September 2014

Providing Clear and Creative Health Insurance Solutions

Your guides through the insurance labyrinth. 

 

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 
Anthem Blue Cross Has Not Renewed Its Commercial Hospital Agreement with San Mateo Medical Center or Stanford Hospital as of August 24th
As of August 24th Anthem Blue Cross will no longer authorize or approve scheduled or elective admissions to San Mateo Medical Center and Stanford Medical Center.  See this article about the conflict between Stanford and Anthem Blue Cross.

You can find a list of alternate facilities served by Anthem Blue Cross here.
Speak to a Physician NOW! 
Check out a new service at Live Health Online. For a $49 fee you can speak with a physician 24/7 and they can even prescribe you medications. If you are with Anthem Blue Cross you can make your usual co-pay or however your office visits are normally handled. You will need a SKYPE (or similar) setup on your computer or tablet.
That Procedure Costs How Much?
We often see studies and articles showing how wasteful and inconsistent the medical system can be. Check this out: NPR article about hospital charges The article starts out with this gem: "One California hospital charged $10 for a blood cholesterol test, while another hospital that ran the same test charged $10,169 -- over 1,000 times more." Shocking! 

 

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 January 1st, 2015. Although temporary plans are not guaranteed to be issued to you, the underwriting process is comparatively simple and may meet your needs until a plan can be issued through Covered California or the private individual and family market. 

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

 

If this scenario applies to you, ask us if you want to see some options.

 

You can also 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.

Will You Be Eligible for a Subsidy Through Covered California Next Year? Find Out!

The Covered California website is up and running at:

www.coveredca.com 

You can go online and see if your expected income will make you 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 when the next open enrollment window opens on November 15th. 

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

We take our responsibility for 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.

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 review us and let prospective customers know about your experience. We really appreciate your time! Thank you.

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. 

What About Group Plans?

Group plans have significantly fewer restricted networks so it's good to hold on to those if you can. 

New mom and pop groups are no longer eligible unless there is another W-2 employee.

 

Owner only groups are generally not allowed, including partnerships, unless there is a W-2 employee on payroll.

 

The new group plans are similar to the individual plans being marketed but there are other choices as well and many have lower out of pocket maximums, in addition to much better access to services and the usual tax advantages of small group coverage.

Testimonials

"The medical insurance sector is complicated to navigate at the best of times and...with the whole ACA thing...it became almost impossible for me. 

Luckily, I crossed paths with Gabriel Caffrey of Caffrey Insurance Solutions and that was a fantastic break. Not only was Gabriel able to explain the tangled web of medical insurance in a manner that I was able to comprehend, but he implemented the insurance solutions for myself and my employees in such a manner that I barely had to do anything. 

It was an incredibly easy and painless process and since then, Caffrey Insurance Solutions has taken care of any and all the issues that did crop up. 

If you want medical insurance, get a broker and if you want the best, I really recommend you visit the Caffrey family!"

--Andrew Gregor, Blue Dog Construction

"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

We at Caffrey Insurance Solutions are busy preparing for the rush of open enrollments which happens every Fall. 


If you have a Qualifying Event like a change in your job, a marriage or divorce or the arrival of a new family member, you can change your insurance plan to reflect these changes. Otherwise, you have to remain with your existing plan or make a change during the Open Enrollment period. 

   

During the Open Enrollment period you can upgrade your policy or lower your costs. If you turn 65 at any time in the year you can make the necessary changes in your plans. This is a good time to talk with experts like Lynn and Gabriel. 

  

For All Individuals  

Open enrollment for individuals begins Nov. 15 and ends Feb. 15, 2015. The first effective date for new enrollments or policy changes will be January 1, 2015. Within this window you can apply for coverage with any carrier but if you qualify for the APTC (Advance Premium Tax Credit) subsidy, which can be significant, we can help you apply through the Covered California website. When we help you apply online we are then available to assist with any questions or issues that may arise with your policy. 

