Sunday, January 6, 2013

California's Status On Healthcare Reform

Hi .. 

Here is a great article written by Michael J. Mishak, of the Los Angeles TImes last December: 
Facing a federal deadline, the CA Legislature must move quickly to pass measures to implement President Obama's healthcare law and revamp the state's insurance market. New legislation will help extend coverage to millions of uninsured Californians and solidify the state's reputation as a key laboratory for the federal law.
Legislative leaders have said they also want to overhaul environmental regulations, curb soaring tuition at public colleges, and tweak the state's tax structure and ballot-initiative system.
But healthcare remains one of the largest and most immediate challenges.
The federal Affordable Care Act takes effect in January 2014, when most Americans face the requirement to buy health insurance or pay a penalty. State lawmakers must pass a series of rules to clear the way for enrollment in a new state-run insurance market next fall, including a requirement for insurers to cover consumers who have preexisting medical conditions and limits on how much they can charge based on age.
Gov. Jerry Brown is expected to call a special session of the Legislature next month — concurrent with the regular session — so healthcare bills that he signs can take effect within 90 days rather than the next year.
"It's a very, very big undertaking to make the promise of the Affordable Care Act a reality," said state Health and Human Services Secretary Diana Dooley. "We are working as hard and as fast as we can in a very complex area with a lot of conflicting information."
As an early adopter of the Affordable Care Act, California has already laid much of the groundwork.
It was the first state to establish an insurance exchange after Congress passed the legislation in 2010. More than 30 other states have since sought federal help in enacting their own. Millions of Californians will be able to purchase coverage, with federal subsidies earmarked for families earning about $92,000 or less annually.
One of the most significant proposals will be an expansion of Medi-Cal, the state's health insurance program for the poor. About 2 million low-income Californians would be newly eligible under the expansion, with the federal government subsidizing costs for the first three years. The state would then shoulder a portion of the bill.
According to a Kaiser Family Foundation study, the expansion could cost the state $6.3 billion over a decade, meaning a 1.7% increase in the amount California spends on Medi-Cal.
California got a head start on the effort by signing up more than 550,000 low-income people in a temporary program. They are expected to automatically move into Medi-Cal in 2014.
Lawmakers will also consider legislation that would create a health plan for people who cannot afford insurance on the open market but make too much money to qualify for Medi-Cal. The option, known as the Basic Health Plan, would provide coverage for individuals with incomes between 133% and 200% of the federal poverty level, or between $15,000 and $21,800 a year.
State Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and author of the proposal, said the plan was needed to help California's working poor. "I don't think they should be choosing between putting food on the table and buying health insurance," he said.
Insurers urged lawmakers to resist requirements that could make policies offered through the exchange unaffordable.
"We think the Affordable Care Act does much to get millions of people coverage, but new insurance taxes, costly benefit requirements and age pricing restrictions all have the potential of driving up costs," said Nicole Evans, a spokeswoman for the California Assn. of Health Plans.
Healthcare advocates said it was critical for the Legislature to promote policies that would ensure a mix of healthy and sick policyholders to keep premiums affordable.
"It should be a goal of the state to have millions of people enrolled on Day 1," said Anthony Wright, executive director of the consumer group Health Access California, "to bring in those federal dollars and make healthcare cheaper for everybody."

Sunday, December 16, 2012

Are Many States Creating Health Exchanges? Study Finds Interesting Input ...

Interesting article found in California Healthline, Daily Digest of News, Policy and Opinion - Friday, Dec. 14th...

"Federal Government To Operate Most Health Exchanges, Study Finds ...

The federal government will operate health insurance exchanges under the Affordable Care Act in a majority of states, according to an analysis by Avalere Health, The Hill's "Healthwatch" reports.
As of Thursday -- one day before the federal deadline for states to declare whether they intend to run their own exchange -- 14 states and the District of Columbia had submitted plans, while three more states publicly have committed to operate their own exchange (Viebeck, "Healthwatch," The Hill, 12/13).

