CA Doctors Could Face Potentially Nasty Surprise

A little-noticed provision in the Affordable Care Act allows exchange participants a 90-day grace period to pay their health insurance premiums.  This was designed to help those who are not used to paying health insurance premiums.

During the first month of grace period when the premium has not been paid, the insurance companies must continue to pay claims incurred by the patient.  During the second month if the patient is still delinquent the insurance company can pend any further claims.  After the third month if the insured has not paid the premium, the insurance company can terminate the coverage.

In the event that the premium is not paid during the grace period and the policy terminates backwards 90 days, doctors  and other healthcare providers in California will have to go after the patient to collect payment for all outstanding claims. 


Essentially this means there can be a 60-day period during which a medical provider who accepts exchange-level health plans is not going to be sure if or when he/she may ever get paid for the medical services provided.


Excellent article from Family Practice News about this.


Dave
www.davefluker.com

Covered California Will Have HSA Plans in Exchange

According to information provided in the last day or so by Michael Lujan at Covered California, the exchange does intend to allow HSA compatible health plans inside both the individual and SHOP exchanges.

Last week sources were told by a spokesperson at Covered California that HSA plans would not be included in the individual exchange.  

As with all things related to the implementation of ObamaCare, information is subject to change at any time and what we know today may well be changed or invalid tomorrow.

If Michael Lujan is correct (and there's no reason to doubt that he is) then the previous blog post is now incorrect.

http://davefluker.blogspot.com/2013/07/no-hsa-compatible-plans-in-covered.html

Dave
www.davefluker.com

No HSA Compatible Plans in Covered California Individual Exchange

Update: According to Michael Lujan at Covered California yesterday, the exchange will in fact have HSA plans available in both the Individual and SHOP exchanges.  This information contradicts earlier information from the exchange which was the basis for this blog post.

http://davefluker.blogspot.com/2013/07/covered-california-will-have-hsa-plans.html

Word out is that the Covered California Individual & Family Health Exchange will not contain any HSA compatible health plans.

HSA compatible health plans are generally higher-deductible plans with some special design requirements.  HSA compatible health plans do not allow any first dollar benefit coverage (except for preventive care which is covered in full) and the drug benefit of the plan must be part of the medical benefit plan and subject to the medical deductible.  

Compatible health plans allow for the establishment and funding of a Health Savings Account (HSA) with an account provider like a bank, credit union or investment firm.  Think of the HSA as a medical IRA account.  Contributions can be tax deductible and funds can be used to pay medical expenses of the health plan as well as many expenses not part of the health plan such as dental, vision and so on.

Anyone wishing to purchase or continue an HSA compatible health plan will have to purchase a plan in the private market (if HSA plans are provided in that market).  Those eligible for subsidy from Covered California will either have to forego an HSA plan to obtain subsidy or choose to lose out on the subsidy to purchase in the private market.

I believe the logic of this move is that high deductible HSA compatible health plans offered inside of the exchange may entice individuals and families with high subsidy levels to purchase them to further reduce their premium outlay while not being able to afford the expenses of either funding an HSA or paying for services under the high deductible.

Dave
www.davefluker.com

Covered California Agent Certification and Rules

New information provided recently by Michael Lujan of Covered California as it pertains to agent/broker certification to sell exchange plans.

Initial exchange certification training for agents will be sometime in September with an August registration sign-up period.  The initial training will be classroom only training, there will be no online training program available until sometime in November at the earliest.  Agents wishing to certify with Covered California will have to sign up for and attend an 8-hour classroom training and pass an exam at the end of the class.  CE credits are intended to be made available for the class.

Additionally, a second online training segment for the CalHEERS program (helps determine subsidy eligibility and enrollment choices) will need to be completed after the classroom training and will be from 2-4 hours online.

Agents are looking at approximately 12 hours of training to certify with Covered California.

The exchange will provide certified agents with a "good housekeeping" logo/symbol to use on marketing materials indicating that the agent is a Covered California Certified Agent.  

Dave
www.davefluker.com

Covered California No Direct Web Interface for 2014

Covered California Individual Exchange will not provide web-based agencies with a working direct enrollment link to the exchange for the initial open enrollment beginning October 1, 2013. As such, enrollments will require agents to do them "on manual" via a Covered California agent web link either in person or via telephone/e-mail communication.  Only Covered California Certified Agents will be able to access the exchange to assist with enrollment.

