Kevin Knauss: Health, History, Travel, Insurance
Posts related to coverage, prescription medications, benefits and providers under health insurance plans.
Unbeknownst to many people, most California health plans cover emergency care anywhere in the United States and treat it as if it were in-network. This means that if you have a Silver 70 plan and are rushed to the emergency room of the nearest hospital while on vacation in upstate New York, your copayment will be $400 just as if the emergency services were performed at your local home office.
All of the out-of-pocket drug cost the consumer pays goes toward pushing them through the coverage gap and potentially into the catastrophic phase. These costs would include any deductible, copayments and coinsurance of the initial coverage phase, and the 25 percent coinsurance in the coverage gap. However, in the coverage gap, the consumer’s accumulated dollar amount is credited with the drug manufacturers 70 percent discount on brand name drugs.
Part of the confusion has been generated by the fact that Covered California added a special income field for reporting the federal Pandemic Unemployment Compensation (PUC) amount after many people had already enrolled. Some people enrolling shortly after they lost their jobs and employer-based health insurance due to the Covid-19 shut down, only entered their California unemployment insurance. Other households included both State and PUC amounts in one weekly amount or separate entries in the old Covered California income section.
Blue Shield of California is taking additional steps to remove barriers and help its members receive the health care they need during the coronavirus (COVID-19) pandemic, announcing today it will cover members’ coinsurance, copayments and deductibles for COVID-19 medical treatments through May 31, 2020.
The FAQs released today detail existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19. The FAQs clarify which COVID-related services, including testing, isolation/quarantine, and vaccination, are generally currently covered as EHBs in these markets. The purpose of the FAQs is to provide guidance to Americans enrolled in individual or small group market health plans, including HealthCare.gov consumers. As questions and issues continue to come to CMS, they will be addressed and added to these FAQs.
The Cease and Desist Order prohibits Aliera and Trinity from immediately transacting insurance in California, including advertising or receiving any money, commission, fee, rebate, payment, remuneration, or any other valuable consideration whatsoever, in connection with any insurance transactions.
For most tax payers, the income they estimated on their application for health insurance will not be exactly the same amount as their final Modified Adjusted Gross Income (MAGI) on their 2019 federal tax return. Part II of form 8962 compares the subsidy you received (column f) to the amount of subsidy you are entitled to (column e) from data supplied by the market place exchange on form 1095-A.
If you want to keep either UCLA or Hoag in your Oscar health plan, you will have to enroll in an off-exchange Oscar plan that is designated with the Circle network. The Circle network that includes UCLA and Hoag will only be available in the metal tier plans of Bronze and Silver.
Kaiser is unique in that because they manage their own pharmacies, we can get a look at the ordering habits of opioids, and by extension, the prescribing of those opioids by Kaiser doctors. With a pharmacy like Costco, that has a higher ordering rate for higher strength doses of hydrocodone, it is hard to pinpoint which doctors or medical groups are prescribing the stronger drugs. It may not even be a doctor in Sacramento County.
If you take a nasty spill on your skate board in San Francisco, and have to have your ankle X-rayed at Kaiser, it will cost $102. But if you break your finger poking your political opponent in the chest, that finger X-ray will cost $111. These costs are lower in Southern California where they have more skate boards and finger poking. An ankle X-ray in Southern California will be $71 and the finger at $78. They don’t mention if there is a discount X-ray cost for both if you poked someone and then fell off your skate board.