Under the ACA, states can operate their own exchange, partner with the federal government or let the government run an exchange for them (Lengell, Washington Times, 12/13).
In a letter sent to governors in November, HHS Secretary Kathleen Sebelius said the administration was extending the deadline for states to submit detailed applications -- or blueprints -- required by federal officials to Dec. 14, but the Nov. 16 deadline to notify HHS of their decisions would stand.
Meanwhile, states that intend to partner with the government will have until Feb. 15 to submit their declaration letter and blueprint. Sebelius noted that the extended deadlines would not affect the anticipated launch of the exchanges in January 2014.
Details of Analysis
Because a large number of states are defaulting to federally run exchanges, Avalere estimated that two-thirds of U.S. residents who obtain coverage through an exchange under the ACA will do so in either a federally run exchange or a partnership exchange ("Healthwatch," The Hill, 12/13). Some experts predict that the federal government ultimately could be responsible for running exchanges in more than 30 states.
GOP Lawmakers Point to Compliance Costs, Lack of Guidelines as Reasons for States' Choices
At a House Energy and Commerce Subcommittee on Health hearing on Thursday, Republican lawmakers pointed to compliance costs and a lack of federal guidelines on the exchanges for many states' reluctance to run their own insurance marketplace, Reuters reports. Rep. Michael Burgess (R-Texas) said, "The uncertain regulatory environment and the overall lack of response from HHS are not encouraging the states or the health plans to move forward."
However, Rep. Frank Pallone (D-N.J.) countered that Republicans who oppose the law for political reasons are simply trying "to delay implementation under the guise of lack of information" (Morgan, Reuters, 12/13). Rep. Henry Waxman (D-Calif.) added, "For some states, no amount of information will ever be enough. And that's the tragedy of politicizing the law" (Sanger-Katz, National Journal, 12/13).
Experts Doubt Federal Government's Ability To Operate Exchanges
Meanwhile, some experts raised questions about the federal government's ability to successfully operate exchanges for so many states. Experts say the largest challenges for HHS will be the creation of a health IT system that can exchange data with multiple states, as well as providing adequate customer service to handle enrollment (Reuters, 12/13).
CMS Refuses To Delay Insurance Exchange Rules
In related news, Gary Cohen -- director of CMS' Center for Consumer Information and Insurance Oversight -- denied Republican senators' request to extend the comment period and delay the finalization of rules governing the health insurance exchanges, Modern Healthcare reports.
"There's not a lot of time between now and October, and people are saying that we need to get these rules; the [insurance] industry in particular is saying 'We need to get these rules finalized in order to know how to develop plans and get them into states,'" Cohen said (Daly, Modern Healthcare, 12/13)."

Tuesday, December 4, 2012

Affordable Care Act "Must Knows!"

Taken from and written by Bruce Jugan ...

