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Showing posts from May, 2013

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
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

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                …

Healthcare Reform Application Video

The video below outlines the application and health insurance purchasing process per HHS and CMS.  As mentioned in my earlier blog post today, the process looks to be two separate steps to complete plan enrollment.

Covered California will be the California state exchange and there may be some variations on this that are state-specific, we will have to wait and see.  I suspect though that the process will be generally uniform across the country whether it's a state or federal exchange.

As always, if you don't see a video below, you are viewing copied and unauthorized content stolen from my blog.  My blog is  

Reform Application Process Video Dave

For more information on California Healthcare Reform, visit the California Healthcare Reform section of my web site at

Exchange Application Process As It Looks

CMS has released a new Obamacare application form which has been shortened down considerably.  About 3 pages for individuals and 7 pages or so for families.  This simplified will make the enrollment task much easier for most people.  There is also a third application form for those who wish to purchase inside of their state's exchange (be it state, partnered or federal - California will be state) who do not receive a subsidy.

Looking at the applications it is becoming clearer that the process to enroll, be it online or via paper application, will be a two step process that will likely have to be completed in two separate sittings.

The "Application" form is a form used to secure the right to shop in the exchange (now referred to as "marketplace") for coverage and pick a plan.

Link to individual application

Once the application is approved, then you will be given some kind of permission to actually go into the marketplace and make your purchase.  Paper application st…