Category Archives: Health

2015 Covered California Health Insurance Plans

New 2015 Individual & Family Health Insurance Plans (Affordable Care Act – ObamaCare) health plans and rates for Individuals, families and children.  Health Insurance is now offered on a guaranteed-issue basis, meaning you can enroll in any company health insurance plan regardless of your current or previous health status.

blue button anthem blue button blue shield1

Subsidy? … Depending on your household income, When you enroll in a new health insurance plan for yourself or family you may be eligible for a subsidy (discount) which may drastically decrease the monthly premium.  Subsidy eligibility depends on “household income.”  You can see the income chart below.

Open-Enrollment … Every year you will enjoy an “Open-Enrollment” period typically from October 1 through December 15, which allows you to view the health insurance plans and premiums in your area and any changes which may occur for the following year.  This is the time you will make any changes with your current company or enroll in a new plan/company.  for the following year.  Changes can only be made during the open-enrollment period unless there is a “qualifying event” which may allow you to change plans outside the annual open enrollment period.

ACA subsidy levels 2015

4 Levels of Coverage … With all companies you will find 4 levels of coverage.  The plans are categorized into four “metal levels” of coverage based on the percentage of coverage the company’s pay.

  • Platinum:  You pay 10% of health costs, plan covers 90%
  • Gold:  You pay 20% of health costs, plan covers 80%
  • Silver:  You pay 30% of health costs, plan covers 70%
  • Bronze:  You pay 40% of health costs, plan covers 60%

All plans will  offer the “essential health benefits” such as: doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

Enroll Online with the company and plan of your choice … Remember, enrollment in a health insurance company is guaranteed, regardless of one’s health history or current health status.  The enrollment process is quick and easy with much less personal information then when insurance companies would medically underwrite.

Do I have to enroll during Open Enrollment?  If you choose not to enroll in an “Affordable Care Act” plan in 2015, you will be fined and the penalty will be the greater of 1% of your taxable income or $95 per adult and $47.50 per child (up to $285 per family).

You can choose to buy insurance from an insurer from your state of residence.  You must keep your plan for the entire year unless you start on an employer health plan or move to an area where your plan is not available.  Also if your income drops to where you are eligible for Medicaid.  Otherwise you must keep your plan or face the fine.

Health Care … Almost everyone gets sick or hurt, or needs some sort of medical help.  To get better you usually need care, like seeing a doctor or staying in a hospital or taking prescription medications.  Health Care includes many different services such as: doctors office visits, hospital stays, emergency room visits, lab and X-ray, prescription drugs, preventive care, well baby visits, well woman visits, immunizations and screenings.

Anthem   –   Blue Shield

Questions?

John Conner
800-700-1246
john@johnconner.com

2015 Anthem Blue Cross Individual Health Insurance

2015 Anthem Blue Cross Individual & Family health plans and rates for Individuals and Families.  Individuals, families and children are now offered health insurance plans on a guaranteed-issue basis, regardless of your current or past health status.

2 Ways to Enroll …

Enroll “On or Off” the Covered California Exchange .. Enrolling Inside the Covered California Exchange is typically for the individual or family who qualify for a subsidy due to their income (see the chart below).  Individuals and families who do not qualify for a state subsidy, will usually enroll outside of Covered California (the plans are the same) although the application process is much quicker because you don’t have to state your income totals.

Anthem of California will offer 4 levels of coverage both inside Covered California and out.  The plans are categorized into four metal levels of coverage based on the percentage of costs covered for an average population:

ACA subsidy levels 2015

  • Platinum:  You pay 10% of health costs, Anthem plan covers 90%
  • Gold:  You pay 20% of health costs, Anthem plan covers 80%
  • Silver:  You pay 30% of health costs, Anthem plan covers 70%
  • Bronze:  you pay 40% of health costs, Anthem plan covers 60%

All plans will offer the “essential health benefits” such as; doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

What is a Health Insurance Marketplace?  It’s a website that is set up to allow the government to regulate health insurance plans.  People can buy health insurance from the marketplace (Covered California) with government aid called subsidies.  All Health Insurance Marketplaces like Covered California must be fully certified and running by January 1, 2015, by federal law.  Also known as an “Exchange.”

Do I have to buy from the Health Insurance Marketplace Covered California Exchange?  You can choose to buy insurance from an insurer like Anthem from the state Insurance Marketplace (Covered California).  If you are eligible to get a subsidy and want to use one, you must buy your plan from a Health Insurance Marketplace like Covered California.

What are my Health Care Reform plan choices in 2015?  Under the new health care law, all new plans fit in one of four levels: bronze, silver, gold or platinum.  These levels make it easier to compare costs and benefits so you can choose the right plan for your needs.

Anthem   –   Blue Shield 

Questions?

John Conner
John@JohnConner.com
916-682-1117 – phone
916-258-0296 – fax

2015 Kaiser Permanente Covered California Plans and Rates

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2015 Kaiser Permanente Covered California health insurance plans for individuals and families are now available.

Anyone can get Kaiser coverage as long as you live in a Kaiser service area.  You can no longer be denied coverage because of a medical condition, and you don’t have to pass a medical exam to qualify for a Kaiser health insurance plan.

