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.

Health Insurance Marketplace changes:

Plan benefit changes to the standard metal-tier (Bronze, Silver, Gold and Platinum) plans are also being implemented. Here are a few important changes to be aware of (all good news!):

  • In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket cost on specialty drugs (once any pharmacy deductible is met). For Standard Bronze Plans, there is a $500 monthly maximum per prescription; and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 per prescription after the pharmacy deductible is met.
  • Another significant change in benefits for 2016 affects the Bronze Plan. The first three office visits will still not be subject to a deductible but can now include a specialist visit in addition to primary care, mental health, and urgent care visits.
  • HSA-compatible plans will have embedded family deductibles. This means an individual family member need only meet the individual deductible and individual out-of-pocket maximums; not family deductible and out-of-pocket.

These changes affect California’s standard Bronze, Silver, Gold and Platinum plans. In the private off-exchange marketplace, carriers offer other plan options in each category which are actuarially equivalent to standard plans, but with slight changes to the plan design. These changes may benefit consumers with a specific need. Continue reading

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.

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