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Are Patients Abusing The Healthcare System?

Interesting conversation on a recent Stefan Molyneux call-in show with someone who works in a hospital emergency room.  

For me, two schools of thought:

1.  Certainly some Medicaid recipients are abusing the system
2.  Certainly some Medicaid recipients believe that they can only get quality healthcare by using the ER




I have not been to an emergency room in many years so I can't speak to the conditions first-hand.  However, I have heard that ERs can be quite overcrowded and chaotic at times.  

Dave
www.davefluker.com

The Middle Class Squeeze - Are Unsubsidized Rates Affordable?

Remember this?



2019 Family Plan Rates 


The bottom two plans are each carrier's respective PPO Plans for 2019




Dave www.davefluker.com

Some California Obamacare Alternatives For 2019

While some health insurance plans have been eliminated by the CA legislature (short-term limited duration health insurance), there are still options available at lower premium cost than ACA plans.

I do not recommend purchasing these health plans as a substitute for a comprehensive ACA health plan.


Health Sharing Ministry

Health Sharing Ministry Plans have been exempt from the Obamacare mandate since the ACA was signed into law.  These plans a faith-based sharing plans and are not insurance plans.  Costs are shared among the members enrolled in the program.  I expect these sharing plans to continue into 2019 and beyond.  We prefer Aliera Healthcare sharing for their wide variety of heatlh share plan choices, that Aliera is not a strict denomination-based ministry, and that Aliera uses the Multiplan PHCS PPO network.  More info...

Fixed Benefit Health Insurance

The go-to alternative for some to replace short-term health insurance.  Fixed Benefit Health Plans are not limited duration and can …

2019 California ACA Open Enrollment Starts Today

The 2019 California Obamacare Open Enrollment Period has begun.  Open Enrollment will run from October 15th through January 15th.  

Enrollments for January 1 effective dates must be completed by December 15th.  Enrollments from December 16th through January 15th will receive a February 1st effective date.

We have live quoting available now for private market and Covered CA health plans.

Free Instant Quotes

Shop or call us for a quote at 408-847-6139.


Dave
www.davefluker.com



Early Renewal Starts Today. Open Enrollment Starts 10/15

California Obamacare early renewals begin today.  You can renew your current health plan for 2019 starting today.    

California Open Enrollment Period begins October 15th and ends January 15th.  You can purchase a health plan or change you insurance company and plan during the open enrollment period.  

If you need help, call your agent or call us at 408-847-6139 if you don't have an agent.  

Dave
www.davefluker.com



California's Last Short-Term Health Plan Now Closed

Effective September 1, 2018, the only remaining short-term health insurance plan in California has been pulled from the market.

IHC removed their offering in late August.  This is most likely in response to the imminent signing of CA SB 910 into law this month.  SB 910 would make the sale or renewal of any short-term limited duration (STLD) health insurance illegal in California.  

As of this writing, IHC will continue to offer a Fixed Benefit Health Plan in California.

The fixed benefit plan is available year-round and can start as soon as the day after application submission.  Unlike the short-term plan, the fixed benefit plan is not limited in duration.

For more information on Fixed Benefit Health Insurance, click here


Dave
www.davefluker.com




California vs TrumpCare

Changes being made by the Trump Administration with regard to the ACA (ObamaCare) are not going over well in California.  

To date, the administration has extended short-term health insurance to 12 months, eliminated the tax penalty for not having compliant health insurance, allowed for the creation of AHPs (Association Health Plans) and floated the idea of decreasing the MLR (Medical Loss Ratio) from 80%.

California is insistent that the ACA and Covered CA will be the marketplace.

There are currently several bills on the Governor's desk awaiting signature to thwart the changes made by the Trump Administration.


Senate Bill 910
Would prohibit insurers from selling, renewing or offering short-term health plans in California.

Senate Bill 1108
Would allow California to seek waivers from the federal government to increase enrollment in Medi-Cal, the low-income health care program. It would also ban the state from requiring anyone on Medi-Cal to work in order to receive benefits. Kentucky …

F Extra Blue Shield (Innovative) Medicare Supplement Launches October 1 in California

Blue Shield of California has announced the launch of their Innovative F Medicare Supplement called 'F Extra'.  

F Extra will be available for enrollment beginning October 1, 2018.  Like Anthem's Innovative F, F Extra will not be available for Birthday Rule transfers and will be subject to medical underwriting.

F Extra will offer the following additional benefits over traditional Plan F...

