Eat healthy food – don’t skip breakfast
Drink lots of water – 8 glasses a day
Take long walks everyday – stay in shape and exercise
Get plenty of rest (7-8 hours recommended) – take an afternoon nap
Have check ups regularly
Smile and laugh – lowers blood pressure
Relax – Reduces stress
See the beauty in everyday life
The Annual Election Period is here– October 15 through December 7. This is when you can add or change your Prescription Drug or Medicare Advantage Plans for 2014.
Anthem Blue Cross is offering three drug plans in 2014: Standard, Plus & Gold Plans, and the premiums have decreased. The Standard Plan has a $310 deductible with basic formulary coverage for $30.20 per mo. The Plus Plan, no deductible, bigger formulary for $66.10. The Gold Plan, no deductible & a robust formulary at $108.80 per month (Higher income households could pay an additional premium surcharge). The Part D Drug Plan is optional but there is a penalty if you don’t participate.
Blue Shield is offering two drug plans in 2014: Basic Plan and Enhanced Plan. Basic Plan has $310 deductible with a lean formulary list at $42.80 per mo. Enhanced Plan has no deductible & a robust formulary at $74.40 per month.
Medicare Advantage Plans are available replacing Original Medicare and change every year.
Medicare Supplement Plans are written in connection with Medicare picking up the gaps in coverage, such as deductibles and co-pays.
Dental and Vision Plans are available too.
Seniors, you are NOT subject to Obamacare and all the health changes with the Affordable Care Act. Celebrate that one!
With so many changes in the Health Insurance business, the Individual Mandate remains unchanged. Starting 1-1-2014, you must have health insurance or pay a penalty. The good news is you cannot be turned down if you have a pre-existing condition. Also there will be tax credits and subsidies available if you qualify based on your income. Many new products will be flooding the markets and there will be choices of plans, networks, co-pays and deductibles , you will need to work with a professional agent who is well trained in the Patient Protection and Affordable Care Act. Starting October 1st, plans and rates will be available and open enrollment begins for a January 1, 2014 effective date. I would be happy to review your options.
SMALL BUSINESS HEALTH OPTIONS PROGRAM (SHOP)
Small Group – Employers with 50 or fewer employees are NOT required to provide health insurance to their employees however many do to attract and retain the best employees. Last month, Covered California announced the insurance carriers who will be participating in the State’s new health exchange for Small Business called SHOP. In Orange County, we have Blue Shield, Health Net and Kaiser. There will be four levels of health insurance available: Platinum, Gold, Silver & Bronze. Certified agents will assist employers in their selection and in applying for coverage. Training & certification of agents is starting soon. The State exchange is just another place to buy insurance. Many carriers will continue to sell Small Group Coverage directly to employers outside of the Exchange. The actual rates won’t be available until after October 1, 2013 for a January 1, 2014 effective date.
The Large Group (over 50 employees) Employer Mandate was recently delayed to 2015. Actually the Pay or Play penalty was delayed. Large Employers with 50 or more Full Time Equivilents will be required to offer affordable health insurance to their full time employees or pay a penalty
In the news, you will see and hear information on the State Health Insurance Marketplace (or Exchange), called Covered California. They just announced the four insurance carriers and the plans that they will be offering in OrangeCounty: Anthem Blue Cross HMO & EPO, Blue Shield PPO, Kaiser HMO and Health Net HMO
There will be four tiers (metal levels) of coverage available with choices of carrier and plans in each level:
Let’s say I want a PPO and choose the Silver Plan 70/30 with Blue Shield.
Some premium figures have been released however rates will not be finalized until July.
There will also be Financial Assistance in the Marketplace. With the expansion of Medicaid, individuals earning less than $16,000 could qualify for free insurance.
Federal Subsidies are available on a sliding scale for Individuals earning less than $46,000 and Families earning less than $94,000, to be applied to monthly premium.
The Marketplace does NOT replace private insurance, its not socialized medicine, there is no death panel – it is a State run agency using private health plans as another channel to secure coverage – or simply another place to shop for insurance.
There are 5.3 Million uninsured people in California
Three reasons why people don’t have medical insurance (1) they have a pre-existing condition (2) not offered by employer (3) unaffordable
January 1, 2014 health insurance will be guarantee issue – no health questions, no pre-existing conditions
Three options for coverage in 2014 (1) employer plan (2) buy insurance through the Marketplace if you are eligible for subsidy/tax credit or buy insurance through the traditional market (3) go uninsured and pay a penalty
Rates based on income, where you live, age & other factors
Covered California open enrollment begins October 1st for a January 1, 2014 effective date
There will also be a Catastrophic Plan for individuals under 30 who don’t qualify for tax credits
Check your 2013 tax return – are you eligible for a subsidy?
Subsidies for Individuals based on income and not having employer health insurance or its not affordable (over 9.5% of your income)
Everyone purchasing an individual plan will have access to expanded benefits, lower deductibles and lower out of pocket maximums
*All new plans must include “essential health benefits”:
1. Ambulatory patient services
2. Emergency services
4. Maternity and newborn care
5. Mental health & substance use disorder services,
including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
*Healthcare.gov: Essential health benefits
There are many changes coming with the Affordable Care Act – also known as “Obamacare”. This Federal Law passed in 2010 was to help more people get affordable health coverage and receive better medical care. With 30 million uninsured, this will be a big job! Open enrollment begins October 1st for a January 1st, 2014 effective date.
Individual mandate requires all US citizens purchase “minimum essential coverage” to avoid penalties.
You have three choices: Employer coverage, Individual coverage (in or out of the state exchange), or go uninsured and pay a penalty.
Subsidies (financial assistance for exchange plans only) available to individuals and families with incomes between 138%-400% of the Federal Poverty Level. Single adults below $46,000 and family of 4 below $94,000 could be eligible for help, as long as they don’t have affordable coverage through their employer.
Cost-sharing Subsidies reduce deductibles and co-pays. Tax Credits or Premium Credits reduce premiums.
Medi-Cal – No cost insurance – is being expanded to includes persons with incomes up to 138% of the Federal Poverty Level.
Come 2014 everyone will be guarantee issue – no underwriting questions on the new applications, no problem if you have a pre-existing condition. However everyone must participate in the plan to make it work – the young & older, the healthy & sick. More to come –
Sue Kidder Health &Insurance Services | PPO & HMO Health Insurance, Life Insurance, Business Health Insurance, Group Medical Insurance, Employee Benefits, Individual
Health Insurance, Family Health Plans, Healthcare Plans, Vision & Dental Insurance, Covered California, Free Quotes, Medicare Supplement Plans, Part D Prescription
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