Jonathan Edewards

“Small Group” Health Insurance – why rates are increasing, and the difference between “Grandmothered” or “Grandfathered” plans vs the new “ACA” plans

January 2016: No more “grandmothered” health insurance plans, and now any employer with 1 to 100 employees is considered a “small group.”

Employers who have more than 50 employees* are now required to provide health insurance, or face a large tax penalty.

 

This infographic, published by Anthem Blue Cross is very helpful for explaining:

“Why are small group health insurance rates increasing?”

and

“What is the difference between the way that the new “Obamacare” /  Affordable Care Act (“ACA”) plans are rated vs the way they were rated previously?”

 

Why are small group health insurance rates increasing, and what is the difference between the way that the new "Obamacare"/ACA/Affordable Care Act plans are rated vs the way they were rated previously. The explanation is: 1. No more "discounts" (previously known as a "RAF"). 2. In many cases, the new ACA plans have better or increased benefits that are mandated by law. The new plans cover more. 3. New regulations regarding how plans charge consumers, designed to spread the cost more equally among the population, so that there are fewer instances of some people paying very little and some people paying extraordinarily high rates. This benefits people who are sicker and older, or who live in areas where hospitals and doctors charge more, and it hurts people who are young, healthy, or live in areas where healthcare costs are very competitive.

Essentially, there are three fundamental trends:

  1. No more “discounts” (previously known as a “RAF”).
  2. In many cases, the new ACA plans have better or increased benefits that are mandated by law.  The new plans cover more.
  3. New regulations regarding how plans charge consumers are designed to spread the cost more equally among the population, so that there are fewer instances of some people paying very little and some people paying extraordinarily high rates.  These new regulations on rates benefit people who are sicker and older, or who live in areas where hospitals and doctors charge more, and the regulations hurt people who are young, healthy, or live in areas where healthcare costs are already very competitive.

* 50 employees = the sum of all your full time employees plus “full-time equivalents.”  Call us at 626-676-3466 for a full explanation.


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Rates and Doctor Networks are changing.  Give me a call for assistance!  As a Covered California Certified Insurance Agent (CIA), I can help you:

  • Renew or Change your plan.
  • Make sure you’re getting the best value.
  • Help you qualify for the correct Tax Credit / Subsidy. (And avoid mistakes that might haunt you at tax time!).
  • Know which plans have your doctors & hospitals “in-network,” and which plans do not.
  • Figure out billing issues and answer other questions.
  • Provide an alternative to waiting on hold with Customer Service hotlines.
  • Troubleshoot.

No Cost to You – No Extra Fees.

 CALL:
626-676-3466

626-676-3466

Breaking News! Cedars-Sinai Joins Blue Shield PPO Network—March 2015

In-Demand Hospital finally becomes accessible to many residents who live on Los Angeles’ West side.

On January 26, Cedars’ website was updated to show Blue Shield’s Individual and Family Plan (IFP) PPO options as “in-network”.

Screenshot of cedars-sinai.edu taken on1/29/15

Screenshot of Cedars’ Insurance Page taken on 1/29/15.

These plans are available both “on-exchange” (through a Covered California Certified Agent) and “off-exchange” (directly through a Blue Shield agent).  There is no difference between “on” and “off” exchange plans; simply a different method of submitting an application for coverage.  (Purchasing an on-exchange plan is the only method to apply for a tax credit/subsidy, however).

Blue Shield’s plans have been the lowest-cost PPO plans available in LA County for the last two years, but the lack of access to Cedars-Sinai was previously a disadvantage that was a deal breaker to many people who live nearby in West Hollywood, Beverly Hills, and Los Angeles, or who value the hospital’s excellent reputation.Print

Now, many people may consider switching plans to take advantage of the premium savings.  However, the opportunity to change plans (or enroll in a new plan) closes with the end of Open Enrollment on February 15, 2015.

Blue Shield also offers excellent Dental and Vision Insurance options, but only when enrolling “Off-exchange”. (Covered California has plans to offer Dental options, but the rollout has been delayed.

If you would like to explore your options with Blue Shield (or any other insurance company) call me at 626-676-3466 and I’ll be happy to provide advice and assistance.

Or, click THIS LINK or the photos below to explore your options online.

 

 

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Open Enrollment for Health Insurance begins again on November 15th

Covered California urges consumers to find a local insurance agent.
Agents can help their clients decide if it’s best to renew their current plan or switch to a new one.

Frustrated with Covered California? Phone lines jammed, and hold times too long? A local insurance agent get help immediately, and answer your questions about health insurance, and help you decide if you should renew your current plan or switch to a new one. Call Jonathan Edewards of Citrust Insurance Agency for help

Rates and Doctor Networks are changing.  Give me a call for assistance!  As a Covered California Certified Insurance Agent (CIA), I can help you:

  • Renew or Change your plan.
  • Make sure you’re getting the best value.
  • Help you qualify for the correct Tax Credit / Subsidy. (And avoid mistakes that might haunt you at tax time!).
  • Know which plans have your doctors & hospitals “in-netowork,” and which plans do not.
  • Figure out billing issues and answer other questions.
  • Provide an alternative to waiting on hold with Customer Service hotlines.
  • Troubleshoot.

No Cost to You – No Extra Fees.

 CALL:
626-676-3466

626-676-3466

How much is the penalty for not buying Health Insurance?

Starting January 1, 2014, most consumers must have health insurance. This may be through your employer, coverage you buy for yourself, Medicare, or Medi-Cal.

Consumers who don’t have health insurance may have to pay a penalty called a “shared responsibility fee” that increases each year up to a maximum amount.

2015: The fee is 2% or $325 per adult, plus kids.

In 2015, the fee is 2% of the annual household income, or $325 per adult, whichever is higher.

In 2016, the fee increases to 2.5% or $695 per adult, whichever is higher.

For example, the chart below shows the penalty with the maximum for an uninsured household of four:
Health-Insurance-Penalty-Fee-2015-2016
If you’re uninsured for just part of the year (longer than 3 months), you pay a pro-rated penalty.  That is, 1/12 of the yearly penalty for each month you’re uninsured.

The penalty is due when you file your taxes at tax time.

Remember, if you are uninsured you also pay 100% of your medical costs.

The Good News: Help is Available.

If you can’t afford either the monthly premiums or the penalty, there is help available.  Call me at 626-676-3466 and we can discuss your options.

 

Your friendly insurance professional

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Give me a call for assistance!  As a Covered California Certified Insurance Agent (CIA), I can help you:

  • Renew or Change your plan.
  • Make sure you’re getting the best value.
  • Help you qualify for the correct Tax Credit / Subsidy. (And avoid mistakes that might haunt you at tax time!).
  • Know which plans have your doctors & hospitals “in-netowork,” and which plans do not.
  • Figure out billing issues and answer other questions.
  • Provide an alternative to waiting on hold with Customer Service hotlines.
  • Troubleshoot.

No Cost to You – No Extra Fees.

 CALL:
626-676-3466