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Covered California Says No to Obama/Jones

Today Covered California, the California state health exchange, stood by their rule requiring all exchange carriers to terminate non-grandfathered coverage plans on 12/31/13.  

President Obama's recent decision to allow a one-year extension of non-grandfathered coverage had no real force as each state must decide independently whether or not to allow it.

California has chosen not to allow it for carriers participating in the exchange.



As a recap, any health insurer participating in the Covered California exchange is required, per the terms of the exchange health plan solicitation, to terminate non-grandfathered health plans on 12/31/31 or have a plan to terminate in place by 12/31/13.

Certain non-grandfathered plans will be extended a bit into 2014 but the majority will terminate on 12/31/13.

The following plans are terminating during the first 3 months of 2014:

*Health Net Life & Health PPO plans with effective dates on or after 10/1/13 extend to 3/31/14
*Anthem Blue Cross Life &…

Obama Authorizes Extension of Non-Grandfathered Individual Plans for One Year

This morning President Obama announced that the administration will allow insurers to extend non-grandfathered individual & family plans for one year out to 2015.  This is in relation to the rash of required cancellation notices of non-grandfathered health plans that have been all over the news.

He left it up to each state's Insurance Commissioner to determine which plans could be sold in the state and also the insurer to determine if the carrier will provide the extended option for the non-grandfathered health plan.

We will have to wait a bit for both Dave Jones and the health insurers in California to announce what they plan to do with regard to non-grandfathered health plans that currently terminate sometime between 12/31/13 and 3/31/14.

I will advise as soon as I receive any official information from any carrier or from the CA Dept of Insurance.

Dave
www.davefluker.com

100,000 Views, Wow!

Earlier this year I noted that my blog has around 64,000 views and wondered when it would cross over the mythical 100,000 view mark.  I figured a couple of years but today it hit that magic number and sits right now at 100,099 views.

The last few days my blog has averaged over 700 views per day with some days over 1,000 views.  

I hope that you have found these blog posts to be of value and helpful to you in your search to better understand health insurance, the market, reform and other topics.

Now let's go for 250,000!

Have a great day!

Dave
www.davefluker.com

What Multi State Plan (MSP) Really Means (Covered CA)

Lots of confusion on this term and many people think it involves coverage across state lines.  It does not.

This explanation from Anthem Blue Cross is the best one I have seen:



The U.S. Office of Personnel Management (OPM) Multi-State Plan Program (MSPP) was recently established under the Affordable Care Act. It directs the OPM to contract with health insurance carriers to offer at least two plans (one at the silver level and one at the gold level) in each local exchange. The MSPP is intended to promote competition in the Marketplace and help ensure consumers have more high-quality, affordable health insurance options. All MSPP plans will include “a Multi-State Plan” at the end of their name when listed on the exchange - this designates it as an OPM-sponsored plans.  It does NOT mean that consumers selecting the plan will have health plan coverage in multiple states.Select silver and gold level Individual plans that our company currently offers have been designated as OPM-sponsored MSPP…

Anthem Blue Cross L & H Extends Some Members Non-Grandfathered Plan To 2/28/14

Insurance Commissioner Dave Jones announced this morning that Anthem Blue Cross Life & Health will be offering an extension of non-grandfathered individual health plans out to Feb 28, 2014.

Similar to the Blue Shield situation, notifications of plan terminations were not done "timely" and did not provide sufficient time (90 days) advance notification.


This only pertains to Anthem Blue Cross Life & Health PPO plans registered with the CA Dept of Insurance.  

Letters will be mailed out immediately to the 104,000 members affected by this change with the option to elect the extension.  Not all Anthem Blue Cross Life & Health PPO members will be eligible as this has to do with a late mail drop on a portion of the existing plans.  If your plan is involved, you will receive a letter from Anthem.

As with Blue Shield Life & Health, there will be a deadline to elect the extension and the member must personally contact Anthem Blue Cross to elect the extension.  For Anthem, …

Electing Blue Shield Life & Health PPO Extension Requirement

Just FYI, if you are currently covered on a non-grandfathered Blue Shield Life & Health PPO plan and have received the letter offering to extend the plan until March 31, 2014, you as the member must call into to Blue Shield by December 7th to elect the extension of the plan.

