December 2013

Your Partners in Understanding Healthcare Reform
Providing Clear and Creative Health Insurance Solutions

CRITICAL INFORMATION REGARDING THE AFFORDABLE CARE ACT AND HOW IT WILL AFFECT YOUR CURRENT INDIVIDUAL POLICIES 


DEADLINE FOR JANUARY 1 COVERED CALIFORNIA
PLAN ENROLLMENT IS DECEMBER 15, 2013. 

 

Lynn Caffrey, Principal, CA License 0557451

Gabriel Caffrey, Broker, CA License 0H66348

Agency CA License 0G80281

About Caffrey Insurance Solutions
Caffrey Insurance Solutions
Phone: 510-444-5447
Fax: 866.530.7365 
That Procedure Costs How Much?

A massive federal database of national health care costs was made public a little while back, according to an article in the Huffington Post.  

Are You Eligible for a Subsidy Through Covered California? Find Out!

The Covered California website is up and running at:

www.coveredca.com 

You can go online and see if you're eligible for a subsidy, and what you might expect to pay for one of the available plans. 

This will help us aid you in deciding the best way to go. If you are not eligible for a subsidy, you might as well buy off the exchange as the application process will be much easier than it is now, the networks may be stronger and the rates for mirrored (same as the exchange) plans will be identical. Also, not all carriers are represented in the exchange. 

At any rate, remember to use us before signing up for the plan you have for this next year. We are Covered California Certified Insurance Agents.

We will also be working in our customary capacity moving forward, assisting our clients with the whole process whether in Covered California or the private marketplace.

We take our responsibilities in servicing your policies very seriously and hope to continue to assist you with these new options as well. As always, our services are entirely free to you.

Not Eligible To Receive A Premium Subsidy? 
Apply Directly!

If you are not eligible for a subsidy but want insurance coverage for January 2014, please consider a direct policy with a vendor such as Anthem Blue Cross of CA, Blue Shield of CA, or Health Net of CA.

 

It is important to keep in mind that these companies still have newly rearranged and limited networks. 

Click the links above to apply for a policy directly with one of these carriers. We will be listed as your agents of record and authorized to help you. 

Best Broker in the  

East Bay

Lynn had the honor of being named Best Health Insurance Broker in the East Bay Express Best of the Bay awards. 

 

The review said that she was "an extremely dedicated full service health-insurance broker".  We work hard for our clients.

Review us on Yelp!

Yelp Page

 

Thanks to your great reviews, we have a five star rating on Yelp. If you have received good service from Caffrey Insurance Solutions over the years, please drop by and let prospective customers know about your experience. We really appreciate your time! Thank you.

How Long Will You Live?
This easy and fun calculator estimates your life expectancy.
  
It was developed by Northwestern Mutual Life, and it tries to predict how long you're likely to live. 

 

The predictions aren't going to be close if you do have a long-term health issue, but generally it works well. Barring long-term health problems, we are going to live a long time, most was into our late 80s or 90s.

As You Grow, We Grow With You

Please ask about additional services and value-added products such as HR administration and online policy management tools. 

Testimonials

"Lynn really helped me in dealing with a declined insurance claim by guiding me through the appeal process and communicating with the insurance provider. She offered continued support until the claim was reviewed and finally resolved. I truly believe that Caffrey Insurance Solutions' dedication in providing insurance as well as exceptional care and support to clients is invaluable."  --Current Individual Client

"Caffrey Insurance Solutions walked us through every state and step of a quite complex system, and we were successful! Without their help I do not believe we would have managed...I would refer anyone with insurance questions to Caffrey Insurance Solutions, and to Lynn Caffrey in particular."    --Alan B.

"Your expert advice is always appreciated. I literally don't know what I would do without you. You give me the most valuable gift of all: time."    --Scott Gordon 

 

"I'm glad there are individuals like Gabriel who can break it down so the average joe can understand the ins and outs of each plan, and make better-informed decisions."
     --Kerwin K.

