In 2017, the ACA will allow states to sell large group health plans through the exchange operating within that state. For example, Covered California will be able to sell fully-insured large group health plans under the state operating insurance marketplace. Currently, large group health plans do not have to abide by the same policies established for small group health plans because Congress feared that it would actually mean more cost to individuals covered by large group insurers. Since most large businesses pay an average of 60% of the cost of their employee’s coverage, large group insurers were not subject to the same rules and regulations
What You Need to Know for Open Enrollment
The open enrollment period is November 15th through February 15th. The open enrollment period is a specified time frame where health insurance companies are required to accept applicants. This is the only period where you can enroll in a new plan or get covered through the rest of the year (unless their is a qualifying event). Here are 5 things you need to know for open enrollment in 2015 plans: Check to make sure the cost of your coverage did not increase dramatically. Health insurance premiums will increase in 2015 so it’s important to check your renewal rates and make sure they are within your current
Navigators Given Grants to Boost Enrollments
On Monday September 8, 2014, Health and Human Services (HHS) agreed to give $60 million in federal grants to help navigator programs on the health care exchange. Last year, HHS awarded states $67 million dollars in grants to help build out the navigator programs. Navigators are individuals who help consumers with questions regarding enrollment. They are trained individuals who are able to assist consumers, small businesses, and their employees looking into health care options. Navigator grants are only permissible in states where the federal government is setting up the exchanges. States with their own healthcare exchanges (like California) must set up their own navigator education program to assist individuals
IRS Breaks Law Under the ACA
As mentioned in a previous post this month, the D.C. Circuit Court was looking at the Halbig v. Burwell case which looks into the issue of whether premium subsidies should be authorized on the federal exchange in states where the government set up the insurance marketplace. The court has now made a decision. What’s the verdict? The court has ruled that “an exchange established by the State means an exchange established by the State.” Therefore, according to the language in the Affordable Care Act, the government cannot legally give premium subsidies to states that did not develop their own state run exchange. However, individuals and families
Halbig v. Burwell Federal Subsidy Case Review
On Tuesday morning, a federal appeals court for the case Halbig v. Burwell raised the question of whether premium subsidies should be authorized on the federal exchange in states where the government set up the insurance marketplace. One court ruled that the ACA authorizes subsidies in states that run their own exchange. However, another court ruled that the wording in the ACA is vague and ambiguous. The language used in the document is open because subsidies are essential to fulfilling the goal of the ACA, making healthcare affordable. Will this decision affect Covered California? This decision does not affect California because that is a state run
Anthem Blue Cross Under Investigation
Anthem Blue Cross is a well-known, major play player in the insurance marketplace. However, the insurance giant is under investigation by the California Department of Managed Health Care. Covered California is looking into the accuracy of Anthem Blue Cross’ provider networks due to a series of complaints by policy holders. This investigation initiated from multiple law suits brought on against Anthem by the consumers including one last June by WellPoint, Inc. What are policy holders upset about? Narrow provider networks Loss of benefits Bait and switch tactics to get consumers with expiring plans to enroll in different coverage where former benefits may no longer be provided without the
Complaints About Covered California Exchange
On July 8, 2014 the Sacramento Bee released a report stating that early 1800 complaints were filed regarding the Covered California exchange processes. It turns out that San Diego residents are not the only ones confused with the provider networks set up under California. Complaints Filed Entail: Health Cards and Enrollment Information Not Received (many participants on the exchange failed to receive their actually medical health insurance cards and information showing proof of their plans) Narrow Provider Networks (not enough physicians available in certain areas) Inaccurate Provider Lists (many mistakes were made when detailing which providers were covered causing patients to seek help for doctors not covered
How Insurance Agents Helped Drive Covered California Enrollments
Initially, California had predicted that about 80% of consumers would look for assistance when enrolling in the healthcare exchange. According to a recent article from the Los Angeles Times, insurance agents were responsible for enrolling nearly 40% of people who enrolled in a Covered California plan. This is a huge testament to the work of these agents in getting people covered despite limited resources and numerous setbacks. Originally, Covered California had planned to have 16,000 certified enrollment counselors prepared to help sell plans on the exchange. Despite their hope, only about 600 counselors were officially certified at the start of open enrollment. By the end
California Took the Lead in Implementing the ACA
According to California Healthline, California was one of the leaders in implementing the Affordable Care Act through the Covered California exchange program. Within the first open enrollment period, California had the highest number of sign ups along with Medicaid enrollments.That’s not to say that it wasn’t a bumpy start with the website issues. However, California’s early preparations did lead to a better growth rate at the end of the enrollment period compared to other state run exchanges. What lead to this success? California focused efforts on enrolling people in Medi-Cal (more than 600,000 state residents received coverage through this expansion) $200 million dollars was spent
How will Single Doctor Medical Practices Be Affected By Obamacare?
It is uncertain whether the Affordable Care Act will actually help or hinder our country’s efforts at creating a better health program for its citizens. However, recent information has revealed that the Affordable Care Act may be hurting small businesses and single doctor medical practices. Many single doctor medical practices have been forced to shut down their businesses due to high costs and have started working with bigger practices to remain profitable. What has caused this? The high inflation rate of Medicare procedures has caused an Escondido community doctor to consider giving up his practice. While only 72, Doug questions whether he can afford to