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Showing posts from 2017

CA Open Enrollment Deadline Extensions December 2018

Quick update on deadline extensions announced last 24 hours.

Covered CA extends deadline for 1/1/18 start dates to December 22nd

Valley Health Plan matches Covered CA extension to December 22nd

Oscar Health has extended off exchange private market deadline to December 31 for 1/1/18 start dates.  

Update 12/15 - Health Net has extended off-exchange enrollments to December 22nd.

Update 12/18 - Anthem Blue Cross has extended off-exchange enrollments to 12/22.

I will add any new announcements to this post to keep it all in one place.

Remember, California Open Enrollment goes through January 31, 2018. 



Stay Grandfathered? Anthem Blue Cross Grandfathered Plan Discontinuation Update (pt 3)

This morning Anthem sent agents the grandfathered plan change downgrade matrix for 2018. 

This shows which plans are being cancelled and which, if any, grandfathered plans those affected can move to.  If they wish to remain grandfathered.

Some plans have grandfathered options, some have no options.  If there are no options to move to another grandfathered plan AND you live in an area where Anthem is no longer selling ACA plans, you will have to change to another insurance company for 2018.  Remember Anthem is only selling ACA plans in areas 1, 7 & 10 in 2018.

Agents are ready to help you with your 2018 health insurance options.  Call your agent, call me, heck, call trump if you want to 😉  Plans scheduled for discontinuation will end on 2/28/2018.  Last date to enroll in a new ACA plan is January 31 however to start 2/1 enrollment needs to be completed by January 15th.


Anthem Blue Cross Errors with Grandfathered Discontinuation Notices

Was hoping Part I would be enough.  This may be a multi-part series 😕

California subscribers may have received a letter early in December indicating that their grandfathered Anthem health insurance plan was being cancelled 2/28/18.  Apparently some letters were sent in error and those plans are, in fact, not being cancelled.

Correction letters were supposedly sent out 12/8 to notify those subscribers of the error.  So be on the lookout if you received a cancellation letter regarding your grandfathered Anthem health plan.

As of today, the only plan I know is being cancelled is the Clear Protection 5000.  Some HIPAA plans may also be cancelled.  

Anthem is not releasing any information to agents about which plans are being discontinued nor which clients are affected.  Nice 🙄

If you have received a cancellation notice and not the subsequent "we goofed" letter, please comment on which plan you are on.  Maybe we can figure out the super secret list of plans.  



Wells Fargo Facing Insurance License Suspension or Revocation

The California Department of Insurance and Insurance Commissioner Dave Jones announced this morning that the department is seeking to suspend or revoke Wells Fargo's insurance licenses.

Department alleges Wells Fargo signed up 1,500 consumers for insurance without their consent
Department of Insurance seeking to suspend or revoke its licenses for alleged improper insurance sales practices related to the company's online insurance referral program, which resulted in insurance products being purchased and paid for by consumers without their knowledge. 
Read the Dept of Insurance Accusation

Read the Dept of Insurance Investigation



CVS To Acquire Aetna For $69B

Drug Store chain operator CVS Health Corp. has agreed to acquire Aetna for $69 Billion.  

This year’s largest corporate acquisition will combine one of the nation’s largest pharmacy benefits managers (PBMs) and pharmacy operators with one of its oldest health insurers, whose national business ranges from employer healthcare to government plans.
 This merger may signal a change in the delivery of certain healthcare services.

CVS plans to use its low-cost clinics to provide medical services to Aetna’s roughly 23 million medical members. In addition to health clinics and medical equipment, CVS could provide assistance with vision, hearing and nutrition.
The merger still needs approval as similar mergers between Aetna & Humana as well as Anthem & Cigna were denied last year.  However, in those cases both parties were health insurance carriers, not pharmacy benefit management.

Read the full article on Reuters



Anthem Blue Cross CA Medicare Supplement Rate Changes for March 2018

Anthem Blue Cross has announced a March 1, 2018 rate change for California Medicare Supplements.  This applies to Pre Standardized, 1992 Standardized and 2010 Modernized Medicare Supplements..

