Another Health Carrier to Leave California

Last month it was Aetna announcing that they were leaving the individual health market here in California, now this month United Health Care announces that they are leaving as well.  It is important to note that they are leaving just the individual and family plan markets, not employer sponsored group plans or Medicare plans. It is important to note that Aetna and United combined only carried about 8% of the individual market this past year.  They never caught on competitively to the new rules and regulations that California set over the past two years.  Once mandatory maternity was introduced last year their rates and plans never came close to the other carriers.  With that said, it is still sad that there will be less choice for consumers overall and it begs the question "who will we see leave next?"  For those of you that are on either an Aetna or United plan, you will need to find a new carrier prior to January 1, 2014.  If you have questions on what to do, you can email us at info@ansainsuranceservices.com or call us at 714-680-5900.

The Five Things You Need to Know Before Obama Care Hits Full Force

For us in the insurance industry there are literally thousands of things we need to know about "Obama Care" or PPACA as we prefer to call it.  PPACA reaches everywhere and touches different people, industries, regions etc. in a plethora of ways.  To say PPACA is complicated is like saying the ocean is a little wet.  But as we reach outside our office we see that there is a great need to understand the law and what it means and doesn't mean.  I can sit here and write for days and days and still not touch upon the issues or details that might mean the most to you.  So I have condensed it into 5 hot spots that I think people should know.

1)  It's not going away! - Cry all you want it is here and moving forward.  Now the trick is to deal with it.
2) There will be winners and losers! - The winners will be those people that have tried to be responsible and purchase insurance, but have been unable to because they had preexisting  conditions.  They had been kept out of the market and were not allowed to "play" so to speak.  There are also those that have made too much to qualify for government programs but could not afford coverage on their own.  They will now be able to enter expanded programs or be given subsidies for their insurance.  The losers will be the people that hardly used their insurance, but had purchased very basic policies to cover them in the event of a major injury or illness.  They are now forced to pay for benefits they will never use.  Take for instance a client of mine who is a 60 year old male.  He is in remarkable shape, takes very good care of himself and enjoys his life as a single grandpa.  He now has included in his medical plan maternity benefits, Autism benefits, and free mammograms and oral contraception.  Will he ever need those benefits? No, but he now pays for them.
3) Health plans will look different! - Beginning in 2014 the health plans will all be divided into "metallic" plan designs.  What this means is that they will all be assessed an actuarial value.  Depending on that value they will be classified as either Bronze, Silver, Gold or Platinum.  Bronze will be the most basic at an actuarial value of 60%.  That means that if an average procedure were to cost $10,000 the plan would pay $6,000 and the insured would be responsible for the other $4,000.  Silver will be 70% so that same $10,000 procedure would be spit with the plan paying $7,000 and the insured paying $3,000.  The gold plan is a 80% plan and platinum is 90%.  Please note that these are actuarial amounts.  Each plan will have those values worked into it's formulas, you may not see them if you don't have a large claim.
4 ) The "Exchange" is not a place! - It is a mechanism to figure out who gets subsidies and what plans qualify for those subsidies.  Here in California our exchange is Covered California. 
5) You think you have it tough? The employers have it tough! - There are so many new regulations coming out for employers, they wont see day light for quite some time.  The paper work will be endless, the compliance will be daunting and costly and the regulations are a moving target.  They will need all the help they can get and maybe a nice glass of wine to help at the end of the day.

So now that you know all that are you ready for Obama Care?  If you have questions or need answers please feel free to call us any time at 714-680-5900.  We are ready!

Covered California - Rates Higher or Lower?

Peter Lee's announcement that the Covered California health plans will cost the same or less in some areas has drawn a lot of press this week.  Is he right or wrong?  Is he comparing apples to apples or apples to oranges?  Well, here it is in a nutshell. The premiums he is comparing over the two year period are 2013 small group premiums and what will be 2014 individual premiums.  Those of us in the insurance business have known that small group benefits are richer than most individual plans, thus they have historically cost more.  That being said, many individuals were able to get a break on prices for picking plans that do not offer all those rich benefits that were mandated into small group plans.  Some of these touted benefits are prescription drugs, free physicals, free oral contraception, physical therapy, and prior to last July maternity.  Thus prior to the health care law a single male that was healthy and not on any prescriptions could benefit from a lower priced plan and not worry about the plans benefits not being as rich as group plans.  For many this was seen as a positive.  For some however, these watered down benefits were a disaster.  If someone purchased a bare bones, high deductible plan because it was cheep then had developed health problems they were stuck in that plan.  In a sense they were paying for something that was not giving them any benefits.  I believe this became such a big problem, because more and more individuals purchased their insurance on-line or without a broker.  They did not have anyone explain the risk they were taking on by purchasing these low cost plans.  As a broker I know I would steer my clients away from such plans.  Only in a few instances were these plans appropriate.  But for the people that these plans were appropriate for the law adversely affects them.  They are now forced to buy richer plans. 