1.  Hearing benefits
2.  Vision benefits
3.  Silver Sneakers 
4.  Life Station Life Alert benefits

The $25 per month first year New to Medicare discount will be available for those enrolling in F Extra.

As more specific information and pricing become available, see my site for details.


Dave
www.davefluker.com



Breaking Down CA SB 910

California SB 910 is again up for third read in the Assembly.  It is item #151 on the 8/16 docket.  As this thing moves around one wonders if it will ever come up for a vote?

SB 910 consists of 13 sections that deal with different and specific health insurance issues in California.  Here is a (very) brief summary:

1.   Mental Health Benefit ID card requirements
2.   Mental Health Benefit website requirements
3.   Health Insurance rate change notification and approval requirements
4.   Short-Term Health Insurance outlawed in California beginning 1/1/19 
5.   Orthodic & Prosthetic devices & requirements
6.   Mammography and related services
7.   Maternity coverage for individual & family plans
8.   Maternity coverage for group health plans
9.   Mental Health Benefit ID cards (seems to duplicate #1)
10. Mental Health Benefit website requirements (seems to duplicate #2)
11. Referral requirements on health plans regarding reproductive/sexual health
12. Renewability requirements for individu…

SB 910 Final Read - Would Make Short-Term Health Insurance Illegal In CA

CA Governor Jerry Brown signed SB 910 into law on August 28th.  Beginning 1/1/19 the sale or renewal of short-term limited duration health insurance will not be allowed in California. 

Update 8/20/18:  SB 910 has moved back to the Senate for vote after being amended in Assembly last week.  Item #151 on Senate docket for today.

UPDATE 8/15/18: SB 910 was scheduled for third reading 8/14 item #41 but was not read as amended.  Now scheduled item #151 for 8/16 third reading.  Assembly is adjourned until Thursday 8/16.  No idea if this will get third read this week or at all.  

UPDATE 8/10/18: SB 910 Third Reading was amended and sent for third reading again on Monday, August 13th.  

Item #157 on today's CA Assembly events list is the third and final read of SB 910.

SB 910 would make the sale of short-term health insurance illegal in California beginning January 1, 2019.

There is a lot on the Assembly schedule so not sure if this will get done today.

SB 910 has already passed the CA Senate an…

2019 California Obamacare Open Enrollment Change

California has traditionally had its annual Open Enrollment Period from November 1st through January 31st.  

Beginning with the upcoming Open Enrollment Period for 2019, the dates have been changed.  California Open Enrollment will begin October 15th, 2018 and end January 15th, 2019.  This applies to both off-exchange and on-exchange (Covered CA) enrollments.

Enrollments completed by December 15th will have a January 1st start date.  Enrollments between December 16th and January 15th will have a February 1st start date.  


Dave
www.davefluker.com


Innovative F Health Net Medicare Supplement Launches August 1st in California

Health Net of California has announced the rollout of a new Medicare Supplement Plan.  

Available beginning with August 1 start dates, Health Net will offer their Innovative F Supplement in California.  Earlier this year, Anthem Blue Cross introduced their Innovative F plan.  Health Net's plan marks the second "Innovative" Medicare Supplement in California.

One huge difference between the two Innovative F plans--unlike Anthem's plan, Health Net's Innovative F is available to upgrade from your Plan F to Innovative Plan F during California's "Birthday Rule" Guarantee Issue Period.   Health Net considers Innovative Plan F an "equal benefit" plan compared to Plan F.

Health Net Innovative F offers additional hearing and vision benefits that include:


Routine Hearing Exam - One Hearing Exam every 12 monthsHearing Aid(s) - includes fitting evaluation. $1000 benefit maximum for two hearing aids (one pair) or $500 for one hearing aidRo…

Anthem CA 2018 Small Group Promotion Begins July 1st

Anthem Blue Cross (CA) has announced the relaxation of rules with regard to small employer group coverage beginning with July 1st enrollments.  Promotion runs through December 15th enrollments.

The biggest change?  Anthem will now allow your employees covered under individual & family health plans ON or OFF exchange a valid participation waiver.  Your employees with individual coverage will no longer be forced to drop that coverage in favor of your group health plan to meet group participation requirements.

Relaxation of participation requirements.  Anthem will allow groups with 5 or more enrolled subscribers to meet a mere 25% participation requirement.  Groups 1-4 enrolled subscribers is also reduced from 70% to 65% participation requirement.

