Over the course of two different letters to U.S. Department of Health and Human Services (HHS) Secretary Burwell, the Executive Director of Covered California, Peter Lee, outlined the benefit of … [Read More...]
Over the course of two different letters to U.S. Department of Health and Human Services (HHS) Secretary Burwell, the Executive Director of Covered California, Peter Lee, outlined the benefit of Certified Insurance Agents to their enrollment activities and suggested there should a uniform commission structure for health insurance agents. Mr. Lee’s comments come at a critical time when many health insurance companies are reducing and even eliminating agent commissions.
Because of all the rhetoric from Republican Presidential contenders about repealing Obamacare I’ve fielded many calls from people wondering if Covered California will survive a Republican President. The fear instilled by the shrill comments of conservative politicians that hate the Affordable Care Act (ACA) is that families who rely on the premium assistance provided by Obamacare through Covered California will suddenly end if a Republican is elected President.
Some individuals and families who enrolled through Covered California have received a letter notifying them they are at risk of losing financial assistance in 2016. The letters being sent out include three reasons why a household might lose the premium assistance to lower their monthly health insurance bill. They are also frightening consumers who actually compiled with all the conditions they list in the letter.
American Indians and Native Alaskans have access to special $0 cost share health plans that are available through Covered California. A recent enrollment by a member of a federally recognized Indian tribe was offered four different Anthem Blue Cross PPO $0 cost share plan where each one had a different premium rate. This is odd since regardless of the metal tier level of the $0 cost share American Indian-Native Alaskan (AI-NA) health plan, they all have the same exact benefits: zero dollar cost share for all services.
All individuals and households who had health insurance during 2015 will receive a Form 1095-x. How you received your health insurance will determine who sends the 1095-x to you. You may receive different 1095s based on whether you had Medicaid, private health insurance purchased through a Marketplace exchange like Covered California, or through employer based health insurance plan. Each of the 1095s will be appended with a different letter ( -A, -B, -C) depending on the issuer of the form.
Health insurance companies are deploying a variety of measures to reduce fraud and abuse such as only accepting paper applications or requiring proof of residency and identity.
As of January 12, 2016, I cannot recommend any individual or family enroll in a Blue Shield of California health plan either directly with them or through Covered California. As an insurance agent I have been dealing with Blue Shield’s nightmare enrollment, eligibility, and billing fiasco for over three weeks.
In 2016 Anthem Blue Cross introduced their new Tiered PPO Network health plans in four counties of California. The Tiered PPO marketing literature noted the member’s cost share would be less if he or she used a Tier 1 hospital, but it didn’t indicate how much less expensive it would be.
One of the most baffling health plan descriptions is the 2016 Bronze 60 health plan that states that the member is responsible for 100% coinsurance after the deductible. Most people who read this immediately shake their head and think, “I have to pay for all of my health care services EVEN AFTER I meet the deductible?” There really is no reason to buy health insurance if it never helps with the costs. The second part of the equation, not always referenced, is the calendar year maximum out-of-pocket amount of the Bronze plan which does limit a health plan members health care expenses.
It took me a long time to realize that the old adage of “It’s not what you know, but who you know” with respect to success was a crock of crap. Regardless of what or who you know, if you can’t produce something that people will consume, you will never be successful. The connections help get in you in the door. But if you can’t produce results, service, or products, you will be of little value to your associates.