Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
FOLX describes their services as encompassing primary care, gender-affirming care, and mental health care. All the services and providers are attuned to the specific health care needs of the LGBTQIA+ community. In addition to virtual primary care, FOLX is a mix of patient advocacy and concierge service.
Except for a few qualifying life events, you have a 60-day special enrollment period window to enroll in health insurance from the date of the event. The qualifying life events listed below are of May 2025. Proposed rule changes by the Trump administration may mean some events are no longer eligible for the special enrollment period.
All health, dental, and vision insurance plans will have mechanisms that have the plan member pay a certain portion of the provided services. When you know how the different parts of the member cost-sharing work overtime, it is easier to predict future costs.
It is my business model to welcome this diverse group of individuals and treat each person with equity and respect. I welcome and include people from all over the world and the U.S. because it makes me a better person and insurance agent. These people bring unique family situations into our conversations. What I learn from their experience, I can pass along to other people.
Blue Shield of California, as well as other health plans, would like to break away from the large Pharmacy Benefit Managers and some of their distorted incentive and pricing structures. Unfortunately, the Pharmacy Benefit Managers perform many tasks involving price negation, handling the payments process from pharmacy to health plan, and managing the pharmacy network.
We will see some health plans not be offered if there is a parallel marketplace with non-subsidized plans that have gaps and caps. Healthy people will migrate to the lower cost health plans leaving people who need health care services in the subsidized plans. This will cause the death spiral of the health plan as claims expenses increase with shrinking premium dollars.
The goal of the program is not to have parents or legal guardians have to pay out-of-pocket for covered services and hearing aids. However, if the family has other insurance, the provider must bill that health plan first, which may require some initial costs by the family. After the private health plan has paid their share, HACCP will supplement the remaining costs.
The virtual PCP can refer to an in-person specialist. The goal for Blue Shield’s virtual PCP implementation is to reduce wait times to see a physician and reduce costs to the plan and member. Behavioral health will also be a part of the Accolade Care virtual system as well as a health coach. PPO plan members will also be able to select an Accolade Care virtual PCP.
All of the categories of health insurance premium assistance – Individual and Family, Medicare, Employer Sponsored – can also help with out-of-pocket health care expenses. The programs will cover expenses that accrue to meeting the maximum out-of-pocket amount of the health plan. These costs include copayments, coinsurance, and deductibles, all of which add towards the maximum out-of-pocket amount.
Not all the below options may be available to you because some are contingent on your age, employment, or income. Those health insurance alternatives available to you are worth investigating and considering if they meet your budget or adequately address health care challenges you may be facing.
