Kevin Knauss: Health, History, Travel, Insurance
Vision Plans Individual and family vision insurance can be purchased at anytime and is not subject to open enrollment periods like group plans. Before you purchase vision insurance for children consult your medical insurance plan for pediatric vision coverage. Many health plans, including individual and family plans purchased through Covered California, include excellent visions benefits […]
The implementation of Obamacare requires it to be administered by a variety of federal, state, and local government bureaucracies. Many consumers have been caught in a swirl of seemingly conflicting and utterly confusing rules, advice, and government forms. This cauldron of Obamacare confusion is particularly acute among individuals over 55 years old who are subject to California’s Medi-Cal Estate Recovery program. The anxiety instilled in this population is compounded by conflicting IRS 1095 forms that seem to open the door to a large tax bill for the repayment of the premium subsidies they received during the year.
Short term medical plans are a less than perfect bridge for individuals and families in between credible minimal essential health insurance coverage. Even though short term medical plans can deny applicants for pre-existing conditions, charge more for being a female, and have caps on how much the plan will pay, they can be a solid backstop to ridiculous emergency room bills. The rates for short term medical plans will usually be in the neighborhood of a California Bronze individual and family PPO health plan.
While the Affordable Care Act has brought transparency for consumers to compare health insurance plans, it has failed to lift the veil of secrecy surrounding how much health care services actually cost. This is particularly important for consumers who have high deductible PPO Bronze plans who would like to learn the health plan’s negotiated rate for a health care procedure.
For independent health insurance agents, such as me, who don’t have access to an already established secure network through a large agency, we have to be more diligent in securing all the different parts of the internet communication puzzle.
Built into the Affordable Care Act is the loss of the health insurance subsidy when the household income exceeds 400% of the federal poverty line. For older adults whose income might be greater than 400% of the federal poverty line they face losing the Advance Premium Tax Credits that makes their health insurance premiums affordable. In some instances the health insurance premiums can shoot up to over 20% of their income.
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.
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.
Blue Shield of California’s billing system that created major headaches for individuals and families in 2014 continues to stumble into 2016. Even through changes to the enrollment website, the simple tasks of determining an applicant’s eligibility and properly applying a premium still seems elusive to Blue Shield in several instances. For whatever reasons, several of the Blue Shield units – underwriting, eligibility, billing, member services, and IT- don’t seem to talk to one another.
