Annual Open Enrollment

The annual open enrollment period is upon us when you can evaluate plans in the new insurance marketplace and replace your existing policy if you so choose. Like in previous years there will be mandated changes to standard plan benefits for the next plan year.  These are the most notable:

  • Embedded Out-of-Pocket. In ACA-compliant plans (Affordable Care Act) the annual Out-of-Pocket (OOP) maximum for self-only coverage applies to all individuals—including those enrolled in two party or family plan coverage. This means that no individual can be required to pay more in annual cost-sharing than the ACA individual OOP limit, even though a family unit as a whole may be subject to the higher overall OOP maximum. In other words, the self-only ACA OOP maximum is “embedded” in the other-than-self-only coverage.
  • Prescription Medication Benefit Changes. In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket maximum on specialty drugs (once the pharmacy deductible is met). For the Bronze standard plan there is a $500 monthly per prescription maximum and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 per prescription after the pharmacy deductible is met.
  • Bronze Level Plan Change. The first cumulative three visits are again not subject to the deductible, but can now include a specialist visit in addition to primary care, mental health and urgent care visits. In addition, laboratory work is not subject to the deductible.

Note: In the private marketplace there are other options available in each benefit category, which may have slight changes from the standard benefit design.

If you need assistance in evaluating plans and making a plan change, or enrolling for the first time, don’t hesitate to contact us.

Phil Dougherty

Open Enrollment starts November 1!

The annual health insurance open enrollment period is fast approaching! This is the time when individuals and families already enrolled in ACA-compliant coverage can review their health insurance and make a plan change, and when those without coverage can enroll as well.  This year, more than ever, it is important to be informed of the changes coming to your specific plan and California’s health insurance marketplace in general.  Read your carrier renewal packets thoroughly!

Important dates to remember:

  • November 1, 2015: First day to enroll in a plan or make changes for the 2016 plan year.
  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: Open Enrollment for 2016 ends. Enrollments or changes between January 16 and January 31 will take effect on March 1, 2016.

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Dental Insurance – Is it worth it?

If you are like the millions of Americans who don’t have dental insurance provided by an employer, you may wonder why there aren’t more “reasonable” insurance products available in the individual market.  There is no shortage of individual dental plans; all medical insurance companies offer them.  But after looking more closely many people conclude correctly that it just doesn’t add up.  So how come? The devil is in the details.

Let’s look at three major coverage restrictions typical of most PPO dental insurance:

  1. Coverage limits.  Most PPO plans provide a maximum benefit of $1,000 or $1,500 annually.
  2. Waiting periods. Typical is a one year wait for major services – no coverage provided for services like crowns and root canals in the first year of coverage.
  3. Limited Provider networks. Dentists must accept a much lower fee for services than their going rate so most don’t participate.

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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