I think this is very good news and am sure that there will be many web-based agents/agencies who do not like this decision.  It will take the enrollments in a very complicated environment out of the "click and buy" agencies and put them in the hands of agents willing to work one-on-one with individuals and families to assist with enrollments.  

Agents will be able to assist with enrollments into the exchange via the web using a special link to Covered California that will attach the agent/broker information to the initial application. Online enrollments will be desired due to the speed of approval versus paper applications (some may still want to do the paper application as well).  The process involves first applying with the exchange for permission to purchase a plan and then, upon verification and approval from Covered California, the individual or family can select and enroll in the actual health plan.

In a recent USA Today article, web broker e-healthinsurance complained about not having direct interface with the exchange to enable "click and buy" shopping.  Such is the nature of the new market and it will require a lot more hands on contact than simply "point and click" plan sales.   Agents who are not "web based entities" will face a similar issue as the online quoting services we use (Quotit, Norvax, HealthConnect, ZapQuotes, etc.) will similarly be restricted from providing agents a direct link into the exchange.  

Outside of the exchange it will business as usual with carrier-direct online applications just like it is today.  For Covered California enrollments, it is important to understand and I believe that a significant number of individuals and families, perhaps even the majority, have little or no experience buying a health insurance plan and will need quite a bit of guidance and direct help.  

So, for 2013 open enrollment the only place to click and apply will the Covered California web site and you can (at no added cost to you) get the assistance of a veteran health insurance agent who has obtained the Certified Designation to navigate through the process of obtaining a new health plan under ObamaCare in California.

Dave
www.davefluker.com

"ObamaCare" Small Ball––The Republicans Are Winning the Battle Over the Big Idea

Last week the President waded directly into the national debate over "ObamaCare" by calling a big media event in the East Room of the White House to talk about the $100 rebates a small percentage of potentially eligible people are getting under the new health law.

Senate Republican Leader Mitch McConnell countered, "If you’re a family in Covington facing a $2,100 premium
increase under

Anthem Blue Cross Spurns CA SHOP Exchange

Anthem Blue Cross (Blue Cross of California) announced today that the carrier will not participate in the Covered California SHOP (Small Business Health Options Program) Exchange in 2014.  This leaves Blue Shield of California as the lead Blue carrier in the public small business exchange market (same as it was under "PacAdvantage" exchange (HIPC) which collapsed when Blue Shield pulled out some years ago due to inability to meet low premium price points).

Anthem Blue Cross CA will continue to sell health plans to small businesses outside of the SHOP and also will continue to participate in the California Choice (CalChoice) small business private exchange.  

It should be noted that employers purchasing small group coverage plans from CalChoice Exchange will have the ability to offer multiple tiers to employees, whereas the SHOP exchange will require all employees to participate only in a single benefit tier (Platinum, Gold, Silver, Bronze) offered by the employer at the time of enrollment. SHOP does not allow movement up or down in tiers even at the employee's expense.

Recently Insurance Commissioner Dave Jones requested that Anthem Blue Cross be barred from participation in the SHOP exchange.  Anthem says that Jones has nothing to do with the decision.

Dave
www.davefluker.com

SIM planning Committees Missing True Consumer Representation

The SIM (State Innovation Model) grant process is well into its final development and consumers are not at the table. In March, CT received millions of federal tax dollars through SIM to completely restructure the health care system that covers at least 80% of state residents. The final model design is due to the federal government in just a few weeks. Of the 75 SIM committee seats defining that health care system model, only three represent consumers of health care. Consumers/taxpayers are the ultimate funders of our health care system, and unlike other stakeholders, more than our incomes are impacted – our lives depend on a functional system. With only three seats for consumers, you’d think that they’d be filled by true consumers and independent advocates, those with direct knowledge of the challenges the SIM needs to address. Unfortunately, that is not the case. Since the implementation of health care reform began in Connecticut there has been a very obvious and, in my opinion deliberate, movement to exclude consumers from the decision making process. So few seats being allotted by the SIM committee organizers and the individuals chosen continue the lack of consumer input to our health care system. Connecticut is rich with passionate consumers and knowledgeable consumer advocates. Knowledge, experience and passion that are all being wasted. One would think the SIM leadership would want the very best input from all stakeholders, especially consumers, at the table to develop the best possible product. I guess not. Kevin Galvin Small Business for a Healthy CT

People Who Haven't Filed a Tax Return to Get Unverified Health Insurance Exchange Subsidies

The head of the Centers for Medicare and Medicaid, Marilyn Tavenner, is out with a "Myths vs. Fact" clarification memo regarding the waiver of the employer mandate and whether the new health insurance exchanges will verify people's incomes when calculating subsidies.