Qualifying Events – Situations which allow you to enroll in a Kaiser plan “outside” the Open-Enrollment period:

  • Divorce, termination of domestic partnership or civil union.
  • Change in full time employment status.
  • Loss of employer sponsored insurance.
  • Voluntary or involuntary termination of employment.
  • Death of parent or spouse.
  • Change in dependent status – i.e. dependent child turning 26.
  • Existing coverage is being changed to a qualified health plan.
  • Marriage.
  • Domestic Partnership (in states which allow).
  • Birth of child.
  • Adoption of child.
  • Placement for adoption of child.
  • Guardianship or court order dependent.
  • Permanent move to a new state.

Be sure to enroll by December 31 to receive a January 1, 2015 effective date.  After that, the next available effective dates are: February 1st and March 1st.  The only way to enroll in a plan after March 1 is if you have a “qualifying event” such as, you are coming off of an employer health insurance plan, or you move to an area where your current plan is not available or if you are moving on or off of MediCal.  There are a few other situations but typically if you miss the Open Enrollment period you will not be able to enroll for the balance of the year.

ACA subsidy levels 2015

4 Levels of Coverage …  With all companies including Kaiser you will see four levels of coverage; Bronze, Silver, Gold and Platinum.  Each level provides a different level of coverage to meet your needs.  Bronze offering the lowest level, while Platinum is the highest.

All plans will offer the “essential health benefits” which are; doctor visits, hospital care, prescription coverage and maternity care, and will include certain preventive care for no charge.

Enrolling “On and Off the Covered California Exchange .. Enrolling “On” the Covered California Exchange is typically for the individual or family who qualify for a subsidy due to their income level.  Individuals and families who do not qualify for a state subsidy, will usually enroll “Off” Covered California (the plans are the same) although the premium amounts are quite different.

Health Care … Almost everyone gets sick or hurt, or needs some sort of medical help.  To get better you usually need care, like seeing a doctor or staying in a hospital or taking prescription medications.  Health Care includes many different services such as; Doctors office visits, hospital stays, emergency room visits, X-Ray and Lab, prescription drugs, preventive care, well baby visits, well woman visits, immunizations and screenings.

Health Coverage … Health Insurance is a lot like the insurance people get on their car or home.  Some people get their health insurance through their jobs, while others buy it themselves.  Without insurance, high medical bills can wipe out savings and even lead to bankruptcy.  Insurance helps protect you financially, if you have a serious illness or injury that requires extensive care.

How you Benefit … Peace of mind .. You shouldn’t have to worry how you are going to pay if you get sick, injured or pregnant.  Life is unpredictable, but when you have Kaiser, you have more control and you can rest easy knowing you are going to get the care you need.

Care when you need it .. You can see a doctor when you are sick or just need preventive care like a check up or screening.  You don’t need to ignore symptoms, or hope they’ll go away.  You can get treated before they get worse.

Quick Quote …  Anthem   –   Blue Shield   –   Kaiser 

Stay on a Healthy Course .. Preventive care helps you catch minor symptoms before they become problems.  Screenings like mammograms and cholesterol level tests can catch problems early, when they are easier to treat.

Quick Quote     Enroll Online

  • Trip Insurance – Insure your vacation or trip anywhere in the world.

Need Help or have Questions?  Feel free to call or email anytime.

John Conner
916-682-1117
John@JohnConner.com

How does an Office Visit Co-Pay work?

First of all, a PPO office visit co-pay works differently than a HMO office visit co-pay.  This causes quite a bit of confusion, especially if a person has come off of a group plan HMO onto an individual PPO plan.  So what’s the difference?  For example, take a Blue Cross of California PPO $1500 deductible plan with a $30 office visit co-pay. When you visit the doctor for an outpatient visit such as; for the flu, or an annual check up, or even a sprained knee from the gym.  As a rule of thumb, you will be responsible for all charges except for the cost of making the appointment.  So if you went to the doctor because of the sprained knee, the visit itself will be covered with your office visit co-pay of $30.  If the doctor says you need an X-ray, “take this slip to XYZ Radiology Associates to make sure there are not any bone chips or a slight fracture.”  The X-ray charges you will be responsible for, which will be credited towards your annual deductible.

Now, your visit is for an annual physical.  Your doctor usually charges $100 for an appointment, but in your case the charge is covered with your plan co-pay.  During the physical your doctor says you should get your cholesterol checked one of the Blue Cross network labs.  That charge will also go towards your deductible.

What about the HMO co-pay, how is that different?  HMO co-pays will usually cover most of the visit costs; the office visit, any lab work and X-ray costs.  An HMO plan co-pay is much more comprehensive in regards to what is covered within the co-pay.

So why would anyone choose a PPO plan?  Two primary reasons:

  1. The monthly premiums for a PPO style plan has a much lower monthly premium then the alternative HMO plan.
  2. Freedom of choice with physicians, specialists and hospitals (over 42,000 providers in California).  If I want to see a particular specialist, or have an operation at a certain hospital, or receive treatment from the most respected medical group, I make an appointment, and go.  I don’t need a referral, I don’t need an approval from a medical group board.  I’m in control.  That alone is why I thing PPO plans offer much more value than HMO plans.

Some PPO’s (Preferred Provider Organization) offer plans with unlimited office visit co-pays, other plans have a limited number of co-pays per year, such as three or five, after they are used you simple pay the cost of the visit.  And others offer no office visit co-pays.

Value for your money.  There are so many plans and companies available today, I understand how comparing plans can be a chore.  I’m here to help.  Within a few minutes I will be able to narrow down the list of plans to just a few for your review.  Making the comparison process much more manageable.  So feel free to call anytime with your question or comments.  I look forward to hearing from you.

 

Need Help or have Questions?

John Conner
www.JohnConner.com
john@johnconner.com
800-700-1246