insurance Archives

Why Single Payer Won’t Happen In California In 2019

December 3, 2018 By Kevin Knauss Leave a Comment

The single payer proposals I have read deal mainly with the consumer side regarding access to care and reduced patient costs. What seems to be missing is recognition that medical groups and hospital have built their budgets around the existing health insurance plan reimbursement rates. There is no mechanism in the single payer proposals to limit the costs such as the cost of labor (nurses) which is a significant financial element for hospitals. Until we get a handle on the cost of health care, health insurance rates will continue to rise and a viable single payer proposal, where you have more than one or two hospitals participating, will only be a dream.

Maintaining Health Insurance Coverage After California Wildfires

November 17, 2018 By Kevin Knauss Leave a Comment

If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.

Tips For Families To Lower Their Health Insurance Premiums For 2019

October 31, 2018 By Kevin Knauss Leave a Comment

Not all family members have to have the same carrier either. Some family members can enroll with a more expensive PPO plan while other individuals enroll in an HMO from the same company or completely different carrier. I have clients where some family members have chosen the Blue Shield PPO plan and other household members are with a less expensive Kaiser plan.

Hospitals By County For Covered California Individual And Family Plans 2019

October 30, 2018 By Kevin Knauss Leave a Comment

You can’t assume that all hospitals part of a larger network are all in-network with the same carrier if one is in-network. In Butte County, Blue Shield contracts with all the Enloe associated hospitals. But Anthem Blue Cross only contacts with Enloe Medical Center – Esplanade. The converse is also true. Blue Cross doesn’t typically contract with Sutter hospitals for their individual and family plans. However, in Amador County, Sutter Amador is an in-network hospital for Blue Cross.

2019 Covered California Renewal And Enrollment Questions

October 17, 2018 By Kevin Knauss Leave a Comment

If a consumer does not like their plan or rate, they must make changes to their account and actively renew their coverage by December 15th for a plan effective date of January 1, 2019. Changes to the account and plan selection between December 16th and January 15th will have an effective date of February 1, 2019.

Prop 8: Are There Problems With Dialysis Treatment, Billing, And Profits?

October 14, 2018 By Kevin Knauss Leave a Comment

The goals of Prop 8 sound good: better patient care and lower costs. Basic economic theory suggests that artificially regulating prices lower leads to shortages. We cannot force the current dialysis clinics to become nonprofit organizations. Just like large retailers close under-performing brick and mortar stores, I would expect no less from the CEO of a dialysis company to close those locations whose primary insurance payer were on the lower end of the reimbursement scale such as Medi-Cal or Medicare.

Lifting Pharmacist Gag Rule May Be Bad For Consumers

October 11, 2018 By Kevin Knauss Leave a Comment

By paying for prescription drugs out-of-pocket, and not having them accumulate toward the maximum out-of-pocket amount for the health plan member helps the insurance company, not the consumer. Not having the drug costs go through the health plan could cost the consumer thousands of extra dollars in health care expenses because they did not meet their maximum out-of-pocket amount for the year.

Kaiser’s Portfolio Of Stable Family Health Insurance Plans For 2019

October 8, 2018 By Kevin Knauss

Kaiser Permanente has seen their market share increase with the Affordable Care Act. Their percentage of Covered California enrollments has steadily increased from 24% in 2015 to 33% in 2018.They have also been very stable in their plan offerings on and off exchange. Kaiser rates increased 3% – 7% in Northern California and 6% – 10% in Southern California in 2018. In 2019, the average rate increase will be 9% throughout California.

Medi-Cal Duplicate Application Errors And Covered California

October 5, 2018 By Kevin Knauss Leave a Comment

The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.

Health Net California Individual And Family Plans For 2019

October 5, 2018 By Kevin Knauss Leave a Comment

Health Net is making it easier to add adult dental and vision to their off-exchange plans. They call the added dental and vision benefits the Plus package. For the EnhancedCare PPO, PureCare EPO, and PPO plans the Plus package of dental and vision benefits is $14.42 per adult. The maximum dental benefit per year is $1,000. Instead of a member cost-sharing percentage these plans have a fee schedule. For example, a filling on one tooth would be $22.

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