Category Archives: California Rate Quote Calculator

How to get a premium rate quote for affordable health insurance in the Covered California health insurance benefit exchange marketplace.

Blue Shield PPO replaces Anthem Blue Cross

Blue Shield PPO replaces Anthem Blue Cross on January 1, 2018, as the only major medical PPO plan in Santa Cruz, San Benito and Monterey counties, according to statements released by Anthem and Covered California.

Which Counties will Anthem keep?

(Anthem will not offer individual policies in Santa Cruz County. Refer to related story…)

Even Kaiser Permanente is jumping on the chance to add new subscribers in selected zip codes of Santa Cruz county [see related Kaiser Story].

Blue Shield replaces Anthem Blue Cross- Kaiser is an option

Blue Shield PPO replaces Anthem Blue Cross?

“Our readers would ask why is the Blue Shield PPO the best option to replace Anthem?”

According to Covered California’s August 2017 published report, “Covered California’s Health Insurance Companies and Plan Rates for 2018,” Anthem held 39% of its 29,050 individual health policies in Region 9 (Santa Cruz, San Benito and Monterey counties):

Blue Shield PPO replaces Anthem Blue Cross

  • 39% Anthem
  • 34% Blue Shield PPO
  • 8% Blue Shield HMO
  • 2% HealthNet EPO
  • 17% Kaiser Permanente HMO

Effective January 1, 2018, Blue Shield appears to be the only individual PPO plan available through Covered California.  In fairness to HealthNet, they offer an EPO plan.  Request a FREE Free Rate quote between Blue Shield and HealthNet.

 

Is Blue Shield PPO Really Your Best Option

The 2018 rates are not released yet, but Blue Shield has filed two sets of rates for the upcoming open enrollment, depending on whether or not CSR funding is approved in Washington.

Sample 30 year-old 2018 Premium for Blue Shield’s Silver 70 PPO:
Without CSR Subsidy Funding                    Including CSR Subsidy Funding

$609.49 monthly (2018)                            $562.63 monthly (2018)

To compare the current (2017) year premiums in your county, use this free quote engine.

 

 

 

Re-Shopping Obamacare For Better Covered CA Insurance

New York Times writer, Margot Sanger-Katz is suggesting consumers should be re-shopping Obamacare coverage. The article argues the savings could be substantial. Even the Health and Human Services agency discovered last year that “Returning Consumers Who Shop Save Money.”

Re-Shopping Obamacare

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

“Returning Consumers Who Shop Save Money.”

Re-Shopping Obamacare

Re-Shopping Obamacare

3 Actions To Keep Affordable Health Coverage- Private Insurance

The previous articles covered Part I and Part II, and this final segment describes the 3rd of 3 Actions To Keep Affordable Health Coverage- Private Insurance. [Small Employers should read about huge penalties beginning August 2015]

  • Going directly to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.
  • In our opinion, the only reason one would choose the Covered California exchange (Part II of story) over your 3rd option (private insurance) is the likelihood of receiving a subsidy or Advance Premium Tax Credt. Otherwise, CoveredCA is not worth the hassle, due to the burden of providing tax forms, proof of California residency, employment information etc.
  • Deadlines: Regardless of your choice among the 3 Actions To Keep Affordable Health Coverage, the 60 day limit applies.

    Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. Read more about Special Events here or request assistance.  

    Need Temporary Health Insurance?   CLICK TO QUOTE

In conclusion of this 3-part article, the easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage form to the carrier (the specific document and method vary by health plan). Don’t risk losing your effective date, use a competent broker who is licensed and certified to help you compare your options under all 3 alternatives above, and will help you submit a properly completed application to the health plan of your choice!

Certified Insurance Agents are a free service to consumers under the ACA and California law. However, the best certified agents will also help you compare your private insurance (PPO, HMO) options vs. your CoveredCA options.  Find a local office of one of these broker-agents, in order to keep affordable health coverage while looking for a job.

Click to return to Part I or Part II of this article.

3 Actions To Keep Affordable Health Coverage While Looking For A New Job

Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. In this three-part series, here are 3 important steps to find or keep affordable health coverage under the Affordable Care Act:

  1. If all else fails, use CAL-COBRA or Federal COBRA as a backstop, although it may not be the lowest price option: Warning, there is a maximum 60 Day Time Limit To Respond or you could lose your COBRA rights and eligibility;

Failure to enroll within the special 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st!  (This is a lessor known problem with the Affordable Care Act).  Read more about Special Events here or request assistance.

If you cannot afford the high cost of COBRA premiums, and really want the most affordable health coverage, then CoveredCA, the Covered California health exchange market may work better for you. Read about the pro’s and con’s of CoveredCA in Part II of this series, or proceed to Part III, “Private Insurance” options.

 

 

Proceed to Part II of this article or skip to Part III.