5 Things Everyone Needs To Know Abouto The Affordable Care Act:

The Affordable Care Act (ACA), health care reform known as "ObamaCare," kicks into high gear in 2014. If you buy your own medical insurance, read on for 5 things you need to know.
1. You MUST BUY health insurance - or pay a tax penalty.
  • You’ll have to buy your own plan if you don’t get coverage through your employer. This is called the "individual mandate." In the summer of 2012, the U.S. Supreme Court found it constitutional for the government to require everyone to buy health insurance. The high court determined that the individual mandate is a tax, so be prepared to either pay for health insurance or pay a tax penalty.
  • You’ll be exempt from paying the tax if the cost of your health insurance coverage would be greater than 8 percent of your household income or you meet a few other criteria.
  • Estimates are that 40 percent of Americans will be exempt from the penalty.
  • In 2014, the penalty is only $95 per adult and $47.50 per child (up to $285 for a family) or 1 percent of family income, whichever is greater.
  • Watch out: If you don’t buy coverage during the "open enrollment period" you may have a difficult time buying coverage when you need it.
2. You CAN BUY any health insurance plan you want. Insurance companies can’t decline you because of a pre-existing medical condition.
  • This is called "guaranteed issue" and it is a HUGE deal. No matter what your medical condition you can get the same plan as everyone else and at the same price.
  • The only things that can influence the price of your health plan in California are your age and where you live.
  • California will have an "open enrollment period" every year when everyone must buy coverage. This prevents people from waiting until they get really sick or injured and buying coverage at the hospital or doctor’s office when they need medical treatment.
3. Your new policy will have much BETTER BENEFITS than the one you currently have.
  • ACA requires every health insurance plan to have "essential benefits." These essential benefits include coverage of both brand and generic prescription medicine, maternity care, low deductibles and comprehensive coverage in and out of the hospital.
  • Gone will be the low-cost, low-benefit plans that are intended for catastrophic coverage and that are popular with people who buy their own medical insurance.
  • Gone will be the adage that "some coverage is better than no coverage." Under the ACA, the minimum available coverage is "comprehensive coverage."
4. The monthly PRICE of an individual health insurance plan will likely SKYROCKET.
  • Hold onto your wallet because 3 forces will cause the monthly price of an individual plan to increase significantly:
    1. No medical underwriting (see No. 2 above).
    2. Much better benefits (see No. 3 above).
    3. "Modified community rating," which changes the way the cost of coverage is spread among the young and the old.
  • While it is terrible for an insurance company to decline to cover people with pre-existing medical conditions, the reality is that "medical underwriting" allows those who are able to qualify for coverage to pay less. Eliminating underwriting will increase the cost for healthy people.
  • The price of medical insurance in California today is lower than just about every other state because of medical underwriting. In 2014, the entire country will look like New York or Massachusetts, which outlawed underwriting years ago; health insurance plans there cost more than twice as much as in California.
5. You may receive a SUBSIDY to lower the cost of your plan.
  • Single people who earn roughly between $15,400 and $46,000 per year will be eligible for a subsidy to lower the cost of their health insurance. Check out this health insurance subsidy calculator.
  • The subsidy amount is higher the less you earn and lower the more you earn. A single person who earns more than $46,000 per year in 2014 is not eligible for a subsidy and must pay the entire cost of her medical insurance.
  • How the subsidy will work: Assume a health insurance plan costs $344 per month for a 30-year-old living in California. If that person earns $31,200 per year ($15.00 per hour) she must pay the insurance company $225.25 each month. The government will pay the insurance company $118.75 per month.
  • People who earn less than $15,400 per year in 2014 will get their health insurance through Medi-Cal, California’s Medicaid program for low income people. This is a big change. Before 2014, a low wage worker with no children did not qualify for Medi-Cal yet he could not afford a health insurance plan. Now he will get Medi-Cal.
If the rules and regulations behind Obama Care sound complicated, that's because they are. And that's why we're here. We’ve been advising clients for more than four decades. can help guide you through the process of finding a health insurance plan that makes sense for your needs and budget. Just give us a call at (800) 746-0045.

Monday, November 19, 2012

Medicare Part B To Increase In Cost In 2013

Taken from California Healthline, under Medicare, 
as reported via AP/New York Times, 11/16

Monthly Premiums for Medicare Part B Set To Increase Slightly in 2013

Medicare Part B premiums will increase by $5 per month next year, CMS announced Friday, the AP/New York Times reports (AP/New York Times, 11/16).

According to a notice published in the Federal Register, the monthly premium for Medicare Part B -- which covers physician visits, outpatient care and medical supplies -- will be $104.90, up by 5% from $99.90 in 2012. Annual deductibles for Part B also will rise, from $140 to $147.

Meanwhile, premiums for Medicare Part A -- which pays for inpatient hospitals, skilled-nursing facilities and some home health care services -- will decline by $10 to $441 in 2013. Part A deductibles will increase by $28, from $1,156 last year to $1,184 in 2013 (Zigmond, Modern Healthcare, 11/16).

Medicare actuaries had estimated that Part B monthly premiums would increase by $9, based on early estimated cost growth for the program (Radnofsky, Wall Street Journal, 11/16).

CMS Acting Administrator Marilyn Tavenner noted that while the premium increase is less than anticipated, it is still enough to account for about one-quarter of a typical retiree's cost-of-living raise in Social Security payments next year (AP/New York Times, 11/16).

Please let anyone you know who is paying for medicare.

Saturday, November 17, 2012

Medicare & Medigap Plan A Basics!