The unfortunate thing about this law is that what happened before will still happen.  People that can not afford a rich plan, gold or platinum, will buy a bronze plan.  Bronze plans actuarially work out to be a 60% - 40% plan, meaning that the insurance carrier pays 60% of the expenses and the insured pays 40%.  A very simplistic example of this would be a person that goes to a doctor and the bill is $100.00.  The carrier would pay $60.00 and the insured would pay $40.00.  That sounds fare right?  Well what if they need to have a procedure that cost $10,000.00?  The carrier would pay $6,000 and the individual would pay $4,000.00.  Most people that chose to be on a basic plan still can not pay $4,000.00 for a service.  I see just as many people having trouble paying for their care now with this law as I did before.  Even when you factor is the subsides that many people will be able to receive and that most people will be on silver plans (70%/30%) people will be forced into delaying care or forgoing it all together. 

To avoid these pitfalls it will be imperative that people talk to professionals and know what their financial situation can handle.  We don't have crystal balls to see into our future and planning for the unplanned is what insurance is all about.  Don't go it alone. 

If you have questions about health insurance please feel free to call Angela and Lisa at 714-680-5900 or email us at info@ansainsruanceservices.com .  For information on Covered California check out their web site at www.coveredca.com . 

CEO of Western Health Advantage Sees Rates Rising 40% to 70%

Garry Maisel, CEO of Western Health Advantage thinks individual health insurance premiums could rise anywhere between 40% to 70% next year in the health care exchanges.  He is quoted in the Sacramento Bee's May 10, 2013 article as saying "We have to reset the benchmark." He spells out the reasons for the rate increases and the benefits that will come with those rate increases.  To read the full article click on the link below:
http://www.bizjournals.com/sacramento/news/2013/05/10/insurance-exec-sees-rate-spike-under.html

Much of the reasons he gives we have already spelled out in previous blogs, but it is still a great article for it's condensed yet thorough interpretation of what is happening in the health insurance world.

If you would like more information on other health insurance carriers in your area please contact us at info@ansainsuranceservices.com or call us at 714-680-5900.

California Lawmakers Grant Unusual Secrecy for Contracts Related to Health Exchange

Apparently lawmakers in California think it is okay to grant blanket privacy rules on contracts that relate to activities within the California Health Exchange (Covered California).  According to the AP in an article from the Washington Post, May 9, 2013 California lawmakers are alone in the nation with the amount of privacy granted to outside firms awarded contracts within California.  No other state has built in to it's laws such widespread secrecy rules.  The law is completely supported by the Assembly Speaker, John Perez and opposed by State Senator Sam Aanestad.  To read the full article click the link below, it is eye opening!
http://articles.washingtonpost.com/2013-05-09/national/39124820_1_covered-california-california-exchange-state-constitution

Is it wise to impose such secrecy at a time when many feel that the health care law is already overreaching?  If you have an opinion on this please contact your state representatives.  If you would like to get more information on health insurance in general or how the law will affect you personally please contact us at info@ansainsuranceservices.com or call us at 714-680-5900.

Part-Time Workers Fear Cut in Hours

Hourly and part-time employees are fearful that their hours will be cut by employers trying to keep their health care costs down.  Full time, under the PPACA or "Obama Care" as it is known, is 30 hours of work a week or more.  Employers that employ 50 or more "full time equivalent"  employees must offer minimal coverage to their full time employees.  So many employers are being forced to decide what to do with their part-time or variable hour workers.  To keep costs down, many employers are making sure their employees do not work more than 27 hours a week, thus staying under the 30 hour rule.  It is an unintended consequence of the law, but now part-time employees may see their take home pay cut as a result.  If you would like to read more about the problem, The Los Angeles Times had a great article by Chad Terhune on this subject.  To read the full article click on the link.
 http://articles.latimes.com/2013/may/02/business/la-fi-part-time-healthcare-20130502

If you have any questions about health insurance or life insurance please feel free to call us at 714-680-5900 or email us at info@ansainsuranceservices.com .  To check out rates and what we do go to our website at www.ansainsuranceservices.com .

Updates on Health Care Reform

Self-funded groups be on the look out for information on PCORI (Patient-Centered Outcomes Research Institute) - it is one of the taxes you will need to  pay for PPACA.  (If you are not a self-funded group your carrier is taking care of filling this tax.)  It is due by July 31, 2013 for groups with plan years that end between October 1, 2012 and October 31, 2013.

Our state legislature has been very busy trying to pass laws to implement PPACA.  Some have been useful and necessary and some are overreaching.  Please take a few minutes out of your day to contact your state representatives and let them know how you feel.  Two such bills are SB639 and SB189.  State Senate Bill 639 (Hernandez) is one of the over reaching bills.  It sets forth to limit choices in individual, small group and large group health insurance policies.  The limits proposed in the bill are not actuarially sound and will do more harm than good in the long run.  State Senate Bill 189 (Monning) proposes bans on wellness plans.  We all know that wellness plans are for the good of individuals as well as our state on a whole.  Limiting or banning all together these plans does not help to make a healthier state.

If you would like more information on the taxes being imposed by PPACA or state legislation please feel free to contact us at angela@ansainsuranceservices.com or call us at 714-680-5900.