Category Archives: Consumer Insurance Advice

Failure to pay attention to your insurance program can lead to unintended consequences

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.

Covered CA Website Causes Suffering During Open Enrollment

Covered CaliforniaCovered CA website causes suffering during open enrollment this week after being fortified for high utilization.  An interview with a San Jose-based Certified Agent provided the following observation:

Today, I assisted at least 4 different clients on their renewal process and/or to start a new application.  The website directed all of the clients into Medi-Cal, even if their income was well above 140% FPL

Calling Covered California directly is not an option, due to five-hour wait times.  Cases such as these require special handling, which is a free benefit of Certified Agents.  For example:

I had a family of three come in with a total annual household income of $49,666.73 and they were placed on Medi-Cal.

Certified Agents can provide local assistance with such glitches, and often times are willing to meet you in person. Read our related article about avoiding Open Enrollment mistakes.  Open Enrollment is here, changes are coming, and websites are frustrating.  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.

Obamacare: Not Easy!   ............  Cake Pop, Anyone?

Obamacare: Not Easy! ………… Cake Pop, Anyone?

Kaiser California Individual Members Pay Twice in December 2014

California Marketplace

The Affordable Care Act hits Kaiser Members hard

Yes, Kaiser California Individual members pay twice in December 2014, in order to help Kaiser Permanente catch up with industry standards.

As explained in a Kaiser Permanente November news briefing to its marketplace partners, Kaiser’s status as a prepaid health plan requires monthly payments before the last day of each month. Apparently, throughout 2014 Kaiser has not been billing its members for prepayment, and now plans to catch up in time for January 2015.  Read our related article about avoiding Open Enrollment mistakes this year.

What Kaiser California Individual & Family members need to know:

  • You will receive two separate bills in December- one for the December 2014 premium and a second bill for the January 2015 premium
  • Both bills must be paid by December 31st.

The news briefing goes on to say certain members may have extra time to pay, based on their Evidence of Coverage or Membership Agreement.  To get free assistance from a California Kaiser agent, send a request to info@coverage-ca.com or phone 1 (408) 641-8950.

Remember, Open Enrollment begins November 15th:  Changes are coming and websites are frustrating. Read our related article about CoveredCA’s problems. 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.

Obamacare Penalty Tax

An Obamacare Penalty Guide For All California Residents

The purpose of this article is to help individuals, families, and early retirees avoid the Obamacare penalty under the Affordable Care Act.  Obamacare Penalty

Don’t miss the next 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.

 

  • Since January 2014, most people will be required to have public or private health insurance or pay a financial penalty AKA the Obamacare Penalty tax.

Avoid the Obamacare Penalty and use the savings to buy vision care insurance

 

  • As of 2016, the penalty has been increased substantially.
  • 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 was 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. Tax issues should be reviewed with your tax advisor.  Here is a resource from the IRS: IRS Affordable Care Act Tax Provisions.

 You can find local assistance.

 

Coverage California ACA Buyer Guide: Covered California

The Regular Open Enrollment (2015) is Complete, but the 2016 Open Enrollment begins November 1st

By Marc Derendinger  

The purpose of this Coverage California Buyer Guide is to help individuals, families, and early retirees take full advantage of the Affordable Care Act (ACA) Open Enrollment and Special Enrollment seasons, and avoid mistakes that could cost you money and opportunity under Covered California (Obamacare) and the private market.  This is a good reference article, so retain it until you need it.

Remember, Open Enrollment begins November 1st, but you may qualify to enroll sooner under a Qualifying Event Special Enrollment provision of the Affordable Care Act (ACA).  We published an introductory article about Special Enrollments here.

Buyer beware, because 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 the good ones can help guide you through the network provider “game of hide & seek” that is being played by California health insurance companies, at the expense of California residents.

Health plans take on a new design structure, with new metallic” plans. (If you already know about metal plans and want to skip ahead to more advanced topics in this series, click here)

Unless you are insulated from all these changes through your participation in a Grandfathered plan, by 2014-2016 you will start to see insurance talk about “metals,” including Kaiser members (for more information on Obamacare vs. Kaiser, Click Here.)   For example, Bronze plans cover an average of 60% of costs, meaning that, on average, you will be responsible for paying 40% of your health care costs.  Also, most services covered by the Bronze plan are subject to a deductible or amount you must pay out-of-pocket before the plan will cover costs.