  

As an aside, individuals whose household income qualifies them for Medi-Cal can apply at any time via Covered California. This website is easy to use and has a FAQ (Frequently Asked Questions) section that will answer most of your questions.  


For Seniors

If you turn 65 this year, you can apply for Medicare from 3 months before your birthday to 3 months after your birthday. See our "Ask Lynn" feature below for more details.
 

For existing Medicare users, the open enrollment period for Part D (prescription drug) plans and Medicare Advantage plans runs from October 15 to December 7. If you are on a drug plan you are not happy with, this is the time to change. Even if you are happy with your prescription drug plan, you need to make sure they will still cover your medications for 2015 and at what price.  

  

It is advisable to confirm that your drugs are still covered by the carrier you selected. You can go to Medicare's find a plan link and research your drug plans online. You can also check out if your test or service is covered by going to the Medicare test or service information page. 

  

For Small Groups

Some two person and strictly owner-only groups may not qualify to remain as a group for 2015. If this is the case with your small company, we can help you make the transition to individual coverage when your renewal dates approach. 

   

For Groups

The new hire waiting period has been extended from 60 to 90 days. We will keep you posted as to how this will be implemented.

Important Covered California Individual and Family Plans Update!

You may have recently received a request for verification of citizenship or lawful presence from Covered California. If you have, it is imperative that you send in the requested documentation either via your Covered California online user account or by fax to 1-888-329-3700 by September 30th. 

 

Make sure to include the special cover page in the letter that lists your Covered California Case Number so that your documents get processed quickly and accurately. 

 

You also may have received letters demanding proof of income verification.  It is likewise crucial to send in documentation before the deadline on the letter. 

 

For more information, please stop by Covered California's website.


Individuals using Covered California should also be prepared to produce information requested by Covered California for 2015. At a minimum, you'll need to prove eligibility of legal residence and income. Some of the acceptable documents include (but are not limited to) a US Passport, Permanent Resident Card, or Alien Registration Card. If your proof of residence document doesn't have a photo you will also need to provide a photo ID. To prove income you'll need to send in a tax return or W-2's or 1099's.

 

Covered California rates will increase slightly next year. The average is 4.2%.

 

The primary carriers will be Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Health Net and Kaiser Permanente in Northern California. Not all carriers are available in all counties.

Fun Health Care Facts

An apple a day

Random Health Facts You Never Knew

1) Motorists who talk on cell phones are more impaired than drunk drivers with blood-alcohol levels exceeding .08.

2) Banging your head against a wall burns 150 calories an hour.

3) In some parts of the world, they protect their babies from disease by bathing them in beer.

4) The word 'gymnasium' comes from the Greek word gymnazein, which means 'to exercise naked.'

5) There are more than 1,000 chemicals in a cup of coffee; of these, only 26 have been tested, and half caused cancer in rats.

What Would Lynn Do?

Question Mark

Dear Lynn,  

 

I'm turning 65 in a couple of months. I'm still working and the company I work for is paying most of the cost of my medical insurance. It's a big company. What do I have to do?

 

Sincerely,  

64 and Counting 

 

Dear 64+,

 

You are probably wondering about these options, but only one is going to serve you best. See if you can pick it.
  1. Sign up for Medicare Plan A, which is effective the first day of your birthday month.
  2. Sign up for Medicare Plan B, which is effective the first day of your birthday month.
  3. Retire now; you won't need the company's benefits.
  4. Read all the literature you've been receiving about Medicare and then decide.
  5. None of the above.

Answer:

  1. Enroll in Part A and stay where you are.

Although it seems logical to enroll in Medicare at age 65, you should only enroll in Part A, the hospital part, which is free if your employer has over 20 people. In this situation, the employer plan is primary and Medicare is secondary. If you were to enroll in Part B, you would have to pay for it and it may or may not do you much good since you already have coverage.

 

It won't hurt (much) if you read all the literature you have received about Medicare but whatever your situation, we will analyze it for you and help you make the best choice. 