Leaving School: 2 Actions To Find Affordable Health Coverage

Time is of the essence in order to maintain or find affordable health insurance when leaving school.   You must take action fast or risk being “locked-out” of the health insurance market for several months, due to a little publicized defect in the Obamacare legislation. We suggest 2 actions to find affordable health coverage when leaving school, which have been made possible under the Affordable Care Act:

Need Temporary Health Insurance?   CLICK TO QUOTE

First, if you have not yet turned Age 26 and have been covered on your parent’s health plan, the Affordable Care Act  allows you to continue on through age of 25.  Is this your best option? Maybe, but there are two reasons to look at other options available through the Affordable Care Act:

  • Your parent’s health plan may have limited medical facilities e.g. Kaiser where you live, or
  • The monthly insurance rate may be lower through Covered California with a subsidy, if you qualify

Second, the following are two new options made available through the Affordable Care Act:

  1. Covered California provides access to most private health plans e.g. Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, HealthNet EPO and PPO plans and some regional providers as well (availability varies according to each of California’s counties- these folks will give you free assistance).

    Extra caution is advised, however:  You must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage, plus a 60-Day time limit applies. Warning: failure to enroll within the special 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st! (This is a lesser known problem with the Affordable Care Act) Read more about your special enrollment qualifying event here;

  2. Apply Direct- to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.

The only reason you would choose the Covered California exchange (above) over this 3rd option is if you were to qualify for a subsidy or Advance Premium Tax Credit. Otherwise, CoveredCA is not worth the hassle of providing personal tax forms, proof of California residency, employment information etc.

  • Deadlines: The same warning applies as above i.e. you must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage; the 60 Day Limit also applies.

The easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage forms to the carrier (the required document and method vary by health plan). Don’t risk losing your effective date on a technicality:  Use a competent broker who is licensed and certified to help you compare all your options, on or off the exchange.  Especially valuable is the broker will help you submit a properly completed application forms to the health plan of your choice!

Certified Insurance Agents who offer educational meetings are a free service to consumers under the ACA and California law. Find a local meeting here.  If you don’t use a certified agent, then you could run into the problems publicized by KPIX 5 (San Francisco):  Watch this news story here.

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!

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.

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. 

Did you know certain Kaiser members may qualify for premium assistance, too?  Read the story here.

 

 

 

 

 

 

 

An Early Look At California’s New Health Insurance ObamaCare Marketplace

October 2013 marks a milestone in the implementation of ObamaCare national health care reform, as a new California public healthcare exchange kicks off its first open enrollment season. We have been monitoring preparations for this event, and offer a sneak preview of coverage in California’s new health insurance marketplace.

Reacting quickly to new federal law (ObamaCare) and guidelines, California is the first state to implement its version of the public health benefit exchange system, named “Covered California.”

What is a Health Benefit Exchange?

CoveredCA Health Plan Benefits Summary

“It is a new insurance marketplace in which individuals and small businesses will be able to purchase competitively priced health plans using ObamaCare federal tax subsidies and credits beginning in 2014,” according to Covered California Director Michael Lujan.  Also see www.healthcare.gov.

After attending meetings and listening to new Covered-CA Director Michael Lujan, I have accumulated a personal stack of Post-its, which I find particularly interesting, and I hope you do, too:

Facts & Features of the Covered California Health Benefit Exchange

  • There will be separate exchanges for individuals and small business.
  • Medical questions will not be asked; all will be accepted.
  • Financial questions will be asked only to qualify you for possible subsidies.
  • Applicants must be U.S. citizens or otherwise “legally present.”
  • The private insurance market will continue to exist and compete with public exchanges.
  • Rates & Information can be obtained through certified Assistors and Agents (e.g. Derendinger Insurance).
  • An Assistor is limited to providing information on Covered California quotes, whereas a certified agent may provide Covered California quotes as well as quotes from competing private health benefit exchanges and even individual insurers e.g. Kaiser, Aetna. (See updated story on Aetna) Also, a certified Agent can provide ongoing claims assistance and other service issues.
  • There is no extra cost to consumers for using the services of an Assistor vs. a certified Agent.
  • Open Enrollment is expected to begin in October, with coverage effective January 1st.
  • There are four enrollment methods:  Paper, Phone, Fax, or Web.
  • Public exchanges will limit plans to four categories, Platinum, Gold, Silver, and Bronze, which must line up with a coverage value of 90%, 80%, 70%, and 60%, respectively.
  • Participating insurance companies will develop new plans to fit into these “metallic” categories.
  • Rates will be updated this summer.
  • Rate Bands will vary according to one-year brackets, versus the current 5 or 10 year brackets.
  • There may be no greater than a three to one ratio from the most expensive to least expensive age band.  (This should present some challenges to the status quo, in my opinion.)

Is The Health Benefit Exchange Marketplace Good for California Consumers?

Paraphrasing Alan Katz, a long-time health industry observer:  “The new Covered California Health Benefit Exchange is not going to be as good as some people hope for, yet it is not going to be as bad as others fear.”  In between these lines lies the potential of this reform, which include guaranteed medical plans for early retirees, hope for families burdened with pre-existing medical conditions, and affordable healthcare plans for 7 million* uninsured Californians. *California Healthcare Foundation (December 2012)

For updates on California’s changing healthcare system, follow us on Twitter:

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Editor’s Note:  The Derendinger insurance agency has served the California insurance market for 54 years.  Marc can be reached at (408) 252-7300.  You may find more information at www.derendingerinsurance.com.