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Showing posts from May, 2017

Blue Shield Tops Covered CA Enrollments

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California Healthline reports that Blue Shield of California has the highest share of enrollees in Covered California Health Benefits Exchange (Covered CA).

The data, from Covered California, show that Blue Shield had 389,480 enrollees in the exchange as of December 2016, about 31 percent of the market. Anthem was next with 310,690 members, for a 25 percent share. Kaiser Permanente was third with 297,030 exchange enrollees, or 24 percent. Health Net and Molina Healthcare were fourth and fifth, respectively.
I believe this, in part, may be due to Blue Shield offering the only state-wide PPO plan on the individual exchange market.  Anthem offers a PPO as well but it is limited to certain areas of the Central Valley and Central Coast. 

A new analysis, also released this month, shows that Covered California continues to have among the healthiest exchange enrollees in the nation — a designation Covered California officials hopes will tame premium increases.
Rates for 2018 plans have been filed…

Healthy California Act SB 562 Cost Estimate: $400 Billion

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The cost estimate came in for the 'Californians for a Healthy California Act' (SB 562) as announced yesterday by the Sacramento Bee.  

"The price tag is in: It would cost $400 billion to remake California’s health insurance marketplace and create a publicly funded universal heath care system, according to a state financial analysis released Monday."

"California would have to find an additional $200 billion per year, including in new tax revenues, to create a so-called “single-payer” system, the analysis by the Senate Appropriations Committee found. The estimate assumes the state would retain the existing $200 billion in local, state and federal funding it currently receives to offset the total $400 billion price tag."

I have considered that a chunk of the shortfall could be recovered from employer plans. The article says that $100-$150 billion could be available to offset.  

Remember, the Healthy California Act, if made law, would eliminate all private health i…

Cost Share Reduction Subsidy To Continue 90 More Days

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The Trump Administration will continue to fund cost share reduction subsidies for another 90 days.  

At issue is a court decision which determined the subsidy to be illegal.  The appeal was originally filed under the Obama Administration and continues under the Trump Administration (for now).

"A federal appeals court on Monday granted the Trump administration a 90-day delay on its decision to appeal a case brought by House Republicans against ObamaCare subsidies paid to insurers."

This is going to create a bit of uncertainty in the markets as insurers prepare for 2018.

"Insurers need to decide by June whether they will continue to operate in the ObamaCare exchanges, and companies will have finalized their 2018 premium requests before the end of the three-month window."

Read the full article at TheHill


Dave
www.davefluker.com




Tourist Owes Mexican Hospital $40K - Claims They Won't Let Her Leave

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Fox News reports that a retired Idaho Teacher, who got sick while on vacation in Mexico, now owes $40,000 to the Mexican Hospital.  Her son claims they won't release her until she pays the balance owed. About $8,000 has been paid so far.

The article does not state whether the 67-year-old is covered by Medicare or a retiree health plan.  Either way, it seems that her domestic health insurance isn't going to do much on her behalf (they are using a GoFundMe to try and raise the balance).  Certainly not until she returns home and files claim forms.  

Stories like this are a good reminder of the importance of global health insurance coverage when traveling abroad.  Insurance companies like GeoBlue provide benefits in over 180 countries and handle any claims in the host country.    

Fox News Article



Dave www.davefluker.com


UPDATE
May 17, 2017.  Follow up article says she was allowed to leave last Friday and is now home in Idaho.  
Vickki Moormann Home

Jimmy Kimmel Chats With Senator Bill Cassidy (R-LA) On AHCA (TrumpCare)

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An interesting conversation between television host Jimmy Kimmel and Louisiana Senator Bill Cassidy (co-author of the Cassidy-Collins Senate Bill).  

I think it's obvious that the Senate does not share the "love" for the House Bill that was recently passed.








Dave www.davefluker.com


House Passes American Health Care Act (TrumpCare)

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Today the US House of Representatives passed the AHCA (American Health Care Act) by a narrow margin of 217 votes.  All yes votes were GOP and all Democrats voted against--as well as a small number of GOP Representatives.  

Now the TrumpCare makes its way to the US Senate where it is likely in for contentious debate and some likely changes.  The Senate has indicated that they are working on their own bill.

While something needs to be done with regard to the ACA (ObamaCare), there is great debate whether this is the best or most appropriate solution.  Some States or portions of States are facing a situation where no health insurer will be available in 2018 from which to purchase health coverage.  

Even Covered CA hinted in an agent e-mail earlier this week that California could see rates increase up to 48% for 2018.  

Here's a quick overview of what the AHCA (TrumpCare) would do...

*Eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate impos…

Molina Healthcare Ousts CEO and CFO

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Molina Healthcare has fired CEO Dr. J. Mario Molina as well as his brother who served as the CFO.  

Molina Healthcare is a traditional Medicaid provider and offers services for Medi-Cal and Covered CA health plans in southern California (as well as other states).

"This comes out of nowhere. Molina, a major player on the Affordable Care Act's individual marketplaces, had a rough 2016 due to the ACA plans. But the company was still profitable overall. Molina has been one of the most outspoken health insurance CEOs and was particularly critical of Republican efforts to repeal and replace the ACA."

Full Article from Axios.com



Dave
www.davefluker.com



Tokio Marine HCC To Suspend Short Term Health Sales

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Tokio Marine HCC has announced that the company will no longer offer short term health insurance plans as of 6/1/17.  

"We have made this decision based on the 90 day policy duration limitation to the STM insurance marketplace that was effective April 1, 2017.  This has caused many producers in the web broker community to focus their efforts on other supplemental health insurance products like limited medical plans.  As a result of marketplace conditions, we are no longer able to profitably maintain this business. "

This leaves IHC and Petersen International Underwriters for Californians seeking short term coverage.

Dave
www.davefluker.com



Covered CA Benchmark And Premium Tax Credit Subsidy Limit

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When it comes to clients under age 30, it is often the case that the generic income chart shows income level that should receive the premium tax credit subsidy.  In many cases they do not receive subsidy--even with income in the 300-400% range.  This creates some confusion and an understanding of the "benchmark" used in this calculation.

The benchmark plan is the second lowest cost Silver plan in any rating area.  Subsidy eligibility is strictly based upon the premium cost of the benchmark plan.

This is from a recent case...

Single Age 27, Los Angeles, MAGI (modified adjusted gross income) $34,000.  This is generally found on line 37 form 1040.

According to the income chart (see below), that income should qualify for the premium tax credit subsidy.  In this case however, due to the low premium of the benchmark plan in the LA rating area, no subsidy is allowed.

Premium tax credit subsidy is designed to reduce the total annual premium for health insurance to not more than 9.69% of …