I noted a couple of things in her memo.

Her memo indicates that the exchanges will request additional income information from a "

Beware ObamaCare Scams

As we move closer to the initial open enrollment, it is important to be aware of the current and potential scammers out there who will use ObamaCare to try and obtain your personal information and/or money.

Because it has not yet been clarified with regard to Navigators and Assisters (not Agents) using telemarketing and/or e-mail marketing, you may not really know who is contacting you with regard to new health insurance.  

Licensed agents can be verified both with Covered California (if they are certified) and on the CA Dept of Insurance web site on the "Check License Status" tab at the top.  Navigators and non-agent Assisters will most likely be verifiable through Covered California (at least I would hope so).  

Also, the changes under ObamaCare have little direct impact on Medicare beneficiaries and, as such, anyone calling you about changes to Medicare due to the implementation of ObamaCare may be running a scam.  I can't stress enough how important it is and will be in October for each individual and family to decide, based on their own research, who they want to work with to purchase a new health insurance plan under ObamaCare.  

Some things to watch out for:

*If anyone calls you and says they are from "ObamaCare", be very suspicious.  

*If anyone contacts you and says you need to pay them money, or that they will get you an ObamaCare ID Card or that they need any of your personal/financial information, be very suspicious.

*If anyone contacts you and tells you that you need to buy an ObamaCare plan from them right now or you will be jailed because "it's the law now", hang up immediately.

*If anyone contacts you stating that they need your Medicare and personal information because "change is on the horizon" or something similar, be very suspicious

I am sure that there will be additional and more creative scams unleashed on California residents leading up to the October open enrollment and likely through the open enrollment.

The simplest way to avoid any potential scam is to decide who you want to help you with your health insurance coverage, be it Covered California, Private Market or Medicare Supplement/Advantage plan.  If you know who you are working with ahead of time, you won't be susceptible to any potential ObamaCare scams.

To quote the old Hill Street Blues TV show, "Let's be careful out there".



Dave
www.davefluker.com

Health Insurance Exchange Subsidies Will Be Granted on the Honor System!––Is There Something Wrong With "ObamaCare's" Federal Data Hub?

Come October millions of people will be applying for tens of billions of dollars in federal health insurance premium subsidies on the honor system.

On the Friday after the Fourth of July––when the administration apparently hoped no one would be paying attention––the Obama administration dropped 606 pages of regulations. Buried inside was the news that that insurance exchanges can ignore any

Administration Delays the Employer Mandate––But What About Small Employers?

The administration suddenly announced tonight that the requirement that all employers with 50 or more workers offer health insurance has been delayed until 2015.

If an employer with 50 or more workers did not provide health insurance to their full time workers in 2014, they would have been subject to a fine of $2,000 per worker. The employer would have also been subject to a $3,000 fine for each

ObamaCare Employer Provision Delayed Until 2015

The provision of the Affordable Care Act (ObamaCare) requiring employers with 50 or more employees to offer health insurance or face a penalty per employee has been pushed back one year.  It will not be implemented until 2015.  

(see CNN Article)

ObamaCare requires employers with 50 or more employees to provide health insurance coverage to all full-time employees.  Should an employer not meet this requirement, the penalty imposed would be $2000 per employee starting with the 30th employee.  Many businesses have claimed difficulty with meeting the reporting and compliance requirements beginning on January 1 and some have begun to reduce hours of employees as well as cease or severely constrict hiring of new employees.

No doubt between now and 2015 we may well see additional changes to this part of Obamacare to encourage hiring and discourage hour reductions.  

At any rate, businesses with 50 or more employees now have an extra year to get ready for whatever the final ObamaCare requirements will be.

This action does not impact small businesses with less than 50 employees nor does it impact the individual & family health market.

Dave
www.davefluker.com

United Health Leaving California Individual Market

Following Aetna's announced withdrawal from the California individual & family market, United Health has announced that it plans to leave the California market on 12/31/13.

(see LA Times article)

Approximately 8,000 members will be effected by this withdrawal and have to purchase new, Obamacare-compliant health coverage from one of the remaining health insurers in 2014.

Unlike Aetna which sold individual & family health plans in California under it's company brand, United Health has not sold branded coverage plans to the California individual & family market. Instead they have sold through two subsidiary carriers--PacifiCare and Golden Rule. 

In any case, both Aetna and United Health cannot re-enter the California individual health market for five years once they withdraw.

Dave
www.davefluker.com