Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Health Net announced that under the Affordable Care Act Medical Loss Ratio requirements they would be issuing a rebate of .3% to their small groups in California based on 2012 expenditures. The letters dated May 30, 2013 are being sent to the small group administrators and subscribers.
Anthem Blue Cross of California will be notifying certain small employer groups that they will be receiving a rebate under the Affordable Care Acts’s Medical Loss Ratio (MLR). They missed the 80/20 target for small group plans overseen by DMHC. These plans consist of Health Maintenance Organizations (HMOs) that are overseen by DMHC.
Covered California will be offering 13 different health insurance plans to individuals and families. Some of the plans will be offered through large commercial insurance companies and other from smaller regional organizations. Ten of the thirteen plans have some form of easily accessible report card on their services from either a state agency or accreditation organization.
The contract to offer health insurance through California’s new health insurance market place mandates that plans pay a monthly Participation Fee per person enrolled per month for the privilege of being in Covered California. The $13.95 Participation Fee for individual members is just one of the many elements of the proposed Covered California contract that plans must adhere to if they want to be a contractor in the exchange for 2014.
It’s hard to compare the plans side by side because of the diversity populations they serve and lack of data on some of the health insurance companies. Much of the information about the different health plans and companies is spread out over several different agencies, reports and websites.
Ironically, many of the agents listening and asking questions have undoubtedly been ardent opponents of health care reform and many have actively called for the repeal of Obamacare. But here they were, listening to hear if they could make a dime off the tax-payer subsidized, guarantee issue health insurance plans that many have called the end of America and the beginning of socialism.
Only two plans, Anthem Blue Cross and Blue Shield of California will be available in all the 19 regions in California. All of the regions will have at least 3 health insurance plans to choose from. Many of the plans are region specific to areas such as San Diego, Los Angeles and the San Francisco Bay area. In addition, some of the plans have concentrated primarily in Medi-Cal and Medicare market and this will be their first push into the individual market.
The Centers for Medicare and Medicaid released the cost they pay for the top 100 hospital treatments for beneficiaries of Medicare across the country and the data presentation is virtually worthless to the average human being. The Charge master data set was successful in highlighting the complex and dysfunctional system we have in the U.S. for tracking and paying for health care.
The overwhelming majority of the funds in the individual market are allocated to organizations targeting specific counties to promote Covered California.
Seriously, can you fathom a middle income man paying over $8,000 per year for health insurance? From COBRA or HIPAA.
