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

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.

If you are not eligible for a subsidy but want insurance coverage for March 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. 

• Anthem Blue Cross 
• Blue Shield
• Health Net

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

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.

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

"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.

Alert! 

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

A temporary insurance policy may provide a good solution for your insurance needs until March 1. Although temporary plans are not guarantee issue, the underwriting process is 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 March 1. 

In most cases temporary medical coverage can be effective the day after you apply! (Important caveat: they do not cover prescription 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 the rest of 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 costs to you are the same either way, and we want to continue our working relationship with you.

You do only have until February 15th to submit application for coverage effective March 1st 2014, and until March 31st 2014 to complete the current open enrollment period.  

All individual Health Net clients have been dropped by Health Net as of January 1, 2014. If you are unaware of this fact, you may already be living without coverage and we want to hear from you so we can help. Please contact us right away if you are not certain you are covered.

If you are with Anthem Blue Cross or Blue Shield, even though your 2013 plan has ended, you have been mapped to an ACA compliant plan so you won't be completely stranded while you are deciding. Please check your mail for communications from your insurance carrier.

You cannot 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. 

What Would Gabriel Do?

A: Your options are:  

1. Let them enroll in Medi-Cal. Premiums are lower and possibly free. Providers will be different but likely still fine for your needs.
2. Sign the whole family up for a non-subsidized plan to avoid the issue.
3. Get work and company-paid benefits as soon as possible.
4. None of the above.

This came up time and time again while we were enrolling people through the Covered California exchange.  Whereas adults are eligible for benefits at 133% of the federal poverty level (between $16K and $46K for a single person), children are eligible at a much higher level.  

A single family of one 60-year-old adult and 2 children can have a household income of $51,000 and the children will still be eligible for Medi-cal. 

What we ended up doing in many instances was enrolling the adult or adults by themselves with the appropriate subsidy and paying full price for the children directly with the carrier.  The children are much less expensive to cover so the bottom line is still considerably less than paying full price. 

Tactics for Crossing Covered California's Finish Line

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

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 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.

Covered California Verification Requirements

You may have noticed that your Covered California account is still listed as conditionally approved. If that's the case, your policy will still be active as of the requested effective date, but Covered California wants some verification on your eligibility. 

The most common requests are for identity and income verification. You can address these missing documents by logging in to your account and clicking the "Manage Verifications" link in the box on the bottom right.

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 2012 taxes to see if they're consistent with your projections and adjust your subsidy accordingly. If you have been over-subsidized, you will have to pay it back when you file your taxes for 2014.

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.

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