Category Archives: Health Care Reform

Anthem Blue Cross to all but leave the individual market in CA

Anthem Blue Cross has announced that they will offer Individual/Family plans in three regions of Northern California only next year, which will include most upper northern counties, Santa Clara County, and the Stockton/Modesto area.  Anthem BC will continue to offer their EPO product in these areas. Members outside of these areas will have their existing coverage through the end of this calendar year. Enrollment in new coverage from a new carrier can take place during the open enrollment period (Nov 1 through Dec. 15) with coverage starting January 1. This affects both on-exchange (CoveredCA) and off-exchange market plans.

This does NOT affect Medicare Supplements, Medicaid, employer based plans, and Grandfathered plans (plans in effect prior to 2010).

So why the exit? Too risky. The instability of the marketplace, the shrinking Individual market, and heavy regulatory environment makes pricing plans with any confidence impossible. They will leave it to others and wait for workable changes from Washington.

Phil Dougherty

ACA & State Reform Update

ACA UPDATE 6/28/2017

The Better Care Reconciliation Act (BCRA), the ACA replacement bill put forth by Senate Republican leadership, is short the necessary votes to pass this month (June), so they will attempt to schedule a vote following the July 4th recess provided they can rally defiant Republicans to support the bill.

The BCRA bill mirrors a House bill in a number of ways, but there are several key differences also. Even if it passes the Senate, it must pass the House first before going to the President for signature. The House could pass it as is, or negotiate a new compromise bill.

Although the specific timing to complete this process is unclear, both Congress and the Administration continue to be focused on the repeal and replacement of the ACA.

For those concerned about immediate changes, the BCRA includes a transition period of several years before some provisions go into effect and others sunset. And not all ACA provisions are impacted by the BCRA bill.

In short, the BCRA would repeal the individual and employer mandate and penalties, end some Medicaid funding, repeal most ACA fees and taxes and maintain some protections for pre-existing conditions. For more details, read this recent Kaiser Foundation update:

Summary of BCRA

California State Reform Measures

Effective July 1, 2017,  bipartisan legislation will go into effect barring “balance billing” from non-participating providers when being treated in In-network facilities. This limits a patient’s cost-sharing responsibility for services rendered from out-of-network providers at an in-network facility, to the amount the patient would have paid to an in-network provider and counts the cost-sharing amount toward the individual’s deductible and out of pocket limit.

A good example of this, and one many of my clients have faced through the years, is when a patient uses an in-network hospital or clinic, and unbeknownst to them, are treated by an out-of-network provider (one who does not contract with the insurer), such as an emergency physician,  second surgeon, radiologist or anesthesiologist. This consumer protection bill is intend to protect health care consumers from these surprise bills. Some welcome legislation.

California Single Payer

The state’s Single Payer initiative will remain “in committee” until further notice. There is still plenty of passion and support for such a solution, but the bill lacks specifics on funding, delivery of care and cost controls. But, it did what many believe it was meant to do: start the discussion and build on the momentum. The goal now among its supporters is to get it on the ballot for November 2018.

More updates to come. Stay tuned.

Phil Dougherty

 

 

Everything on the Table

In my reading of daily news from various sources, it is clear we are no closer to a solution on healthcare than we were three months ago. Here are just a handful of recent headlines:

Senate Republicans continue work on ACA replacement

Time may be running out on Senate Obamacare talks

Ideas emerge as Senate debates health care

Trump Seeks Delay of Ruling on Health Law Subsidies, Prolonging Uncertainty

Senators explore options for pre-existing conditions

The most interesting headline is what’s happening right here in CA:

Calif. single-payer health care bill would cost $400B, analysis finds

A current bill in the CA legislature (SB562) would remove insurance companies from healthcare delivery and provide 100% coverage for all legal and illegal residents (including Medicare recipients, Medi-Cal recipients, employer based insurance participants, enrollees in CoveredCA and private insurance plans). All public funds currently utilized on healthcare (Medicare, Medi-Cal, CoveredCA subsidies) would be used to cover half of the $400 billion estimate with the other 50% coming from employer and personal tax increases.

Gov. Jerry Brown has concerns and the bill would need Washington’s (Trump) approval in releasing federal funds to such a program. California loves to be first and you can bet other states will see how this progresses.

The longer it takes for an Obamacare “fix”,  the greater success single payer initiatives will have in gaining followers.

Stay Tuned.

Phil Dougherty

 

 

 

Will a Repeal of Obamacare Affect My Medicare?

Will a repeal of Obamacare affect my Medicare? 

I have been asked this by a number of concerned clients in response to the recent headlines from Washington.

First, to clear up any confusion, Medicare does not fall under Obamacare (ACA Law), or vice versa. These are two entirely separate government programs designed to serve two different groups of people with minimal overlap. To elaborate, Medicare provides insurance to Americans sixty-five and older or those with disabilities. It provides access to contracted providers nationwide and has its own cost mechanisms and eligibility rules. In contrast, Obamacare created marketplaces through which eligible consumers (those who are not Medicare eligible) can purchase insurance from insurance companies. Income based subsidies are possible for those who qualify and eligibility is determined by state residency and enrollment guidelines.

