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

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.

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.

Open Enrollment for Individuals and Familes Ends in 20 Days!!

No new individual or family applications will be accepted after March 31 except in cases of qualified loss of group coverage or similar life events. 

For an April 1 effective date, we need your applications completed by March 15.

For a May 1 effective date, we need your applications completed by March 31.

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 March 15th to submit application for coverage effective April 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 November 15, 2014 for coverage starting in 2015.

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. 

Client Spotlight

Outcome:

After a lot of letters and discussion, they finally agreed to a 50% reduction in the charge.  He feels that he now has closure and some element of fairness.  We agree.

Situation B:

Katy B. has a relative who joined the exchange for a plan in another state.  The plan turned out to be an EPO where the subscriber has touse the doctors on their list and there is no provision for out of network coverage.  

Outcome:

The restrictions in the network were not at all clear during Katy's relative's application process.  Her relative received a devastating diagnosis soon afterand needed much more care than the restricted list provided.  Katy lobbied hard to be able to retract her original plan choice - and got it!  

Broker's Note: 

This particular strategy will not work with our clients as our plans are clearly marked, but you can still terminate one plan and start another for the remainder of the open enrollment period.

Moral of the Stories and Sad Facts of Life

Be prepared to fight. Things are not going smoothly. 

Here are some issues we have encountered with our clients:

Providers are listed in active directories and our clients later learn they are not actually on the plan. In some cases this has to do with contracts not being finalized before the directories go live online, in other cases directories are simply listing plans in error. As yet, we do not know how to avoid this situation but we strongly encourage our clients to double check with their doctor's offices before scheduling visits to confirm plan coverage.

There is a mandate to purchase coverage for pediatric dental benefits with all plan purchases even if you do not have dependent children. This is meant to provide inexpensive dental care for everybody 19 and under, but it may raise your quoted rates a bit. We are unable to provide you advance quoting on these rates as they are only available during the checkout process while purchasing your policy.

There are certain covered hospitals that are not listed on the plans, and in many cases going to an in-network hospital doesn't mean most of the physicians there are in-network. For example, Anthem Blue Cross of CA says that they have Alta Bates and Summit Hospitals but not most of the doctors affiliated with them.

Blue Shield has been rejecting claims, saying that in-network providers are not in the network.

Blue Shield has been rejecting some preventive care claims. (These do have to be done in network to be covered.) 

For more information on what constitutes Preventive Care, please take a look here.

Premium billing is still very messed up and it is difficult to get help over the phone. But for the moment at least, that's how it has to be done.

The Good News!

There are no pre-existing condition limitations.

Lots of people can take advantage of subsidies, making the insurance more affordable.

The benefits of the new plans are very good.  The only exception is the out of pocket maximums,  which are $6,350 for an individual and $12,700 for a family for most plans.

What About Group Plans?

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.

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

Doing this assures that we remain your broker. If you are not a current client, this chooses 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.

About Caffrey Insurance Solutions