Download a PDF of the Metallic plans here:  CoveredCA Health Plan Benefits Summary

While the Bronze plan has the cheapest monthly premium, Silver Plans provide a lower risk of out-of-pocket costs, making it a better value for most people. Silver 70 plans cover an average of 70% of costs, meaning that, on average, you will be responsible for 30% of your healthcare costs.  Most common covered services under the Enhanced Silver Plan do not have a deductible.

The higher the metal value, the higher the value of benefits covered under the plan.  Hence, Gold plans expect to cover an average of 80% of the cost of medical services and Platinum, an average of 90%.  Higher benefits also lead to higher premiums, so talk to a certified professional to analyze all your options.  Under California law, only Certified Insurance Agents can compare your options under Medi-Cal vs. Covered California public exchanges vs. private market plans.  There is no added cost when you use these experts.

Insurers Will Battle Within Metal Tiers

If you are looking to benefit from lower prices in a new competitive market, I suggest starting with the Silver Tier, where five insurance companies (in Santa Clara County) compete for your business (see our Obamacare Rate Guide for examples).  Since they offer similar plans within the metal tier, companies are forced to compete on price and provider network.

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/

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

 

 

 

 

 

IS THE RIGHT PERSON GETTING YOUR MONEY? Life Insurance Beneficiary Designation

The Bad Life Insurance Beneficiary Designation

Since 1968, our insurance office has handled many Life Insurance death claims, and seen some unfortunate cases where a bad life insurance beneficiary designation directed death benefits to unintended recipients e.g. old and long forgotten girlfriends, boyfriends, former spouses (even the wrong former spouse), and

A Good Life Insurance Beneficiary Designation

so on. Please be advised your Will or Living Will (Revocable Living Trust) cannot override a life insurance beneficiary designation in California. What this means is if you intend your trust to receive life insurance benefits directly from the insurance company, then it is necessary that your life insurance beneficiary designation be updated to include the trust/trustee’s name. Failure to do this has unintended consequences.

Unintended Consequences

For example, we recently handled a death claim in which the deceased’s disabled son was named beneficiary, and a Special Needs Trust had been established. However, the insurance company refused to pay death benefits directly to the trust/trustee because the trust was not mentioned in the beneficiary designation. Such a situation has negative implications for State and Federal disability benefits. We all want to avoid unintended consequences. If you have any type of trust, we encourage you to discuss the issue of the life insurance beneficiary designation with your attorney and update personal, employer and union sponsored life insurance policies accordingly..

Remember, your employer, union, retirement plan administrators, and your private insurance policies all have separate life insurance beneficiary forms. Keep a list!

The Beneficiary Form

Now is the perfect time to review your Life Insurance Beneficiary Designation. There are two areas on most Beneficiary Change forms, which require completion in order to name or change your Beneficiary:

1). Primary Beneficiary Name
2). Contingent Beneficiary Name

How it works: If you die while the Primary Beneficiary is still living, the Primary Beneficiary (or Beneficiaries) will receive 100% of the policy benefits, and the Contingent Beneficiary will receive zero benefits. Remember, the Contingent Beneficiary is a “back-up” beneficiary, in the event your Primary Beneficiary has pre-deceased you. Also, it is acceptable to name more than one Beneficiary by listing each name, with the corresponding amount of insurance.

Life Insurance Beneficiary Designation Examples

For example: John Smith, Brother, born March 21, 1963- $50,000 and Sally Smith, Sister, born August 1, 1959- $100,000.

If the Beneficiaries are receiving equal amounts, then you may state “Equal Shares” after their names. Please do not name minor children as Primary Beneficiaries nor as Contingent Beneficiaries. This leads to all sorts of problems, as the insurance company will not pay death benefits to a minor. Your survivors will be required to go to court and ask a judge to name a financial guardian. Even if the judge appoints the same financial guardian as requested in your Will, the court’s permission may still be required for certain types of investment decisions. A mishandled life insurance beneficiary designation results in a cumbersome, frustrating, and costly way of fulfilling your wishes.

NoVisionInsuranceConclusion

Let’s be smart and think: Is the right person getting my money? Review your life insurance program today!