrollment opportunity.

The state has recognized this issue and has taken some steps to assist those who are in the middle of certain treatment.  It is called Continuity of Care. Click here for the web page from the Department of Managed Health Care, which explains Continuity of Care in detail. If you think you may qualify, contact your insurance carrier to begin the process.

*Since there are two exchanges in which to acquire new insurance (Covered CA and the private exchange) and multiple plan options within the same carrier in each exchange, there are network discrepancies surfacing between carriers and providers. Always check with your provider first before making appointments to see if they accept your insurance.  In speaking with them on the phone be as descriptive as you can and have your ID card handy.

As the plan year moves along, clarification and exceptions to rules are likely. Feel free to contact me if you have a question and I’ll do my best to provide you with the latest information.

Phil Dougherty

Tax day is also the last day to enroll in coverage.

Presentation3It appears no more delays or postponements are in the works.  April 15 is the last day to enroll in a plan for individuals and families.  In the private marketplace (not CoveredCA) several carriers (Anthem Blue Cross, HealthNet, and Blue Shield) have kept their doors open for those who have not yet enrolled in coverage and do not have a qualified alternative (group insurance or a grandfathered plan, for example).

You can obtain a quote and enroll online on our website:

The next open enrollment is October 15 – December 7, 2014 for a January 1, 2015 effective date.

Phil Dougherty


ACA open enrollment ends on Monday, March 31.

When the initial open enrollment period winds up at the end of March, the opportunity to purchase an ACA-compliant plan will close until the next open enrollment, which runs from October 15 through December 7th, 2014, for an effective date of January 1, 2015.  In the meantime, a “Special Enrollment Period” is available to change plans, or enroll for the first time, for those with a life changing event.  These include marriage, divorce, birth or adoption of a child, or loss of a job. Continue reading

Out of state…read the fine print!

171 (5)For decades the “Blues” (Blue Shield and Blue Cross) provided access to their nationwide provider network so you could stay in-network when out of state.  That was huge for families with sons or daughters in out-of-state colleges and a real advantage over HMO’s and less robust PPO’s that provided emergency only coverage when out of state.

Well, Blue Cross and some of the Blue Shield plans sold in the new private and public marketplaces today provide only emergency coverage. This is disappointing to say the least. Continue reading