Monthly Archives: November 2015

Shopping California Health Insurance

Shopping California Health Insurance? Smart consumers with existing insurance policies are returning to the California group insurance market.  Don’t be stuck with your plan for another year.

Shopping California Health Insurance Locally

View online pricing, free of charge.

New Sutter Health Plan Includes PAMF Doctors

PAMF doctors are found in few health plans in Covered California. Even if you go to the individual private market, PAMF doctors are found in one or two individual plan plans, if you are lucky.

Exciting news is…in 2016, a new Sutter Health Plan will include PAMF doctors in many parts of the bay area.

Rates, PAMF Doctors, and More

Get rates and Download the Application.

Additional Sutter Health Plan Resources:

  • Side By Side Quick Comparison of Sutter Health Plan Options
  • Download and Review a sample Individual Bronze Plan EOC
  • Download and Review a sample Individual Silver Plan EOC
  • Download and Review a sample Individual Gold Plan EOC
  • Download and Review a sample Individual Platinum Plan EOC
  • Download Enrollment Guide
  • Download the Application
  • Get Rates

or view online pricing, free of charge


Sutter Health Plan has Affordable Coverage

If you’re looking for affordable health care coverage, Sutter Health Plus offers a variety of HMO products for individuals and families in Northern California.

The doctors, hospitals and other service providers in network (e.g. PAMF) have a strong commitment to personalized, convenient, high-quality care.

Sutter Health Plus membership has its benefits, including access to:

  • A nationally recognized network of local providers and hospitals e.g. Palo Alto Medical Foundation
  • Comprehensive medical benefits
  • Pharmacy coverage
  • A 24/7 nurse advice triage line
  • Wellness
  • Free preventive care services, e.g. annual well visits, immunizations
  • Coverage for emergency care anywhere in the world
  • My Health Online allows members who chose a provider (who offers this service) to schedule appointments, email doctors, view test results etc. There is also a mobile app

Watch the Health Online Video

As the individual marketplace continues to deteriorate, the small group market has gained a firmer footing, including stable PPO networks and easier participation rules with Kaiser and traditional PPO plans.  Is it time to review available small group plans?

View online pricing, free of charge

9 Risk Factors Applying To Covered California

In addition to the advantages, we have documented at least 9 disadvantages i.e. 9 risk factors applying to Covered California.  Despite limited media attention, these factors require caution and understanding, because of the potential for problems after you apply to Obamacare.

9 Risk Factors Applying To Covered California

9 Risk Factors Applying To Covered California

We encourage California residents to study the balance of this report carefully, in order to make the best decision for your family.

9 Risk Factors Applying To Covered California

9 Risk Factors Applying To Covered CaliforniaDescription of RiskPossible Solution
Risk Factor 1The State of California (via county social services agency) verifies the financial information on your CoveredCA application and has the power to make you “ineligible” for CovCA insurance if there are discrepancies between the application, filed income tax returns, immigration documents etc.Understand that CovCA uses last year’s tax return information to estimate your APTC subsidy, however the true amount will not be known until you file this year’s tax return. Work with a Certified Agent who can discuss these issues with you.
Risk Factor 2The verification of your application occurs during an indeterminate period of time, usually between January and August, but usually after you have cancelled your former insurance.
Risk Factor 3A frequent and undesirable outcome of the agency’s application verification process is that your insurance is revoked and you are temporarily placed in Medi-Cal, pending approval by a Medi-Cal eligibility case worker. Medi-Cal representatives will use the authority of the State of California to issue a system-generated freeze, named “soft-pause” on your file at CovCA. It effectively prevents Covered California IT engineers from “fixing” or undoing this Medi-Cal action. Your only recourse is to personally visit the county social services agency and attempt to determine the identity of your case worker, and then to arrange a meeting in the hope of opting out of Medi-Cal.
Risk Factor 4Placement into Medi-Cal, outside of “open enrollment” season is not a qualifying “special event.” This prevents you from re-applying elsewhere, since no health plan will accept your application until the next open or special enrollment.If this occurs during an open enrollment period, you can re-apply directly to Kaiser or another health plan. Otherwise, you will have to stay on Medi-Cal until the next Open or Special enrollment period.
Risk Factor 5Involuntary loss of health insurance could result in losing access to your personal physician(s).There is really no remedy, except to find a Medi-Cal doctor or specialist and transfer your chart.
Risk Factor 6Involuntary placement into Medi-Cal mid-year could occur during a course of treatment, surgery etc.We have observed cases where this has happened, and it is unfortunate.
Risk Factor 7Split Family Coverage: Since Medi-Cal eligibility for children is at 250% of FPL, compared to 138% for Adults (in most cases), a common outcome of a family application is that the adults are processed for CovCA insurance with a subsidy, but the children are declared ineligible and are pended for Medi-Cal.Work with a Certified Agent who can estimate the probability of this occurrence and will be prepared to submit child-only applications directly with the insurance carrier (off-exchange) to avoid Medi-Cal. It may be necessary to submit dual applications (on and off exchange) if the open enrollment deadline is near.
Risk Factor 8f your income increases during the year, your APTC subsidy could be less, resulting in you having to repay the IRS for part or your entire APTC subsidy.Ask your Certified Agent to lower the monthly APTC subsidy to give a safety margin. When you file your tax return, you will get the difference paid to you, assuming you are eligible for it.
Risk Factor 9If the IRS determines you were eligible for qualified, affordable employer-sponsored health coverage, your APTC subsidy will be reversed, subjecting you to penalties and interest.When an employer offers an employee health insurance, a report is sent to the IRS, identifying the employee by name and social security number, even when you decline the coverage. This is how the IRS cross-checks this information. If you declined coverage, you may still qualify for the subsidy via an exception. Work with a Certified Agent or your tax preparer to see if you qualify for the exception.

Caution is advised when you buy Obamacare through CoveredCA. To read more about the pros and cons of Covered California in general, and whether you should buy the Obamacare Kaiser plan, read this story at

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