Blue Shield has set the requirement that only the member may elect the extension and only by contacting Blue Shield directly in order to ensure compliance with certain legal issues involved in the extension.

No one else, including your agent, can do this for you.  Blue Shield is very strict on this requirement.

Dave
www.davefluker.com

EPO, PPO How Does It Work?

Both Anthem Blue Cross and Blue Shield of California are offering EPO or PPO plans in select areas of California.  For example, in LA and Orange Counties, Anthem offers EPO only whereas Blue Shield offers PPO only.  

To further complicate the matter, each carrier treats crossover services differently.  As I am getting this question frequently, I want to clarify how this works.

For Anthem Blue Cross members:

If you have a PPO in 2014 and use services from an EPO provider, you pay per the terms of your PPO contract.  

If you have an EPO in 2014 and use services from a PPO provider, you will be treated as "in-network" but will have to pay for benefits at the higher Tier 2 price level (you get the lower Tier 1 price level with EPO Providers).


For Blue Shield members:

If you have a PPO in 2014, all EPO providers are in the PPO network so you can use the EPO providers the same as the PPO Providers.

If you have an EPO, you cannot use any PPO providers at all and if you do they are conside…

HealthSherpa - How To Build A Good, Fast and Accurate Reform Quote Site

3 young men in San Francisco, Ning Liang, George Kalogeropoulous and Michael Wasser, got together to design a functional, easy-to-use and fast healthcare reform shopping site.

HealthSherpa.com works great, I tried it!  The only thing is that it sends you to carrier contact information to buy directly from the carrier but that is not an issue really as obviously they can't link out to the agents.  It also doesn't seem to link to the exchange.  
I understand that they put this site together in very short time and it is outperforming healthcare.gov and coveredca.  It's fast and accurate.  Give it a try!
healthsherpa.com



They have also added a subsidy calculator on there so you can see whether or not to visit the exchange (Covered CA) or buy in the private market.
They did a great job, I like the look and feel and the very rapid results with a minimum of information input required.
Dave www.davefluker.com

Blue Shield CA and Health Net CA Extend Non-Grandfathered Until March 31, 2014

California Insurance Commissioner Dave Jones announced this morning that he has received agreement from Blue Shield Life and health to extend current non-grandfathered coverage plans through March 31, 2014.

Blue Shield had already notified members that their non-grandfathered individual & family health plan PPO would terminate on December 31, 2013 and that they would be transferred or elect new coverage with a January 1, 2014 effective date.

As of today both Blue Shield and Health Net* have agreed to provide continuation of non-grandfathered coverage for the extra 3 months up to 3/31/14 (only PPO plans). This will allow individuals and families more time to shop for new coverage as well as allow time for the provider networks to mature and solidify.

*Health Net is only extending Health Net PPO plans that were purchased with effective dates on or after 10/1/13.  Any PPO plan including Farm Bureau and all HMO Health Net plans terminate on 12/31/13.  Only Health Net PPO plans with effec…

Why CA Non-Grandfathered Plans Are Being Cancelled

The Covered CA health plan solicitation requires all health Insurers who participate in the Covered California Individual Exchange to "terminate all non-grandfathered health plans not later than December 31, 2013 or have a plan in place to terminate them by December 31, 2013".

Apparently some of the media and some of our less-than-truthful politicians are not trying to spin this as though the insurance companies have made some decisions on their own to cancel your coverage.  This is not even remotely true.

I noticed that Covered CA has moved the links to information on the health plans solicitation requirements (on the hbex site) so I will, as time permits, find the actual solicitation requirement which states what I wrote above.

Peter Lee is on record with the LA Times just 4 days ago (October 26th) confirming the same thing.  And he runs the exchange!  

Anthem is not canceling your plan because they want to.  Neither are Kaiser, Blue Shield nor Health Net.  They are forced to …

Anthem Blue Cross CA 2014 Provider Directories Finally Available

The Pathway Network provider directories are now online for searching.  Anthem will be using the Pathway/Pathway-X networks for all 2014 Individual & Small Group health plans in California.

