Health Care Reform Open Enrollment

Open Enrollment as required by the Affordable Care Act (ACA) begins tomorrow, October 1, 2013 for a January 1, 2014 effective date.

Last week a very well respected Executive Vice President of an insurance company said “Anyone telling you they know what is happening in 2014 is deluded, lying or does not know what they are doing.”

This past Friday I attended an eight hour certification course for Covered California the Health Insurance Exchange/Marketplace. Some comments from the instructor were;

“There is a tidal wave coming.”

“We will have to make the best decisions with imperfect information.”

“We cannot be experts on a moving target, there are changes every day.”

Peter Lee, the Executive Director of Covered California has said “There will be bumps along the way.”

The reason I quoted these individuals is to illustrate that there are problems with open enrollment. As of now I do not have enough information to help you make informed decisions on your health insurance. There is not enough information from insurance companies in terms of rates and benefits. Covered California’s online system is not entirely up to speed and the online system of the IRS which is needed to verify subsidy information for those who qualify has glitches.

There are some steps you can take that will be helpful. Covered California is the Exchange/Marketplace that will allow one to apply for premium and cost sharing subsidies. The insurance companies that will participate in Covered California are Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser. Local medical groups will also participate. Benefits will be standardized and rates will be set by the participating companies. The same benefits and rates will be sold off Covered California in the open market. The only reason that one would apply through Covered California is to receive a subsidy. Some companies have indicated that they intend to offer other policies with a different set of benefits, for example Cigna is not participating in Covered California and has indicated they intend to mirror benefits of Covered California and have an entirely different set of benefits.

I have attached two documents for your review which relate to subsidies. The first is The ACA: Understanding Subsidies. The Chart has a dark area, a medium shaded area and a light area and describes annual household income for 2012 and household size. If your income is in the dark area you are entitled to Medi-Cal at no cost. I am not involved with Medi-Cal but I am told there are good benefits. The problem is finding providers who accept Medi-Cal. If you do not opt for Medi-Cal  you can purchase any plan available, however, you will not be eligible for a subsidy. If your income falls in the medium shaded area you are eligible for premium and cost sharing subsidies. If your income falls in the lighter shaded area you are eligible for a premium subsidy. In the two later examples we should send your application to Covered California. If your income exceeds the amounts in the lightest area you are not eligible for a subsidy and should not apply through Covered California, instead your coverage should be in the open market off the Covered California Exchange/Marketplace. The second document is to determine your Modified Adjusted Gross Income or MAGI for 2012 under the ACA. This is the income that will be used to determine if you qualify for a subsidy. Please discuss this with your tax preparer if you think you fall in the income range for a subsidy.

There is a provision in the ACA for those who have a current change in income. For example if your income in 2012 was $150,000 which exceeds the level for a subsidy and your current income is $30,000, Covered California will review your situation and possibly approve your subsidy request. It is important to note that if you receive a subsidy and your income increases or exceeds the subsidy threshold it is your responsibility to notify Covered California and the IRS. Your subsidy will be reduced or cancelled. If you do not comply the IRS will add the appropriate amount to your next tax liability. Subsidies can be applied to your monthly insurance premium whereby you will receive a reduced premium or be credited to you at the end of the year.

I previously sent information on networks. As a reminder all Covered California plans and those plans off Covered California with the same benefits will have smaller networks of doctors and hospitals. This will have to be taken into consideration when choosing a plan. The companies that market benefits that do not mirror Covered California benefits should have a broader network of doctors and hospitals.

If your coverage is “grandfathered”, policies sold before March 23, 2010, you do not have to enroll in an ACA mandated plan. You can keep your plan which will have less benefits but will have the full network of providers that you have today. This will be part of our decision making process.

The information above does not apply to Medicare. Some Medicare enrollees have family members who are under 65 and are affected by the ACA.

Please be patient.


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The Dennis L. David Insurance Agency | Long Term Care Insurance, Los Angeles Medical Insurance, Anthem Blue Cross Healthcare Insurance, Whole & Term Life Insurance Policies, Cigna, Disability Insurance, Blue Shield of CA, Group Health Plans, Aetna, Group Medical Insurance, Skilled Nursing Insurance, Medicare Supplement Insurance, Medicare Part D Prescription Drug Plans, In-Home Care, Disabled Work Insurance, Disability Benefits, Culver City Health & Life Insurance, Family & Individual Health Insurance, Health Care Reform & Affordable Care Act Assistance, Obamacare, Covered CA Health Insurance, Health Plans, Kaiser Insurance, Genworth Life, John Hancock Life, Culver City Long Term Care & Disability, Employee Benefits, Beverly Hills, Hollywood, West Hollywood, Santa Monica, Pacific Palisades, Marina Del Rey, West Los Angeles, Los Angeles, El Segundo, Sherman Oaks, Encino, Los Angeles, Manhattan Beach, Los Angeles County CA, California

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