2010 Modernized
Plan A 0.0% Plan F 3.4% Plan N 0.0% Plan High F (Closed) 0.0% Plan G 0.0% Mod Disabled 5.8%
1992 Standardized
Plan A 1.5% Plan C 1.9% Plan F 1.4% Plan I 1.7% Plan J 2.5% SmartChoice 9.9% SmartChoice Preferred 9.9%
ClaimFree Companion Care 0.0% ClaimFree Prudent Buyer 0.0% ClaimFree Prudent Buyer Platinum 3.0% ClaimFree Std Plan A 0.0% ClaimFree UltraCare 0.0% ClaimFree UltraCare Plus $10K 0.0% ClaimFree UltraCare Plus $25K

Anthem Discontinuing Individual Grandfathered Health Plans Early 2018

Anthem Blue Cross California notified agents this morning that they intend to discontinue 200 individual & family grandfathered health insurance contracts effective 2/28/18.

Grandfathered plans are those health insurance plan purchased prior to 2010 and still in force.

To reduce the administrative burden of maintaining multiple products/contracts, we will be discontinuing about 200 grandfathered plans/contracts, many of which only have a few members. This change will impact around 14,000 members and some of these members may have other Anthem options to replace their plans.

As of today, the specific products and contracts are unknown.  I was told we should expect more information by mid-December.  

For those on grandfathered plans, be aware that Anthem is only selling individual health insurance (EPO) in areas 1, 7 and 10 (Santa Clara County, Stockton area and northern Counties).  Those in other rating areas will need to change insurers and find new coverage (and move to ObamaCare).

I …

Sutter Health Destroys Evidence In Antitrust Case

LA Times is reporting that health giant Sutter intentionally destroyed 192 boxes of documents that were being sought in a lawsuit.

The lawsuit accuses Sutter of abusing its market power and charging inflated prices.

I’ve pushed the button … I’m running and hiding. … ‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for.
— Sina Santagata, Sutter executive assistant
The United Food and Commercial Workers and its Employers Benefit Trust initially filed the case against Sutter in 2014.

Read the full LA Times Article



HealthNet Traditional PPO & EnhancedCare PPO For California 2018

When it comes to HealthNet individual & family health plans, things can get a little tricky.

HealthNet has offered their traditional PPO plan in selected areas of California for a few years now.  This PPO is a broad-network plan.  In areas where it is available, the network exceeds that or competitor Blue Shield.  The new EnhancedCare PPO is a smaller network PPO plan introduced in certain regions for 2018.

In 2018, HealthNet has made some changes so I want to cover them here.

Traditional PPO (off exchange only)
HealthNet's traditional individual & family PPO plan for 2018 will be available in the following regions:

Region 2  Marin, Napa, Solano, and Sonoma counties
Region 4  San Francisco County
Region 5  Contra Costa County
Region 7  Santa Clara County
Region 8  San Mateo County
Region 9  Santa Cruz County
Region 10 Merced, San Joaquin, Stanislaus, and Tulare counties
Region 14 Kern County (partial)
Region 15 Los Angeles County: ZIP codes starting with 906-912, 915, 917, 918, 935

Dept of Managed Health Care Fines Anthem $5 Million

According to Kaiser Health News, the California Department of Managed Health Care (DMHC) has fined Anthem 5 million dollars for failure to address member grievances.  

According to DMHC, between 2013 and 2016, it (DMHC) identified 245 grievance-system violations by Anthem.  

Rouillard cited one example in which Anthem denied a submitted claim for an extensive surgical procedure, even though it had issued prior approval for the operation. Twenty-two calls contesting the denial — placed by the patient, the patient’s spouse, the couple’s insurance broker and the medical provider — failed to resolve the complaint. It was not until the patient sought help from the managed-care agency, more than six months after the treatment, that Anthem paid the claim.
Read the full article at KHN



California Silver Plans Cheaper Off Exchange in 2018

Rates are now live for California ObamaCare 2018 health insurance plans.

Silver Plans on the marketplace experienced an additional premium rate increase.  This increase is to compensate for the loss of CSR (Cost Share Reduction) subsidy funds from the federal government.  

Those who receive tax credit subsidy (and cost share subsidy) will generally not experience any substantial premium increase for 2018.  

Those who are not eligible for subsidies and want a to enroll in a Silver plan would be better served purchasing coverage in the private market.

An example I ran on myself aged 58, Santa Clara County:

Blue Shield Silver 70 PPO Covered CA $1,298
Blue Shield Silver 70 PPO Off Exchange $1,198 (save $1200/yr premium)

Anthem Blue Cross Silver 70 EPO Covered CA $1,066
Anthem Blue Cross Silver 70 EPO Off Exchange $1,021 (save $540/yr premium)


California Obamacare Quoting Goes Live Tonight At 9 PM (PST)

I have been informed online instant quotes for 2018 ACA California health insurance plans will be live tonight beginning 9 PM PST.  For both agents and consumers, this will be our first comprehensive look at plan choices and rates.  

