Kevin Knauss: Health, History, Travel, Insurance
Posts specifically related to California health insurance, enrollment, premiums, plans, termination, Covered California, Medi-Cal, Medicare, small groups.
Hidden within every health plan sold through Covered California is a fee to fund their operation. This per member per month (pmpm) fee applies to both individual and family plans, small group plans sold through the exchange and adult dental plans if they are ever offered. These fees, paid by the health plans and insurance […]
The 1095-A Health Insurance Marketplace Statement doesn’t give a clue on how the Monthly Advance Payment of Premium Tax Credit is calculated. Even though consumers who purchased health insurance through the Marketplace entered their Modified Adjusted Gross Income (MAGI) into the enrollment system, this income in not listed on the 1095-A they receive. The MAGI […]
How health insurance companies and health plans determine premium rate increases is a little bit of a mystery. Covered California didn’t add to the consumer’s understanding of this process when they released their 2015 health insurance booklet. The plan rates booklet is mostly marketing material and fails to provide specific rates by region, carrier, and […]
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 […]
One would assume that the probabilities of a second Covered California enrollment nightmare would be less than being struck by lightning. But for one family, lightning has struck not once, but twice. Covered California and Blue Shield have teamed up to disenfranchise all but one family member because the mother delivered a healthy baby boy in […]
Thanks to the Affordable Care Act all individual and family plans now include coverage for maternity care. These new health services, many of which are provided at no cost to the patient, also extend to the new born. Prominent in many private health plans is coverage for routine infant circumcision.
Covered California enrollments assisted by Certified Insurance Agents are producing a minimum of $9.2 million per month in commissions as estimated from enrollment statistics released by the states ACA exchange. While this number may sound impressive, a good chunk of the enrollments were for individuals and families who already had health insurance. With many health […]
With a peek at the enrollment statistics released by Covered California after the end of the ACA open enrollment we are able to visualize just how large the health insurance industry is in the state. While the enrollment data is only for individual and family plans (IFP) purchased through Covered California, the 1.3 million individuals […]
The first challenges individuals and families faced with the smaller provider networks offered in California was keeping their current physician or finding doctors that would accept the new health plans for health care treatment. The next hurdle has been doctors referring or using out of network physicians for patient care. Patients are now getting slapped […]
Solid information is hard to come by when it relates to what health insurance plans will cover for gender reassignment surgery in California. In response to the Insurance Gender Non-Discrimination Act passed by California in 2013, some health plans have created detailed medical policies for transgender health benefits. For a variety of reasons the health insurance companies don’t make their policies readily available to the general public. I was able to locate two detailed outlines issued by Blue Shield of California relating to gender reassignment surgery.
