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.

Although open enrollment runs through February 15, 2015, you have until December 15, 2014 to make a change for a January 1, 2015 plan start date.   Other possible effective dates are February 1, 2015 and March 1, 2015.

When evaluating your plan choices, please carefully consider the following points before making your final decision:

  • Provider choice and network shrinkage caused a major disruption in the healthcare marketplace this year and, because of this, consumers are particularly sensitive on the subject.  Major carriers like Anthem Blue Cross and Blue Shield will continue to offer PPO plans but still with significant “holes” in them.  Carriers offering PPO plans with large networks (Healthnet and Assurant) are increasing premiums on new plans by 10%-15% or more.  Consumers will have to weigh the savings in premium against provider access limitations.
  • Provider search tools from most carriers aren’t particularly user friendly.  Don’t rely entirely on the results of a search. It’s important to check directly with your provider and ask if they accept the plan you are considering.
  • Be wary of EPO. EPO stands for “Exclusive Provider Organization”. As an EPO member you receive no benefits when seeing out-of-network providers (except for an emergency). Also, EPO provider networks are typically smaller than a carrier’s PPO network.
  • Be sure your current providers accept EPO coverage and that any provider you may want to access in the future is participating in the EPO network as well. Many EPO plan participants didn’t realize a provider or facility didn’t take their plan until treatment was needed.  Be sure and conduct a general search of the providers in the various specialties within the EPO.
  • If prescription drug coverage is important to you, be sure and check the formulary drug list of the plan before you enroll. Another cost-cutting maneuver by the carriers to keep plan premiums down is to include mostly lower cost generic medications  in their formulary as opposed to more expensive generic and brand name drugs.
  • Check the plan for out-of-state coverage. Most plans now treat out-of-state providers as out-of-network and cover only emergencies.  Assurant Health and Blue Shield PPO plans are the only plans offering clear descriptions of their nationwide access to providers with in-network benefits for more than just emergencies. Anthem Blue Cross PPO and EPO plans, and Blue Shield EPO plans, do not include their BlueCard coverage for access to out-of-state providers. Those of you with college students out-of-state should consider purchasing the college insurance plan if benefits back home don’t follow your student to school.

Anyone who does not obtain coverage next year (and doesn’t have a qualified alternative) may face a penalty of $325 per adult/$162.50 per child or up to 2% of household income, whichever is higher.  Since several of the healthcare reform deadlines and mandates have become “soft”, many are counting on a reprieve in this initial year’s open enrollment. 

ENROLLMENT DEADLINE:  December 15, 2014 for a January 1, 2015 start date.

A Word about CoveredCA

This is the public marketplace where one can enroll and receive financial assistance if they qualify in the form of a subsidy and cost sharing reductions. Eligibility is based in part by household income. If you want to consider coverage through CoveredCA you can use their Shop and Compare tool to get an estimate of the assistance: If you wish to enroll through this market you can do so on their website or by contacting CoveredCA directly at 800-300-1506.

The private market does not offer the subsidies but does include more carriers and plan options in each benefit category.  It’s also a simpler enrollment process since there is no financial disclosure or IRS income verification.  Please visit my website to read more on various health insurance topics:

How OnlyHealthInsurance Can Help

If you are considering individual or family health insurance, have decided to enroll in a private exchange plan, or are not sure what type of plan you’re eligible for, we hope you will contact us for assistance. After understanding your personal circumstances and health insurance needs, we can make an assessment and recommendation for the most appropriate solution.

Phil Dougherty

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.

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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!

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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?

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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. 

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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