Specialty Dental will receive a 24-month rate guarantee if enrolled by December 15th, 2018.

Dave
www.davefluker.com





New: Oscar Health Small Group for Los Angeles & Orange Counties Available 5/1

Oscar Health, known for low premium individual health plans with high tech features, has expanded their product offerings in California.

Small businesses in Los Angeles and Orange Counties will now have access to Oscar group health plans.  These plans will have the same features enjoyed on individual plans including 24/7 telemedicine & concierge services and fully functional smart app.

I am hoping that Oscar Health will expand their offerings to larger portions of California.

If you are interested in a free, no obligation quote for the new Oscar Health plans, send and e-mail or give me a call (1-800-509-0659).  

Dave
www.davefluker.com





Beware Medicare ID Card Scams

As with anything new, there are those who will find a way to take advantage of people to line their own pockets.  Such is the case with the new Medicare ID cards.  New cards are scheduled to be sent in waves with California beginning in May, 2018.

As reported by The Motley Fool earlier this month, scammers are using two techniques to obtain personal and private information from vulnerable seniors.  Two basic techniques that are being used are - 

1.  Telephone calls claiming to be from Medicare requesting seniors pay a fee for their new ID card (claim it's not free which is not true) and,

2.  Telephone calls claiming to be from Medicare requesting personal and banking information for verification in order to get your new ID card from Medicare.

No doubt there will be more attempts and techniques employed in these phishing schemes.  

It is important to remember that Medicare will never call you to obtain any personal, financial or private information (just like the IRS).  Medicare does no…

California Senate Bill Would Outlaw Short-Term Health Insurance

California Senate Bill 910 (Hernandez), which was re-referred to Health Committee on March 14th, would prohibit any insurer from selling short-term health insurance in California.

"This bill, commencing January 1, 2019, would prohibit a health insurer from issuing, selling, renewing, or offering a short-term limited duration health insurance policy, as defined, for health care coverage in this state."


"10123.61. (a) Commencing January 1, 2019, a health insurer shall not issue, amend, sell, renew, or offer a policy of short-term limited duration health insurance policy for health care coverage in this state."

Some California residents use short-term health insurance in lieu of compliant but more expensive Obamacare coverage or as an interim coverage between compliant health plans.  

Within the last year or so we have seen two carriers terminate their short-term health offering in California.  HCC Tokio Marine dropped their plans in 2017, and Petersen International Under…

California Sues Sutter Health Alleging Excessive Pricing

California Attorney General Xavier Becerra has sued Sutter Health, accusing them of illegally quashing competition and overcharging customers and employers.

"A 2016 study found that hospital prices at Sutter and Dignity Health, the two biggest hospital chains in California, were 25 percent higher than at other hospitals around the state. Researchers at the University of Southern California said the giant health systems used their market power to drive up prices — making the average patient admission at both chains nearly $4,000 more expensive."

Of the lawsuit, "it said Sutter employs a variety of improper tactics, such as gag clauses on prices, “punitively high” out-of-network charges and “all-or-nothing” contract terms that require all of its facilities to be included in insurance networks."

I'll be keeping an eye for updates on this as many in my area of California use Sutter Health services.  This limits the choice of health insurance plans significantly.

Read t…

California MRMIP Alive & Well For 2018

California's MRMIP (Major Risk Medical Insurance Program) has apparently survived the proposed budget cut last year.

In 2017, the proposed 2018 budget would have eliminated the MRMIP and the MRMIF (Fund) and transferred the fund balance to the newly established Health Care Services Plans Fines and Penalties Fund.  See my blog post from 2017

MRMIP is qualifying health coverage for mandate/penalty issues.  It is available year round for enrollment (assuming no waiting list) to California residents who are denied enrollment in a qualifying health insurance plan (Obamacare).  

Online 2018 MRMIP Brochure with benefits, rates and application form


Dave
www.davefluker.com





Idaho "Freedom Blue" Health Plans Coming Soon?

Vox.com has released some details about Idaho Blue Cross' plans for new, non-ACA health insurance plans.  As mentioned in my blog post of February 1, Blue Cross received legislative approval to offer skinnier and less expensive health insurance plans to individuals & families.

http://davefluker.blogspot.com/2018/02/the-idaho-experiment-exit-obamacare.html

Apparently the five new plans will be dubbed "Freedom Blue" and will come in between 25%-50% cheaper than Obamacare plans.  From what I am reading, it appears that the plans will have some new provisions as well...