So, back to the question, would a repeal affect Medicare? I think more indirectly than directly. There are provisions in Obamacare that do affect Medicare, most notably Part D, the prescription drug program and specifically the Coverage Gap or “donut hole” within the drug plan design. A full repeal could negatively impact Medicare Part D beneficiaries and increase their share of cost. President Trump has not addressed this specific provision but only reiterated his personal wish to preserve Medicare and keep it functional.

Of the recent GOP reform plan that never came up to a vote, a change to the Coverage Gap provision was not one of them. The bigger question I think is, will major changes to one government healthcare program indirectly impact the economies of an entirely different government healthcare program. The answer is, maybe, or even probably, but how exactly cannot be determined at this time. Significant changes to Medicare are looming, but due to its own economic challenges. More on that in future issues.

UP A Creek?

Despite the fact that the first round of “Repeal and Replace” fizzled, a significant change is coming. In early April, the new administration announced that it would cut back the enrollment period for next year’s individual plans offered through the existing Affordable Care Act exchanges.

Previously the annual open enrollment period was from November 1 through January 31. The adjusted period will run from November 1 through December 15; a month and a half shorter. The administration has been quiet on important questions concerning the continuation of premium and cost sharing reduction subsidies and the insurance mandate and penalties, creating some uncertainty in the marketplace.

This indecision and the shortened enrollment period will make it difficult for carriers to prepare and price their plans for 2018. Some have threatened to withdraw from markets or the ACA entirely unless they receive some clear regulatory guidance. This could send the ACA up a creek without a paddle.  Stay tuned.

 

ACA and the Trump Administration

We have received numerous inquiries from clients as to the fate of their health insurance. We know that President Trump has signed an Executive Order and that change to the law is inevitable. Here are a few reminders and thoughts on what to expect:

  • The ACA is still the law. Even though change is expected, the ACA remains in place and unchanged at this time. The law still requires most Americans to have health insurance to avoid tax penalties.
  • Open Enrollment continues through January 31. There’s still time for individuals and families to enroll in coverage for 2017. You can purchase coverage through the private market through a broker like me, or enroll via Covered California, the public marketplace.
  • Whatever changes come, they’ll take time. Changes will require specific legislative and administrative action. Health policy experts predict that consumers will be given a transition period while Congress puts together any replacement plan.

We’ll keep you posted on important news and updates that directly affect your health insurance. Thanks, Phil

ALERT! Open Enrollment Deadline Date Change

In my previous blog I stated that CoveredCA, the public marketplace, announced they were extending the open enrollment deadline to February 15th. This is incorrect. The last day of open enrollment is January 31st.

CoveredCA mistakenly reported the wrong date range for a March 1, 2017 coverage start date.

The correct plan selection dates for a March 1, 2017 coverage start date are January 21 – January 31, 2017.

 

Open Enrollment Ending Soon!

The health insurance open enrollment period is scheduled to close on January 31, 2017, for the private market (also called off-exchange). The private market is where you enroll in a plan directly with an insurance company through an agent or broker like me.

CoveredCA is the public marketplace (also called on-exchange) and is where one can enroll in subsidized insurance or Medi-Cal if income qualified. CoveredCA recently announced that they will extend their enrollment period through February 14th.

Enrolling in coverage in either marketplace by either deadline will result in a March 1 effective date. To understand more about California’s marketplaces, watch our latest video: http://onlyhealthinsurance.com/individuals-and-families.html

Let me know if I can help you further. Phil

Open enrollment begins November 1 for Individual/Family Insurance.

As we approach another open enrollment period, I wanted to share information that may help clients and friends make a decision about their health insurance. Premium rates and plan information is trickling in from carriers and it appears rate increases are again a reality. Please read your plan’s renewal packet carefully to learn how rate and benefit changes will affect you.

Important Dates
Open enrollment runs from November 1, 2016 through January 31, 2017. This is the period when you can change plans for the 2017 plan year. However, if you want to change plans for a January 1 effective date, you’ll need to enroll by December 15. If you do nothing at all, your existing plan will renew on January 1. Whether you choose a new plan or stay with your current plan, the first premium payment will need to be paid by December 31.

Here is a rundown of the major changes and announcements for this year’s open enrollment.

Rate increases
Expect rate increases for all plans. This is due to a number of factors, most notably:

  1. Two federal programs that have helped health insurers offset costly medical claims, and cover sick patients in general, are set to end this year. These programs were intended as a temporary cushion for insurers, who are now required to accept all applicants regardless of their medical histories.
  2. The rising cost of healthcare, especially specialty drugs.
  3. Adverse Selection. Some consumers waited to enroll in coverage until a health problem arose. This impacted PPO plans particularly hard.

Specific Carrier Details Continue reading

Open Enrollment Approaches

Starting November 1, open enrollment in the individual and family health insurance marketplace begins and will continue through January 31, 2017. This will be the fourth year of open enrollment under the Affordable Care Act (ACA) and many consumers are now familiar with the language and rules of reform, the types of benefit plans offered, and the deadlines that loom. But, a year is a long time (perhaps not long enough) to be away from the excitement of another health insurance enrollment anniversary. Continue reading