Covered California Open Enrollment Notices

Members will receive Covered California open enrollment instructions over the next two weeks, informing them of the Renewal Process.  If you need assistance understanding the 2015 changes, click here to request help.  Read story, If you want to review details about last year’s open enrollment or just get a free quote at this website.

Due to an online systems limitation from October 13 to November 3, 2014 only, you will be unable to login to your account in order to report changes for the 2014 plan year.  Covered California has developed a work-around during this period and you can receive assistance from Certified Insurance Agents here.

Remember, Open Enrollment begins November 15th:  Changes are coming to certain PPO networks.  If you did not use a Certified Agent last year, now is a good time to find one…they are a free service of Covered California and are here to help.

Breaking News: COBRA Coverage California Open Enrollment May 15 – July 15

Beginning Thursday, May 15, Covered California will launch a limited-time special-enrollment period for people who have COBRA health insurance, either Federal COBRA or Cal-COBRA (COBRA Coverage California), and would like to switch to an exchange plan.

People who have health coverage through COBRA (the Consolidated Omnibus Budget Reconciliation Act) will be eligible to shop for and buy coverage through Covered California from May 15 through July 15, including local assistance from Certified Insurance Agents, at no additional charge.  The two-month window mirrors a U.S. Department of Health and Human Services (HHS) ruling announced May 2 that allows COBRA enrollees to buy plans through the federal exchange up to July 1.

Read the full press release here or jump ahead for a Rate Quote, right now!

Open Enrollment Closed March 31, 2014

We heard the Website is overwhelmed.  CoveredCA put out a message to agents, today that Paper Applications may be completed and signed and faxed to the following phone numbers, BY March 31, 2014:

FAX NUMBERS FOR COVERED CALIFORNIA PAPER APPLICATIONS:  1-888-329-3700 OR 1-916-636-3400.  Frequently, you get the “all circuits are busy” signal.  Unfortunately, the State of California did not plan adequately.

Paper Application

Customer Service:  1.800.300.1506

Website Problems Challenge December Deadline For California Individual Family Enrollment

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For January 1st coverage, the December deadline for California Individual Family enrollment is just days away, yet the Covered California website is down for repairs.  Fortunately, you can download an application today, and even request free assistance from a local Certified Insurance Agent.

FREE RESOURCES FROM COVERAGE CALIFORNIA:

Already started an online application, but frustrated with results?  Get free help from a San Francisco bay area Certified Insurance Agent.  How?  Beginning November 26, 2013, simply login to coveredca.com and follow the instructions below:

GETTING HELP IF YOU HAVE ALREADY REGISTERED ON COVERED CA

  1. CLICK “Find Help Near You” in the upper right corner
  2. CLICK “Find An Agent”
  3. CLICK the name search box and type in “DEREN”
  4. CLICK on the search results for “Marc Derendinger”
  5. CLICK the “Continue” button
  6. CHECK the 3 agreement boxes and Accept this person as your designated agent.

Don’t worry, you can change or revoke this designation at any time, but the benefit to you is getting access to a personal advocate with 30 years industry experience…free of charge!

Now that you have completed the designation, call us and we start helping you right away!

408.475.8219

California Marketplace

2014 Health Plan Options For Californians

For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.  Have an individual Kaiser plan?  Read this article.

Got questions? Frustrated with the Affordable Care Act?  Life’s too short to waste time with all this:  Request free consumer assistance from Certified Insurance Agents, below:

https://coveragecalifornia.eventbrite.com/

 

Treasury Department Changes “IRS Use It Or Lose It” Rule

We heard rumors the IRS would modify or eliminate it’s Section 125 forfeiture requirement, also known as the “IRS use it or lose it” rule, in Flexible Spending Account (FSA) plans.  Well, the news is out:

October 31, 2013, the Treasury Department issued Notice 2013-71, providing employers more flexibility with medical reimbursement accounts.  Effective with 2014 plans years, plans that do not offer a grace period, may allow up to $500.00 to roll-over.  Currently, left over balances are forfeited to the plan (which often falls under the indirect control of the employer).

The key elements in this IRS Use It Or Lose It notice are 1) the $500 carryover is an alternative to the existing grace period rule, and 2) the plan must be amended in a timely manner.  Talk to your Section 125 administrator or employee benefits broker or attorney, for more details. For a copy of this notice, click here.