Up to 50% rate up for applicants with health conditionsPre-existing conditions exclusions for those who fail to maintain prior coverageLifetime maximum benefits $1,000,000There will likely be issues between Idaho and the federal government.  
Read the full article on Vox

Dave www.davefluker.com


Aetna Under Investigation by California Insurance Regulators

Aetna is currently being investigated by the California Dept of Managed Healthcare (DMHC) and the California Dept of Insurance (DOI) in relation to recent testimony in a lawsuit.

"The Department of Managed Health Care, which regulates the vast majority of health plans in California, said Monday it will investigate Aetna after CNN first reported Sunday that one of the Hartford, Conn., company's medical directors had testified in a deposition related to the lawsuit that he did not examine patients' records before deciding whether to deny or approve care. Rather, he relied on information provided by nurses who reviewed the records — and that was how he was trained by the company, he said."


"In an emailed statement Monday, Aetna did not directly address the question of case reviews by non-physicians. It said its "medical directors review all necessary available medical information for cases that they are asked to evaluate. That is how they are trained, as physici…

Blue Shield Combines California Medicare Supplement Discount Programs 2018

Blue Shield CA has made changes to the discount programs available to California Seniors going onto or already on Medicare Supplement coverage.

There are currently two discounts available.  

1.  New to Medicare premium discount of $25 per month for the first twelve months from original Part B effective date.  Another $3 available if paying by Easy$Pay.  This discount applies to plans A, C, D, F & G.  Does not apply to plans N nor HD F.

2.  Household Savings Program discount of 7% for two party enrollments.

In the past, the two party discount and New to Medicare discount could not be combined and the optimal setup was to separate spouses for at least the first year.  Now couples can enjoy both of the discounts at the same time.

The ability to combine these discounts makes for great premium savings.Call or email for a free quote and information.  

Dave
www.davefluker.com






The Idaho Experiment: Exit ObamaCare

Legislators in Idaho have approved a plan to allow insurers to offer residents alternative health insurance that is not compliant with the ACA (ObamaCare).  

These types of plans would likely resemble plans we saw in California prior to the implementation of ObamaCare--Tonik, RightPlan, ClearProtection, SmartSense.  Insurance carriers would still be required to offer ObamaCare-Compliant health plans for those who wish to enroll.  

"The Idaho plan would make it possible for insurance companies to offer cheaper plans that might be more attractive to people who have to buy their own insurance and do not benefit from the federal premium subsides offered under the Affordable Care Act. The catch is that those plans would be skimpier."

With the removal of the mandate to purchase ObamaCare in 2019, Idaho, and other states, fear massive rate increases as younger, healthier people opt to forego buying expensive health plans.  

For insurers as well as states, the mechanics involved would b…

The Best Health Insurance For California Millennials

Be sure to visit and bookmark our Millennials web page for frequent updates and news.

The Best Health Insurance for California Millennials

California millennials are entering their prime earning and acquisition years.  Many millennials are choosing to explore business startups and self employment, as well as testing the job market.

In some cases millennials may not have access to health insurance coverage through an employer or their parents.  This leaves the options of purchasing private health insurance, setting up a small employer benefit plan for your startup/business, or choosing to go without health insurance.  Statistically about 25% of California's uninsured population is made up of millennials between 26-34.  

When I look at health insurance for millennials, I look at three things: Quality, Affordability and Technology.  New players are entering the market with health insurance products designed for the Millennial Generation.

For millennials choosing to purchase private health…

Top 30! Our Blog Ranks #24 Best Health Insurance Blog On The Web

A nice surprise start to the year as our California Health Insurance Blog has been recognized by the panel at feedspot.com as one of the top 30 health insurance blogs on the web.  Our blog came in at #24.

We are in very good company with several well-known blogs including healthcare.gov.  Our friends and colleagues at insureblog came in #22.  


These blogs are ranked based on following criteria Google reputation and Google search rankingInfluence and popularity on Facebook, twitter and other social media sitesQuality and consistency of posts.Feedspot’s editorial team and expert review
Here is a link to the full list


A great way to start the new year!

Dave
www.davefluker.com





Covered CA Extends February 1 Deadline

Covered CA has announced the extension of the deadline to enroll for coverage beginning February 1, 2018.

Normal deadline would be January 15th.  It has been extended to January 19th. 

Some carriers may extend off-exchange to match Covered CA, but this is not guaranteed,  I will update this post for any changes in off-exchange deadlines.  So stay tuned.

Dave
www.davefluker.com