Take a spin to the link below and 'shop til you drop' for your complimentary quote.  Think of it as "Black Tuesday" for California health insurance.  Quoting both Marketplace (Covered CA) and off-exchange plans.  

Get My Quote Now


Unintended CSR Consequences? Super Cheap CA Bronze Plans for 2018?

With the removal of the cost share reduction subsidies by the federal government, and the resultant additional silver premium changes to cover the CSR in 2018, some interesting results are found on Covered CA (and likely all marketplaces).  

Quick Primer.  CSR (cost share reduction) subsidy is the subsidy used to reduce the share of cost on a silver health plan.  These are known as enhanced silver plans and the CSR helps reduce things like copays, deductible, out of pocket annual max and drug costs.  CSR is available to adults wit incomes in between 138%-250% federal poverty level.  These enhanced silver plans are expressed as Silver 73, Silver 87 and Silver 94.  Which one you qualify for depends on income level.

Note: families with children under 19 years of age can qualify for enhanced silver in California.  However, the children under 19 will not be entitled to enroll  in the enhanced silver plan with their parents  The income level for Medi-Cal (California Medicaid) is raised to 266…

Direct Primary Care A Growing Market Under ObamaCare/TrumpCare

Direct Primary Care, also known as 'concierge medicine', is gaining traction across the country.  DPC is primary medical care without insurance or other third party payer,

Direct primary care is essentially becoming a member of a primary care doctor's practice.  Monthly membership fees are reasonable and may include certain services at little or no additional cost.  

DPC doctors normally feature transparent pricing for services they provide.  Often services include telemedicine (Skype, e-mail, etc,,), longer and more thorough office visits and may even include house calls.  

Coupling a DPC membership with a lower cost, high deductible health insurance plan can provide for comprehensive coverage and lower premium costs.  This can also be used with a MedicaidPlus strategy (I will cover this in a future blog) to create even more premium savings.  

While expansion of DPC providers continues, there are still areas where no DPC providers are nearby.  For Santa Clara County residents…

Trump Administration Terminates Cost Share Reduction Subsidy Payments

On Thursday, in addition to issuing an executive order to make changes in health reform, the administration announced that the federal government would cease paying all CSRs immediately.

Cost Sharing subsidies are not the same as tax credit subsidies. 

Tax credit subsidies, which can be advanced, are applied to the premium payment on a health insurance plan purchased through the marketplace.

Cost Share Reduction subsidies are available to help lower the costs of services under the health plan,   CSR applies to things like deductible, co-pay, drug cost and out of pocket annual maximum.  All CSRs are in the Silver metal tier and, depending on income level, can be at 73%, 87% or 94% reduction.  

In California the CSR is available to people who have income between 138%-250% of the federal poverty level (see chart).  

In response, health insurers have increased the premium rates for all indiviudal & family Silver tier plans to make up for the loss of funding.  

Those enrolled in Enhanced Si…

Trump Executive Order Changes Health Insurance Landscape

Today, President Trump signed an executive order to make changes in the health insurance marketplace.

The Executive Order mainly addresses three areas and goes a ways towards the Rand Paul concepts.

1.  Association Health Plans.  Health plans sponsored by an association could be sold to groups who are members of the association.  These plans would not have to meet ACA (Obamacare) essential benefits and coverage mandates.  This could reduce premium costs.

2.  Selling Across State Lines.  Association health plans could be sold across state lines which, in theory, could reduce premium costs.  

3.  Short-Term Health Insurance.  Currently these plans are only available for 90 days or less.  This EO would restore short-term plans to a longer period (six or twelve months depending on state).  Prior to the rule change under Obama HHS/CMS, short-term plans in California were limited to six months duration per enrollment.  

I suspect there will be some fighting over this executive order.  California…

Covered CA Slaps CSR Surcharge On 2018 Silver Plans

Covered California, California's state health insurance marketplace, went live this afternoon to shop and compare plans for 2018.

California Healthline reports that Covered CA chose to raise rates an additional 12.4% (weighted average) on Silver plans.  This action is due to uncertainty about the Trump Administration continuing to fund the cost-share reduction subsidy.

