The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
Posts related to the benefits included in health insurance plans for individuals, families, small groups, Medicare.
Understanding the new California pharmacy prescription drug cap
Individual and family plans offered through Covered California in 2016 will include new pharmacy prescription drug benefits. The benefit, also mirrored in many off-exchange health plans, caps the amount a consumer must pay every month for a particular prescription. While that sounds straight forward, the rules surrounding any pharmacy deductible and tiered drug formulary can be complicated and confusing.
Covered California 2014 versus 2015 health benefit comparisons
There have been few changes to the standard benefit design between 2014 and 2015 health plans offered through Covered California. A comparison of the metal levels offered in 2014 to the standard benefit design announced by Covered California for 2015 individual and family plans reveals modest changes to copayment amounts for prescription drugs, maximum out-of-pocket […]
Will Covered California Medi-Cal claw back payments?
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
Bronze versus Silver Plan Pharmacy Benefits
Even though health insurance plans have been greatly simplified with the introduction of the metal tiers of Bronze, Silver, Gold and Platinum under the ACA, careful consideration should still be given when comparing the coverage and benefits. In particular, for many people that have recurring brand name prescriptions medications, selecting the least expensive Bronze plan […]
Anthem Blue Cross Releases Transgender Health Plan Benefits
Anthem Blue Cross California has released information regarding the coverage of medically necessary procedures to treat gender identity disorder, commonly referred to as a person being transgender. Effective immediately, all new and grandfathered plans will cover surgeries, hormone therapy and counseling associated with transitioning from the birth sex to the sex the individual identifies with.
Emergency Regulations Ensures Competitive Health Insurance Market in California
The emergency regulations force all “non-grandfathered” plans to include the 10 EHBs which means that plans offered through Covered California won’t be put at a substantial competitive disadvantage. Plans not offering all the benefits would have been priced lower than plans in the state exchange. While health insurance plans offered outside the Covered California may still be less expensive for a variety of reasons, at least they will have equivalent benefit designs.
Are Medicare Advantage Plans Threatened by Reform?
It was an urgent plea by an insurance company that I had to act now to save Medicare Advantage Plans.
Health insurance industry masks opposition to healthcare reform
Health insurers cloak their opposition in the form of membership and donations to organizations that appear to be consumer friendly but advocate for changes in the ACA that will benefit the insurance companies.
VSP threats for government pie work
After Lynch’s threats to decamp from Sacramento and move to a state that really loved him surfaced, local leaders and politicians put the screws to the Exchange.