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

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

"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.

Critical Update for Covered California Enrollees!

If you are enrolled through Covered California, you have the choice of allowing an automatic renewal on January 1 or renewing your enrollment online.  Here are the criteria.

Individual and Family Open Enrollment Period Update (Open Market and Covered California)

We are currently setting appointments to assist you with individual and family plan enrollments.  You may be joining for the first time or wish to explore another carrier.  Open enrollment begins November 15 for a January 1 effective date and will continue until February 15, 2015 with the latest effective date being March 1.  

You also may have received letters demanding proof of income verification.  It would be good to handle this at the same time but it can be done later.

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

To schedule a time slot for an enrollment with Covered California or direct to any of the carriers we work with, please click here. 

Important Covered California Individual and Family Plans Update!

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.

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.

Many of you have been frustrated by the lack of providers.  We share this concern with you.  Unfortunately, this provider situation will not necessarily improve in 2015.

We do have one other carrier to try for you in some counties, including Alameda.  Cigna has a fairly priced Silver ($2000 deductible) plan.  It works similarly to an EPO where you have to use their providers.  You can check their providers. Also, please be aware their prescription drug formulary is somewhat reduced. 

Medicare Open Enrollment Period Update

Open enrollment period to switch between different Medicare Advantage Plans and Part D prescription drug plans began on October 15th, and will run on December 7th.

If you wish to learn about your options for setting up an Advantage plan, let us know. This is also the time to do a review of your presciption needs as plans change their formulary drug lists and rates each year at this time.

We would recommend that you explore the resources available at Medicare.gov for an overview of these options. We stand ready to assist you with the enrollment and to handle your questions.

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)

Cigna EPO  

Kaiser Permanente (HMO)

Health Net of CA (EPO, directory to be released shortly; PPO available for full cost non-subsidized plans to direct enrollees.)

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.

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:

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.

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.

About Caffrey Insurance Solutions