In August, Covered California announced that 2018 premiums would rise by 12.5 percent, on average, statewide. That ticked down slightly to 12.3 percent during regulatory review. But the exchange also warned that the additional increase, averaging 12.4 percent, would be added to the silver-tier plans if President Donald Trump failed to commit to continued funding for the so-called cost-sharing subsidies that help reduce some consumers’ out-of-pocket expenses. Those payouts total about $7 billion this year nationwide.California Healthline Article

Stay tuned for more updates and information regarding 2018 California healt…

Anthem Blue Cross Announces Innovative F Medicare Supplement Plan for CA

Anthem Blue Cross (CA) has announced that they are releasing a new Medicare Supplement (Medigap) Plan for California residents.  The plan will be available beginning January 1st, 2018.

'Innovative F' will offer benefits not covered by a Medicare Supplement base plan.  These will include a hearing benefit (exam, fitting and allowance) and a vision benefit (exam, lens co-pay and allowances for frames and contact lenses).

Anthem states that the Innovative F will have a very competitive premium rate.  Innovative F will include the Silver Sneakers fitness program and will be eligible for the Plan F 'new to Medicare' $20 per month first year discount.


Anthem 2015 Cyber Attack Settlement Agreement Reached

Anthem has reached a settlement agreement related to the 2015 cyber attack.

Under the settlement, which was preliminarily approved by the court on August 25, 2017, Anthem does not admit any wrongdoing or acknowledge that any individuals were harmed as a result of the cyber attack.
$15 million of the fund will be allocated to pay actual out-of-pocket costs, up to a set amount, that settlement class members claim they incurred due to the cyber attack.It will pay for two years of credit monitoring and identity protection services for settlement class members who want them.It will allow settlement class members who already have credit services to submit a claim to receive alternative compensation for up to $36 instead of credit services.

Kurtzman Carson  Consultants (KCC) will manage the settlement and is the best resource for questions.

Anthem Announcement

Click here to register for the settlement


800-509-0659 Toll Free

Blue Shield CA Raises 'New To Medicare' Premium Discount

Blue Shield of California is now offering a Medicare Supplement Discount of $25 per month for the first 12 months for those new to Medicare (Part B).  

For California residents turning 65 and enrolling in Medicare, or those who are enrolling in Medicare Part B after 65 for the first time, this discount is available on Supplement Plans A, C, D & F (G will be coming out soon and will also offer this discount).  This discount is not available on High F nor Plan N.

An additional $3 per month discount is available if you choose to pay your premiums using their EZPay automatic deduction.  

Blue Shield currently offers year round birthday rule open enrollment for California residents.  

Call or e-mail for a quote and discounted premium rate on your Medicare Supplement plan.


800-509-0659 Toll Free

No Vote For Graham Cassidy Healthcare Bill (Trumpcare Dead)

The US Senate will not vote on the ACA Repeal Bill (Graham Cassidy) this week.  

The budget reconciliation process ends on September 30th.  This is the time frame allowed to pass a bill with only 51 votes and not 60 votes.

Essentially, #Trumpcare is dead at this point.  

Read the full healthcaredive article here


John McCain Torpedos Graham Cassidy Bill

Today Arizona Senator John MCCain announced that he would not be supporting the Graham Cassidy Healthcare Proposal.  

“I cannot in good conscience vote for the Graham-Cassidy proposal,” the Arizona Republican senator said in a statement, using the bill’s nickname.

The Senate has 52 Republicans.  With McCain's decision and Rand Paul already stating he would not support Graham Cassidy. the matter is in serious doubt.

The proposal needs 51 votes to pass the Senate.  VP Mike Pence could provide the 51st vote in the event that the proposal were to receive the necessary 50 votes for Pence to be the deciding vote.  

Problem is, the positions of Susan Collins (ME) and Llsa Murkowski (AK) are also in doubt. Collins stated today that she is leaning against the bill.

Read the article on Fox News


Medi-Cal Implications of Graham Cassidy For Low-Income Californians

News sources are reporting that the last grasp Graham Cassidy bill will be voted on early next week.  Ahead of the September 30th deadline (the last day the bill could pass with less than 60 Senate votes).

Certain provisions within this legislation would have a direct  and potentially negative impact on Medi-Cal (California Medicaid).

Under the ACA (ObamaCare), California expanded Medi-Cal as allowed under the law.  This expansion is, in large part, funded by the federal government and not the state government. Adults with incomes below 138% Federal Poverty Level and children under 19 with family incomes below 266% are eligible to enroll in MAGI Medi-Cal.  The expansion did away with asset testing and eligibility is determined by income.  

Simply put, under the proposed Graham Cassidy bill, the expansion of Medicaid (Medi-Cal in California) would be reversed and future federal funds that might be used by states would be provided in block grants.  This reversal would essentially remove th…