 

Medical insurance is very confusing and it needn't be. We help seniors with their plans on a daily basis. We can help you determine the cost benefits of staying on your company plan vs. Medicare plus a private Medicare supplement plan. 

What is a Qualifying Life Event? 

Before you apply or decide you want different health insurance, make sure that you qualify for a Special Enrollment Period. Here are some examples:

  • Marriage or divorce
  • Having a baby, adopting a child, or placing a child for adoption or foster care
  • Moving your residence, gaining citizenship, leaving incarceration
  • Involuntarily losing other health coverage:
    • if you lose your job-based coverage you have 90 days to activate COBRA
    • COBRA expiration
    • aging out of a parent's plan (turning 26)
    • losing eligibility for Medi-Cal or CHIP 
    • similar circumstances 

Important: Voluntarily ending coverage doesn't qualify you for a Special Enrollment Period. Neither does losing coverage that doesn't qualify as minimum essential coverage. (Temporary plans do not qualify as minimum essential coverage.)

  • For people already enrolled in the Covered California health insurance exchange for 2014 coverage: Having a change in income or household status can affect eligibility for premium tax credits or subsidy reductions. You are required to notify Covered California of income changes and you will be required to re-apply for coverage with a provider when you report those changes. Minor changes in your online profile might result in unexpected and confusing changes to your coverage. Please give us a call before submitting your changes to your Covered California plan.
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.

If you qualify for a Special Enrollment Period, you may also be able to get premium tax credits or lower out-of-pocket plans through Covered California health insurance exchange plans. You can also enroll in a plan outside the exchange if you qualify for a Special Enrollment Period but your income is too high to get discounted costs through Covered California. There are also more insurance carriers available than those contracted with Covered California.


 

If you are denied qualification we can help you appeal through the agency's appeal system.

 

Medi-Cal: You can also apply for Medi-Cal coverage via Covered California at any time if you think you may qualify. We are happy to assist with these enrollments if you need help.

 

Fees and Exemptions: Remember, if you don't have minimum essential coverage, you must either pay a fee or have an exemption from paying the fee.

Finding Your Medical Providers

For Your New Coverage

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.

Covered California Small Business Health Options Program (SHOP) Update 

Lynn Caffrey

As of October 1, 2014, small businesses seeking group coverage through Covered California's SHOP have expanded choices. To date, SHOP groups have been restricted to offering a single level of coverage to employees, without an option for buying up to more comprehensive plans. 

New SHOP group plans will have Dual Tier Choice, which will allow employers to offer health plans from two adjoining Metal Tiers -- Bronze + Silver, Silver + Gold, or Gold + Platinum. 

This gives our small group clients with average wages under $50,000 per year improved access to coverage with strong tax incentives. Eligible small businesses can claim between 35% to 50% of employee premiums as a special tax credit which will be calculated when company taxes are filed. In practice, this lets small businesses just getting started to bootstrap themselves into the insurance marketplace and provide flexible options to their staff while recouping some of the costs of putting benefits in place.

We have been writing a lot of SHOP cases in the last few months, and are pleased to have Dual Tier Choice to offer our clients moving forward.

Moral of the Stories and Sad Facts of Life

Solutions -- Not Problems

Be prepared to fight. Things are not going smoothly. 

 

Here are some issues we have encountered with our clients:

 

Some medical services providers are listed in active online directories (see article above) and our clients have later learned that the providers were 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. Before scheduling visits to a provider, we strongly encourage our clients to double check with their doctor's offices.

 

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. Anthem is also no longer contracted with Stanford Hospitals or San Mateo Medical Center.

 

Blue Shield has been rejecting claims, saying that some 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.

Check Out Our Video on Youtube!
Caffrey Insurance Solutions, Inc. Video
Caffrey Insurance Solutions, Inc. Video

 

About Caffrey Insurance Solutions 

Caffrey Insurance Solutions is a family business that provides insurance brokerage 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, all 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]