Plan A is basic to all medicare coverage.  It is an individual option as well as a part of all enhanced optional coverage. Here is an outline that includes what Medicare Plan A covers and how a Medigap Plan A may be utilized with it.  As always . your questions are welcomed!  Call me, Kathy Hope, at 800-792-9114.

Plan A Coverage 
Is Included In All 10 Plans
Medicare Part A pays for hospitalizations for the 1st 60 days but only pays a portion of the daily costs from the 61st day through the 150th day.  You must pay the coinsurance amounts for those days.  
Medigap Plan A pays the coinsurance amount for those days and provides an additional 365 lifetime days.  
Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year.
Medigap Plan A pays for the first three pints of blood not paid for by Medicare. 
Medical Expenses:
Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. 
Medigap Plan A pays the coinsurance (generally 20% of the "Medicare approved" amount) under Medicare Part B.
Note the definitions of deductible & co-insurance
Deductible - must be paid before medicare activates.
Co-insurance - After deductible and paid in addition to medicare covera

Wednesday, November 7, 2012

How Healthy "IS" Living In California?

How healthy is living in California?  A little bit more healthy than in 2010! 
Here is a recent study as published at 

California climbed two spots from its #26 ranking in 2010, and is now ranked as the 24th healthiest state to live in, according to the 2011 America's Health Rankings® by the United Health Foundation.

The good news:
Smoking has been on the decline in California, falling by 20 percent over the past decade (though nearly 3.4 million adults still smoke).

The bad news:

  • The number of obese Californians has risen by 2 million over the past decade. More than 6.9 million California adults are now obese.
  • Diabetes among adults has also risen over the past decade, from 6.8 percent to 8.6 percent of adults.
  • The percentage of children in poverty has increased from 18.5 percent to 23 percent over the past five years.
California's best and worst category rankings:

Smoking – 2nd
Early Prenatal Care – 3rd
Occupational Fatalities – 4th
Infant Mortality – 5th
Lack of Health Insurance – 45th
Air Pollution – 50th


Thursday, November 1, 2012

"Covered Califonia" - New Name For CA Health Ins. Coverage

We finally have a new name for our California Health Insurance ... are you ready?
It is ......  Covered California 

Here are all the details as written today by David Gorn in the Capital Desk Column of California Healthline.  Here you go:

"Exchange Picks New Name: Covered Californiaby David Gorn
The California Health Benefit Exchange board voted Tuesday to adopt a new name for the health insurance coverage it will offer starting January 2014 -- Covered California.

The decision comes after months of work. In August, the long list of potential names was winnowed to about a dozen possible names -- including CaliHealth, CalAccess, Wellquest, PACcess and Covered California. The list alos included unusual trademark names such as Ursa, Healthifornia, Eureka, Beneficia, Cal-Vida and Condor, as well as the crowd favorite, Avocado.

After designing logos, holding focus group meetings and running trademark searches, that list was cut down to four finalists in September: Ursa, Eureka, CaliHealth and Covered California. Trademark concerns emerged around Ursa and CaliHealth, and those names were dropped, said Chris Kelly, who made the final name presentation to the exchange board.

Kelly presented final logo designs to the board for Covered California (tagline: "Your destination for affordable healthcare"), a related-but-separate design for Covered, CA and Eureka ("Where California discovers affordable healthcare"). After gauging the final set of focus group opinions, Kelly said the recommendation to the board was to go with Covered California.

Eureka was seen by focus groups as more of a private insurance program, Kelly said. Covered California was particularly well-liked by the Latino population in the focus groups, and by almost two-thirds of respondents overall.

"We're looking for a brand consumers can relate to, and inspire them to enroll in health care in the exchange," said Oscar Hidalgo, director of communication and public affairs at the exchange. "This is a real pivot point for us, using that brand and tagline and logo for future campaigns to help consumers relate to our mission. We're still working on a few other things to complement that, and that should be done by the next exchange board meeting."
The next steps, Kelly said, are to secure the final trademark and finalize the logo and tagline, which should be done by Nov. 12. Those final designs should be ready for the next exchange board meeting, he said, on Nov. 14."

California Health Insurance