"You are different from any image I have had of an insurance broker. I simply enjoy being with you. I experience a combination of efficiency, care, honesty, commitment and flexibility. I couldn't ask for better.               --Miki Kashtan


Lynn and Gabe profile picture
To all our Clients and Friends,

 

Instead of a "What would Lynn or Gabriel do" feature this month, we are going to tell you what we wish we could do.  We wish we could make this stressful time go away, get everyone enrolled without glitches in subsidy-eligible plans (that cover all requested doctors) in time for the January 1 enrollments.

 

As you might suspect, things aren't going all that well.  Some days the websites work and some days they don't.  We've managed to get about 60 of you enrolled in Covered California and another 40 or so directly enrolled with the carriers.  That's definitely not enough and doesn't represent a majority of our clients, not to mention the many new people who have contacted us.  And we can't work any harder, despite hiring extra staff and keeping very long hours.

 

The deadlines for January 1st enrollments are here.  Covered California will accept applications until December 23 for a January 1 effective date.  The carriers, as far as we know, are holding to December 15.  Since that is on Sunday, please plan on contacting us Friday to get these applications in if you need assistance.

 

In truth, the best we can do at the moment is wish you all a happy holiday season and assist you with your insurance needs as best we can.

Alert! 

If You Are Currently Without Coverage, A Temporary Policy May Be The Answer

We are close enough now to January 2014 that a temporary policy may provide a good solution for your insurance needs. Although temporary plans are not guaranteed issue, the underwriting process comparatively simple and may meet your needs well until a plan can be issued through Covered California or the private individual and family market for January 1. 

 

In most cases temporary medical coverage can be effective the day after you apply! (Important caveat: they do not cover presciption medications.) 

 

Ask us if you want some options if this scenario applies to you. Or if you prefer, you can try the direct application linked here, which will assign us as your broker of record and save you some time. We will service any policies applied for this way.

Don't Panic!

Please do not panic about getting on a new health plan for 2014. 

 

Whatever you do, it is best not to do it entirely on your own, even though it might be tempting to just get it done. The cost is the same either way, and we want to continue our working relationship with you.

 

You do only have until December 15th to submit application for coverage effective January 1st 2014, and until March 31st 2014 to complete the current open enrollment period.  If you are an existing Health Net, Aetna or United Health Care client in Alameda County you should email us immediately to touch base as Health Net is not serving individuals in Alameda County after 12/31/2013.

 

If you are with Anthem Blue Cross or Blue Shield, even though your plan is ending you are most likely being mapped to an ACA compliant plan so you won't be completely stranded while you are deciding. Check your letters.

 

You can not get guaranteed coverage if you apply outside the open enrollment period except in the case of certain qualifying events. The next open enrollment opportunity after this one does not begin until October 15, 2014.

 

We know the latest facts and are here to help you. If you go directly to the carriers or to Covered California, you will not have an agent to assist you if you have any problems now or in future. 

 

If you have spoken with us regarding a Covered California plan in the last couple of weeks and we have not yet gotten back to you, please call in so that we can finalize your enrollments. 

Tactics for Crossing Covered California's Finish Line

Solutions -- Not Problems

If you are eligible for a subsidy (see link), go to www.coveredca.com and get a quote.  

 

After that, decide on a plan.

 

Even if you are not eligible for a subsidy, it's a quick tool to give you an idea of the cost for other plans.

Contact us (link) to set up an enrollment meeting but please do the following first.

 

General Fact Sheet about Covered California Subsidies

 

Expediting your Covered California Enrollment

  • Go to: www.coveredca.com
  • Click: Apply Now
  • Click: Create Account (top right)
  • Click: Individual or Family (top left)
  • Click: Terms and Conditions Agreement Checkbox
  • Create: User Account
  • Set Up: Password, PIN (4 digit) and Security Questions
  • Log in.
  • Click: Find Help Near You
  • Click: Agent
  • Search for: Caffrey (bottom right)
  • Click: Lynn or Gabriel Caffrey
  • Authorize: One of us as your agent of record

This assures that we remain your broker. If you are not a current client, this specifies us as your broker. Without this step, we cannot help you troubleshoot your account if there are issues. This step us usually quite easy to do but the new system has made it complicated. 