For a big picture look at the effect of the Affordable Care Act in California, read our related story.

For additional employer requirements under the Affordable Care Act legislation click here.  For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.

Got questions? Request free consumer assistance from Certified Insurance Agents, below:

https://coveragecalifornia.eventbrite.com/

 

Affordable Care Act “ACA Tax” Beats Up California Employers

New Health Insurer Tax, Exchange Tax, Transitional Reinsurance Tax, and Risk Adjustment Tax

The name for each ACA Tax begs the question: “Why are Employers paying for these taxes?”  The public perception, at least in California, is the ACA Tax is a health insurer tax, right?  Effective October 28, 2014, Blue Shield of California notified all small business customers that this ACA Tax is being passed through to employer group plans:

“Today we are mailing a letter to all of our small business customers renewing from February to December 2014 to notify them of the upcoming 2014 taxes and how they will impact their dues and/or premiums.” [Blue Shield of California letter to policyholder, October 28, 2013]

California Marketplace

The Affordable Care Act hits California employers hard

ACA Tax (Part I):

“Beginning on January 1, 2014 the health insurer tax and transitional reinsurance tax will be added to your base medical rate and you will see the increase on your bill.”

  • Health Insurer Tax – est.  1.3% of premium
  • Transitional Reinsurance Tax – est. 2.3% of premium

In addition to this ACA tax cost, two additional Affordable Care Act taxes will be added effective with your 2014 group anniversary date, and will become part of the group premium rate:

ACA Tax (Part II)

  • Exchange Tax – est. .2% of premium
  • Risk Adjustment Tax – est. .02% of premium 

For a big picture look at the effect of the Affordable Care Act in California, read our related story.

For additional employer requirements under the Affordable Care Act legislation click here.  For rate comparisons of new group health plans, click here.  For non-group e.g. individual family plans click this link.

Got questions? Frustrated with the Affordable Care Act?  Life’s too short to waste time with all this:  Request free consumer assistance from Certified Insurance Agents, below:

https://coveragecalifornia.eventbrite.com/

 

 

Calculating Premium Assistance Subsidy Eligibility For The Covered California Advance Premium Tax Credit

CovCalHorz-328px

 

Do I Qualify To Have Premium Assistance Subsidy Eligibility?

(Use this chart as an estimate, but eligibility varies by age, income and region)

                        CoveredCA-ComparisonChart  Download a Paper Application                            

Number of people

in household

2013 annual family income

levels to qualify*

1

$45,960 or below

2

$62,040 or below

3

$78,120 or below

4

$94,200 or below

5

$110,280 or below

6

$126,360 or below

7

$142,440 or below

8

$158,520 or below

* 2013 modified adjusted gross income levels are the latest available; assistance will be based on estimated 2014 modified adjusted gross income. Chart estimates of premium assistance subsidies are courtesy of Kaiser Permanente.  *Contact a local Certified Insurance Agent to learn about additional eligibility requirements, click here or download a Download a Paper Application.

 

 

26 Year Old Rate Premium Assistance Subsidy Example

(Premium Assistance Subsidy is provided in the form of a

Covered California Advance Premium Tax Credit)

CoveredCA-ComparisonChart

Kaiser Permanente

Low Cost Plan

(Monthly Premium Includes Subsidy)

2013 Annual Family Income

Qualification*

$323/mo.

$34,000

$167/mo.

$32,000

$143/mo.

$30,000

$119/mo.

$28,000

$93/mo.

$26,000

$66/mo.

$24,000

$38/mo.

$22,000

$9/ mo.

$20,000

(Assumes the Covered California Kaiser Bronze Plan, enrolling a single 1 person household, living in San Jose, California (Santa Clara County), eff. 1/1/14.  For additional articles about Kaiser Permanente and the Affordable Care Act, Click Here.) 

*Contact a local Certified Insurance Agent and to learn about additional eligibility requirements or Download a Paper Application.

                                                                  CoveredCA-ComparisonChart

 

 

 

55 Year Old Rate Premium Assistance Subsidy Example

(Premium Assistance Subsidy is provided in the form of a

Covered California Advance Premium Tax Credit)

CoveredCA-ComparisonChart

HealthNet PPO*

Silver Plan

 (Includes Subsidy)

2013 Annual Family Income

Qualification**

$156/mo.

$20,000

$179/mo.

$22,000

$215/mo.

$25,000

$280/mo.