Use the link below to access the PDF directories (it's not searchable online yet) for your area to find out which providers are in-network for ObamaCare coverage plans from Anthem Blue Cross.

Anthem Provider Directories



Dave
www.davefluker.com

Understanding Anthem Blue Cross CA 2014 Plans & Networks

Anthem has not yet rolled out all of the plans/networks/information for 2014 ACA plans but I want to update what we will all be seeing in the near future as choices for health insurance enrollment with Anthem Blue Cross.  


Some areas will not have a PPO option like LA county/Orange county and will have an EPO and HMO option.  Other areas will have a PPO option.  The Anthem program for 2014 will break down like this:

Networks:

The ACA networks for Anthem individual plans will be called "PATHWAY" and all participating providers will need to be contracted with the appropriate Pathway network.

Pathway PPO
Pathway HMO
Pathway Tiered (EPO)

Provider searches (once available online) will show two versions of Pathway for searching, Pathway and Pathway-X.  Pathway indicates off-exchange and Pathway-X indicates on-exchange.

EPO will be a tiered network with lower costs for inpatient & outpatient services in tier 1.

Plan names will reflect if plan is on-exchange or off-exchange as follows:

On…

Covered CA Certified Agents - How To Get To Your Account, Agent Number & Dashboard

Because I'm a nice guy and I'm hearing that many CA agents don't know how to get to their profile/dashboard/account on Covered CA once they have been certified, I wanted to post how to do it.  Covered CA will not advise you of the steps to access your agent # or certification #.

Once you have completed training and the final exam, and have provided the signed contract pages and E&O and all of that to Covered CA, the following steps:

Before I forget, you need to use Internet Explorer for part b as it won't work on Chrome nor Safari (I didn't try Firefox but heard that it won't work either).  You will also need your original log in username and password from when you originally registered with Covered CA back in August (not your learning center log in) so I hope everyone kept that log in information from the registration.

A

1.  Go to www.coveredca.com and click on the start button
2.  Once the Calheers screen comes up, click on the "find help near you' li…

Sorry To Be Gone So Long

Wanted to get a quick update out here.  Covered California Certification has been a complete time drain and far more lengthy process than I could have imagined.

First the 8 hour mandatory in-person training followed by 4-6 hours (turned into a lot more as the sliders on the slide screens online were jacked up) online followed by an open-book test. Once all of that was done waiting for the follow up e-mail from Covered California letting me complete the contract and become fully certified.  I guess i should be grateful it only took a full week to get that e-mail after I passed the exam (LOL).  

So yesterday I got the famous "e-mail" and contracting paperwork to fill out and sign.  Sent that in this morning so I wonder how long it will be until they actually let me know my login and let me do the profile updates.  

Man, what a process.  AHIP for Medicare Advantage is waaaaaay easier than this even with the carrier specific certifications after the AHIP training.  

Anyway, some day…

Covered California...And Then There Were Twelve

In late May Covered California announced that there would be 13 health plans in the individual & family health exchange.  

This week one of the 13 health plans, Ventura County Health, changed position and withdrew
from the exchange at least until 2015.  

So, Ventura County's health plan is out leaving 12 total plans available for open enrollment beginning in October.

Dave
www.davefluker.com

Covered California SHOP Small Group Plans Announced

Today Covered California released a list of carriers who will offer plans inside of the SHOP Small Group Health Exchange beginning in January 2014.

I have links below to the information at Covered California.  Six total insurance carriers for the entire state, 3 plans in LA Metro and 3 here in Santa Clara County.

The six "finalists" for SHOP include:     


*Blue Shield of California
*Kaiser Permanente
*Health Net of California 
*Western Health Advantage
*Chinese Community Health 
*Sharp Health Plan



Conspicuously absent from the Covered California small group SHOP exchange are national carriers Aetna, UnitedHealth and Anthem (Anthem Blue Cross CA is a subsidiary of Anthem/Wellpoint).  

