Kevin Knauss: Health, History, Travel, Insurance
Posts related to small group employer based health insurance plans, eligibility, employees, enrollment, rates, plans.
Based on the real-world comparisons I’ve done for individuals and families in small group plans, most would benefit from enrolling in Covered California. Anecdotally, I’ve talked to several employers who either have or are considering terminating their group coverage.
Under California legislation SB 78, employees of small groups who had previously waived coverage will have a Special Enrollment Period to sign up for health insurance through their employer for 2020.
Between the single carrier option or the small group exchanges, it doesn’t appear that one has better rates over the other. In general, HMO plans will always be less expensive than PPO plans. You should get quotes for plans from a single carrier as well as the small group exchanges. Even though the information can seem overwhelming, that’s where your insurance agent can help filter out carriers and plans that don’t fit your needs.
The first comparison was of two individuals at a Sacramento company enrolled in a Sutter small group HMO Silver plan. The rate for the 60-year-old employee is $838 and $688 for the 56-year-old employee. An IFP Silver plan directly from Sutter Health Plus HMO is $1,115 for the 60-year-old and $958 for the 56-year-old. The IFP rate is 25% and 28% higher than the small group plan at the respective ages. The lowest IFP plan available to these employees in the Sacramento region is a Kaiser Silver HMO plan at $990 for age 60 and $851 for age 56.
Why should your employment dictate whether your health insurance is worse or exponentially better than your neighbors? Shouldn’t all health plans be the same? The human condition does not change depending on who you work for. The individual who works for the State of California, a union, or a self-insured plan can have the same health conditions as a self-employed individual. People routinely move from large group plans to individual and family plans and their health conditions don’t change. But the price and member cost sharing is far higher under small group and individual and family plans than it is with some of the union plans. Is that fair?
Under the Department’s new rule, AHPs can serve employers in a city, county, state, or a multi-state metropolitan area, or a particular industry nationwide. Sole proprietors as well as their families will be permitted to join such plans. In addition to providing more choice, the new rule makes insurance more affordable for small businesses. Just like plans for large employers, these plans will be customizable to tailor benefit design to small businesses’ needs. These plans will also be able to reduce administrative costs and strengthen negotiating power with providers from larger risk pools and greater economies of scale.
The health plan line-up includes the standard small group benefit design metal tier plans and a mix of what Oscar calls “Classic” and “Saver” benefit designs. The Classic and Saver benefit designs will have lower premiums because the members have a higher maximum out-of-pocket amount or a coinsurance percentage.
The Department of Managed Health Care (DMHC), who regulates most of the individual and family plans offered through Covered California, has developed a website to allow consumers to compare health insurance companies. The Health Plan Dashboard website does not assign any performance review ratings. But it does give consumers a high level view of some of the data collect on the health plans such as enrollment, complaints, and enforcement actions for medical, dental, and vision plans.
One of the most frustrating aspects of the Affordable Care Act is that it excludes family members from receiving the premium tax credits to reduce their health insurance if one of the parents is offered affordable employer group health insurance. One way around this problem is for the employer to offer employee only coverage. Covered California for Small Business health insurance exchange offers the employee only option for employers when they set up their group health plans.
Covered California staff is forecasting that SHOP enrollment will double by the end of 2014 and double again during open enrollment for 2015. A list of assumptions was given for the stellar forecast enrollment during the May 2014 Board meeting where the topic was revenue projections from fees charged on individual small group members. Based […]