$30,000

$348/mo.

$35,000

$387/mo.

$40,000

$427/mo.

$45,000

$670/ mo.

$50,000

(Assumes the Covered California HealthNet PPO Silver Plan, enrolling a single 1 person household, living in San Jose, California (Santa Clara County), eff. 1/1/14)

*The HealthNet PPO has the broadest provider network in selected regions.

**Contact a local Certified Insurance Agent and to learn about additional eligibility requirements or Download a Paper Application

CoveredCA-ComparisonChart

California Marketplace

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Obamacare Penalty Tax

 

 

 

 

 

An Obamacare Penalty Guide For All California Residents

By Marc Derendinger

The purpose of this article is to help individuals, families, and early retirees take full advantage of the initial Affordable Care Act (ACA) Open Enrollment season, and avoid mistakes that could cost you money and opportunity.  This is a good reference article, so retain it until you need it.

 2014 California Health Insurance Requirement

  • Beginning January 2014, most people will be required to have public or private health insurance or pay a financial penalty aka the Obamacare Penalty Tax.
  • Parents with children who are tax dependents will be responsible for making sure their children comply or also face penalties.

[Note: If you are a small business or employer representative researching your obligations under the new law, click here.  The remainder of this article is intended for California individuals and families.]

 What Is The Obamacare Penalty For Not Having Health Insurance?

  • In 2014, individual penalty is the greater of 1% of the family income above the tax filing threshold or $95 per adult and $47.50 per child (max $265 per family).
  • By 2016, the maximum penalty grows to the greater of 2.5% and $2,085 per family. 
  • Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.
  • CoveredCA-ComparisonChart and Paper Application

How will mandatory health insurance and the Obamacare penalty tax be enforced?

The IRS will administer such penalties on personal tax returns.  Besides the Obamacare penalty aspect, there is also some positives, deserving mention:  Follow the actual experience of an Agent’s first week of Obamacare on this Prezi:  My First Week of Obamacare Open Enrollment

In summary, avoid mistakes that can cost you money and opportunity.  Insurance issues should be reviewed with a local Certified Insurance Agent. There is no additional cost and the benefit to you is access to professional guidance. You may be surprised to learn the advance premium tax credit negates much of the cost of coverage, and you avoid the Obamacare Penalty. Find a local Certified Insurance Agent here or Download a Paper Application. Of course tax issues should be reviewed with your tax advisor.  Here is a resource from the IRS: IRS Affordable Care Act Tax Provisions.

Editor’s Note:  Marc Derendinger has 30-years experience in the California health insurance marketplace and serves on the agent advisory group for the State of California Department of Healthcare Services California Partnership for Long-term Care.  His insurance brokerage is located in San Jose and advises many well-known organizations e.g. San Jose Police Officers’ Association, City of Campbell, City of Santa Clara, plus individuals and family businesses throughout Northern California.  California License No. 0563986

 

 

 

 

 

Obamacare Rate Guide

Obamacare Rates and Subsidies (Tax Credits)

27 Year Old Obamacare Rates For Santa Clara County (California)

AGE 27 *                                        CoveredCA-ComparisonChart
2014 Metal Tiers

Least Expensive Insurer

Most Expensive Insurer

Bronze 60

$208/ month

$250/ month

Enhanced Silver 70

$279/ month

$317/ month

Gold 80

$330/ month

$386/ month

Platinum 90

$371/ month

$451/ month

Participating Insurers

Anthem, Blue Shield, HealthNet, Kaiser, Valley Health Plan

*Data estimated with Covered California Rate Calculator- September 2013

Do you want to see specific rates for you and your family? Once of the unique features of the Covered California Obamacare rate structure is each person in your family is allowed to choose a separate plan.  For assistance with calculating rates for members of your family, we suggest you use a local Certified Insurance Agent to save time and avoid costly mistakes. Request a session with one here or Download a Paper Application.

Obamacare Rate Subsidies (Premium Assistance)

According to Covered California, individuals earning under $46,000 have a chance to receive premium assistance, based on family income, as estimated in the following chart.

AGE 27 *                              CoveredCA-ComparisonChart
2014 Metal Tiers

Monthly Premium Assistance

Premium Assistance Can Be Applied To Any Public Exchange Plan, But Not The Private Market

$10/ hour 40 hrs./wk.