Covered California SHOP Press Release (8/1/13)

Covered California SHOP Brochure with rates and plans by rating area (8/1/13)

Dave
www.davefluker.com


Michael Lujan Resigns - Director of Sales for Covered California

I knew about this yesterday morning after exchanging a couple of e-mails with Michael but didn't feel it should be blogged until it was published publicly. The substance of any personal communication I have had with Michael will, of course, remain private.

As announced by the Sacramento Bee yesterday afternoon, Michael Lujan, who served as Director of Sales and Marketing for the Covered California SHOP small business exchange, has resigned on Wednesday, July 31 with effective end date of August 9th.

I hate to see him go but I am sure that he has good reasons to make a change at this time. Michael has always been available to me (and other agents) to answer questions and concerns about both the SHOP small business exchange and the individual & family plan exchange.

I am sure others will join me in wishing Michael Lujan continued success in the future.


Dave
www.davefluker.com





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 sur…

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.  …

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 &…

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 …

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 o…

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…

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…

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

Healthcare Plan Renewal Loophole Divides CA Insurers

Interesting article in today's LA TImes regarding whether or not the state will allow any carrier selling California individual & family health plans in 2014 to reset a December 2013 renewal on non-compliant non-grandfathered health plans to "ride it out" for all of 2014.

The Covered California health plan solicitation requires those plans providing exchange coverage to terminate their non-grandfathered individual health plans by the end of 2013.  Any carrier not participating in Covered California that intends to sell plans outside of the exchange is not bound by this solicitation rule.

The primary concern with this strategy is that carries who do not terminate in 2013 may cherry pick young healthy people and offer them the option to keep potentially lower plan rates for an extra year.  Given that the participation of these same young healthy individuals is critical to the success or failure of Covered California in the short term, this could create a large problem do…

Agents, Shmagents! LA Unified to Empower Students to Sell Obamacare

In a June 20 Heartland article, the Los Angeles Unified School District received almost $1 Million in grant money from Covered California to teach students how to sell Obamacare plans to their families and friends.  Apparently the students, in addition to learning the three Rs, are going to be schooled in the ways of Obamacare, PPACA and Covered California so that they can act as "messengers to their own families".  It also appears that in addition to students, staff and perhaps even teachers will be involved in selling health insurance plans for Covered California.
LAUSD will also use tax-paid staff to promote ObamaCare through phone calls to students’ homes, in-class presentations, and meetings with employees eligible for ObamaCare’s taxpayer-covered healthcare, the grant award says.If the project is successful, Los Angeles families can expect more use of students to push government-preferred messaging. “Teens are part of a ‘pilot’ program to test whether young people can be…

Aetna Suspends Individual Health Sales in California July 1

Aetna has announced this morning that it will suspend any further sales of individual & family health insurance in California effective July 1.

This follows on to the announcement on Saturday that Aetna would be (again) abandoning the California Individual Health Market.

Effective July 1, 2013, Aetna will no longer offer Aetna Advantage Plans for Individuals, Families and the Self-Employed in California.
After reviewing our individual health insurance plans in California, we determined we can no longer meet our customers' needs and remain competitive in that market. A number of factors were considered in making this decision. While it was a difficult decision, in keeping with the best interests of our customers, we believe there are other insurers that can better meet their needsAetna is no longer accepting applications for California health insurance for both individual underwritten coverage and HIPAA.

Dave
www.davefluker.com

Aetna Pulling Out of California Individual Market

The Wall Street Journal is reporting that Aetna will stop selling individual & family coverage in California by the end of 2013.  

Aetna leaving individual insurance market in California, WSJ says
As the federal health law is set to reshape the insurance market in 2014, Aetna will stop selling health insurance to individual consumers in California at the end of 2013, says the Wall Street Journal.
 I will advise if and when I receive information on how Aetna plans to handle in-force grandfathered health plans for individuals & families.  I would suggest anyone with an Aetna individual health plan be prepared to move onto new Obamacare compliant coverage on January 1, 2014.

Wall Street Journal Article

Dave
www.davefluker.com

CA PCIP Reverting to Federal PCIP on July 1

Beginning July 1, 2013, California will no longer operate the state's PCIP. 