 

As always, our services are free to you.

Items You Will Need to Complete Your Application

Lynn Caffrey The initial part of the process of applying for a plan through Covered California involves creating a personal account on their website, which we then connect to as your agent to assist you in the final plan selection and discussion.

 

You can begin application for your own profile yourself if you wish to, although we are also glad to walk through this with you either in person, via telephone, or even via screen sharing session so that we can help you get this done wherever you happen to be.

 

Covered CA Online Account Requirements:

  • User ID: Minimum 8 characters
  • Password: Minimum 8 characters, letters and numbers only
  • PIN: Four digits
  • Security Questions: 5 total, to be selected from question bank

We do not need to see this information, although it is important for you to keep it handy or memorize it in order to be able to go back in and make any adjustments to your account as your circumstances change. The account is your personal account with Covered California and is used to report any changes in your situation over time.

 

Covered CA Income Documentation Recommendations

(to determine subsidy based on estimated 2014 earnings):

  • Your most recent tax return
  • Any other data regarding recent employment or expected income
  • If self-employed, a detailed list of any deductions you may take to cover business expenses
  • A scan of your current driver's license or passport

The numbers Covered California asks for are based on 2014 expected income, but accuracy is quite important as if you fall below a certain threshold you will automatically be registered for Medi-Cal, which many of our clients do not want to happen.

Income and Subsidy Qualification 

During Covered CA Application

Gather your tax or income information so you know your exact adjusted gross income.  The most common sources for this information are your 2012 tax return and any recent paystubs. If you are self employed it is more complicated but please be prepared to estimate your net income (after business expenses, before taxes). 

 

Ultimately, this will work itself out at tax time for 2014 but please be as careful as possible. You will need to come up with income verification of some kind during the application process and they will check your filed 2014 taxes to see if they're consistent with your projections and adjust your subsidy accordingly. If you have been over-subsidized, they may withhold the excess from your 2014 tax returns.

Finding Your Medical Providers

During Covered CA Application

It is crucial that you check for your providers. The lists are not as complete as before and you may not find your doctors. Note that where plans say they are EPO's, you must stay in network.  

 

Due to overwhelming demands on our time we are not able to research every doctor on your lists but here are the resources required to do so:

 

Anthem Blue Cross PPO

Blue Shield of CA (EPO in Alameda County, PPO elsewhere)

Kaiser Permanente (HMO)

Health Net of CA (PPO, not available in Alameda County)

Chinese Community Health Plan (HMO, San Francisco County)

Western Health Advantage (HMO)

 

Also, dependents who live outside of California or the reach of the new EPO networks cannot be covered except for emergencies. If you have children attending college out of state, the student health plan on their campus may be their best coverage option.

Documentation to Have Available

During Covered CA Application

  • Driver's License or Proof of Legal Residency in the USA
  • 2012 Tax Return
  • Pay Stubs

New Census Form For Group Plan Quoting

Upon request, we will be re-marketing all of our small group clients to see if new ACA compliant group plans are the best option available to you. In order for us to calculate your rates prior to the deadline for your particular carrier, please send this in at least two weeks before that. You should have received notice of this deadline already but if you have not let us know.

 

In general, we and the carriers are recommending that you take advantage of a December 1st anniversary to maintain your plans and networks for another year. Many of you have already done or will be doing this.

 

Please fill out the linked census form and return to us at your earliest convenience so we can quote options that will continue to serve you well next year. 

About Caffrey Insurance Solutions 

Caffrey Insurance Solutions is a family business employee benefits brokerage firm that provides insurance expertise for small companies (fewer than 50 employees) and individuals seeking individual or family coverage. We also provide Medicare assistance.  

Caffrey Insurance works with you to find the best insurance benefits that provide the best value, tailored to the unique needs of your company.
 

California License Information
Lynn Caffrey: 0557451
Gabriel Caffrey: 0H66348
Caffrey Insurance Solutions, Inc.: 0G80281

Caffrey Insurance Solutions, Inc.
405 14th Street, Suite 711
Oakland, CA 94612
Phone: 510-444-5447
Email: [email protected]