$188/ month

Covers about 90% of lowest cost Bronze Plan.
$12/ hour 40 hrs./wk.

$138/ month

Covers about 50% of lowest cost Silver Plan
$14/ hour 40 hrs./wk.

$84/ month

$16/ hour 40 hrs./wk.

$27/ month

Participating Insurers

Premium Assistance can be applied to all health plans in the California public exchanges, but does not apply to plans in the private marketplace

*Data estimated with Covered California Rate Calculator- September 2013

Who pays for premium assistance?  Federal dollars pay for the first two years.  By 2016, California exchanges must be self-sufficient.  California may charge fees to insurance companies to make exchanges self-sufficient.  Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.

Another Form of Obamacare Assistance: Cost-Sharing Reduction

Public healthcare exchanges offer a second type of Obamacare rate assistance, in the form of lower copayments and lower out-of- pocket costs. These are referred to as Cost Sharing Reductions.  For example, if your income falls between 100% and 250% of the Federal Poverty Line and you enroll in the Silver 70 plan, you will receive enhanced coverage ranging from 73% to 94% of actuarial value.  The regular Silver plan provides approximately 70% actuarial value.  The best example of how this benefits you would be the resulting reduction of copayments i.e. your Primary Care office copayment would decrease from $45 to $40, $15, or even $3 based on income.

Do you need help understanding your premium assistance rate subsidy?  Do you want to ask additional questions about the Cost-Sharing Reduction or CSR?

These are questions that are best addressed with your local Certified Insurance Agent. When you seek help through a Certified Insurance Agent, there is no additional cost.  A further benefit to you is access to professional guidance as you use your new plan or in the event you wish to change plans later.   Consider this an essential tool to choosing the right plan, and avoid waiting until the next open enrollment to make things right. 

Download a Paper Application for all Covered California metallic plans.  Did you know certain Kaiser members may qualify for premium assistance, too?  Read the story here.

Editor’s Note:  Marc Derendinger has 30-years experience in the California health insurance marketplace and serves on the agent advisory group for the State of California Department of Healthcare Services California Partnership for Long-term Care.  His insurance brokerage is located in San Jose and advises many well-known organizations e.g. San Jose Police Officers’ Association, City of Campbell, City of Santa Clara, plus individuals and family businesses throughout Northern California. License No. 0563986.

 

 

 

 

 

 

 

Obamacare California: The Big Picture For Coverage In California

California Marketplace

What is really happening in the Obamacare California Marketplace?

By Marc Derendinger

Let me start by framing this up in a big picture:  The changes to the California health insurance industry can be characterized as a restructuring of the existing market, not a destruction.  Under the new structure (Obamacare) California private insurers continue to operate and will offer services through the following channels:

  • Existing distribution network
  • Private healthcare exchanges
  • Public healthcare exchanges (individual & small business)

It’s news to many, but there is truly no “government Obamacare plan” in California. In some respects, this is a private market solution to public needs:  For example, private health plan insurers who participate in the public exchanges are serving three markets needs:

  1. Applicants who earn over 400% of the Federal Poverty Level (FPL)
  2. Applicants who earn between 139%- 400% of FPL
  3. Medi-Cal (up to 138% of FPL) 

In the new Obamacare California health plan structure, the healthcare exchange serves the function of “a starting point” for all 3 markets, and can be useful later in moving families off Medi-Cal and transitioning them back to the “premium-paying” world. It does not replace the private market, rather it complements it. Under the current system, it is a costly leap for Medi-Cal recipients to enter the private pay insurance world.  Time will tell if the new structure helps reduce costs or is negated by the cost of new subsidies.

Do you qualify for lower rates with a Premium Assistance Subsidy?  Find out here.

There are additional details covered by the Obamacare Rate Guide and California Buyer Guide, but you should also seek out your local Certified Insurance Agent. There is no additional cost and the benefit to you is access to professional guidance, as you use your new plan or in the event you wish to change plans later.   Compare the new health plans here:  CoveredCA-ComparisonChart and Paper Application.

Editor’s Note:  Marc Derendinger has 30-years experience in the California health insurance marketplace and serves on the agent advisory group for the State of California Department of Healthcare Services California Partnership for Long-term Care.  His insurance brokerage is located in San Jose and advises many well-known organizations e.g. San Jose Police Officers’ Association, City of Campbell, City of Santa Clara, plus individuals and family businesses throughout Northern California.California License No. 0563986