All current CA PCIP subscribers will be required to transition to the federal PCIP in order to maintain some kind of PCIP coverage through 12/31.  Premium rates and provider network for CA PCIP will no longer be applicable.

The CA PCIP will send out a notification letter in May to provide subscribers with instructions. In June, the National Finance Center, the enrollment administrator for the federally-run PCIP, will send out an Enrollment Letter that includes information about the federally-run PCIP plan, how much it costs, and how to activate coverage. Subscribers will not need to complete a new application to qualify for the federally-run PCIP.  To activate their new coverage on July 1, and receive their PCIP ID cards by that date, subscribers must pay their first month’s premium by the deadline stated in that letter.
If a subscriber is in the course of treatment or has received prior-authorization for s…

Covered California Announces Exchange Health Carriers

This morning, Peter Lee announced the insurance carriers selected to provide coverage to California residents in the California Health Benefits Exchange for individual & family health plans.  

A total of 13 health insurers, some regional and some state-wide, will provide health plans to the Covered California exchange.  They are:

*Alameda Alliance for Health
Anthem Blue Cross of California
Blue Shield of California
*Chinese Community Health
*Contra Costa Health
HealthNet
Kaiser Permanente
*LA Care  Health Plan
*Molina Healthcare
*Sharp Health
*Valley Health Plan
*Ventura County Healthcare Plan
*Western Health Advantage

*- denotes regional health plans not offering state-wide coverage plans

The state will be divided into 19 regions or rating areas for health plans and premiums.  All areas will have at least two health carriers available (LA will has six) with metro areas having the highest number of carriers and rural areas less.

Two requirements placed on the participating carriers are good networ…

Aetna, UnitedHealth and Cigna Bail On Covered California Exchange!

On the eve of the announcement of the tentative plans and rates for the Covered California Health Benefits Exchange,  LA Times has leaked three non-domestic carriers will NOT provide health plans to individuals & families in Covered California.

Aetna, Cigna and United Healthcare have all declined to participate in Covered California which opens to new enrollments on October 1, 2013.

That will leave the three major carriers who currently control 87% of the individual and family market in California--Anthem Blue Cross, Blue Shield of California and Kaiser.  I expect other player such as Health Net to be involved as well as a new Sutter HMO co-op plan.

We will know more details tomorrow afternoon once the Exchange webcast is over.

Those who currently have health plans with Aetna or Cigna (UHC does not sell individual & family plans in California) and wish to enter the exchange will have to discontinue their coverage with those carriers and move to a new insurance company.

While the no…

The Value of a Dollar - Obamacare Subsidy

I ran some calculations today in the midst of discussion with fellow agents concerning the subsidy calculations for Obamacare.

I wanted to demonstrate that a pay raise or increase in income of a very small amount could have serious consequences in the new healthcare reform environment.  In this case, the addition of $1 of annual income costs this person $418 monthly subsidy ($5016 yearly) and potential IRS clawback of any subsidy this person was not entitled to receive.

This was based on a single person age 60 however the concept is the same (amounts of subsidy are different) across all ages.

As a broker I would be very leery of suggesting an employer who sends his/her employees to the Covered California Exchange compensate those employees with help that could raise their taxable income.

You can find this calculator and other critical California healthcare reform information on my web site at http://www.davefluker.com/healthcare_reform.html


If you don't see the embedded video above, yo…

The Mythical $95 Obamacare Penalty

I hear this quite a bit from the public but find it a bit disconcerting when I hear it from agents and brokers who are supposed to be better versed in these thing.

The myth is that the penalty for not complying with the Obamacare rule of having creditable qualified health coverage will be $95 in 2014.  Well, if  a person has an adjusted income of $9500 annually then yes, the penalty is $95 in 2014.  Of course, that person would qualify for no-cost Medi-Cal (CA Medicaid) and would be able to obtain qualified health coverage and avoid the penalty.

The actual penalty for 2014 is $95 OR 1% of income, whichever is greater.  By 2016 this goes up to 2.5% of income.  Below I have broken out the actual numbers for the penalty for California residents should they choose to avoid buying a qualified health plan under Obamacare.

Income               2014               2015               2016
                           1%                   2%                 2.5%

$20,000             $200                …