On November 15th, the Covered California open enrollment period kicked off. After website glitches and high call volumes last year, the Covered California team had new goals and hopes for this year. One of the primary goals was to decrease call abandonment in the customer call center.
Last year, three out of every ten calls were dropped so the exchange had a goal of dropping less than 3% of calls. However, the abandon rate is still something they are struggling with as consumers seek answers to password resets, re-enrollment questions, ongoing open enrollment inquiries, and changes in their Medi-Cal status. Covered California Director Peter Lee is encouraging individuals and families to call during low volume times (rather than Monday mornings when everyone is busy).
Still, open enrollment for 2015 has already surpassed the 2014 numbers at this time last year. Currently, there are 11,357 people enrolled in Covered California only 4 days after the exchange opened up. Last year, it took 15 days to reach just 11,000 enrollments.
Covered California is also rating plans this year to help simplify the process of selecting a plan for applicants. The rating is a star scale (four being the greatest) based on plan quality and can be found in the “Plan Preview” section.
Covered California Quality Ratings Include:
- Access to Care
- Preventive Care
- Clinical Care
- Ability for patients to get an appointment
- Ability to get patient questions answered
- Follow up care
Kaiser Permanente is one of the plans with 4 stars and is currently places in the top 25% of all plans. One star plans represent the bottom 25% of plans.
Do you have questions regarding enrollment or the new rating system? Give us a call to learn more.
November 15 marked the open enrollment period for the Covered California exchange. There have been some changes to the medical plans and policies covered under the exchange which will be announced as they are released. Covered California representatives are encouraging all physicians and policy holders to become familiarized with some of these updates especially since they predict that there will be a 45% increase in enrollment compared to 2014.
How should participating physicians prepare:
- Verify that they are still part of a carrier’s network (many providers have narrowed their networks since 2014 so it’s important to check on this status)
- Verify the exchange product type (make sure that your practices are still covered under the new plans and product offerings of the providers on the Covered California exchange for 2015)
- Ensure that staff members are knowledgeable of benefit packages, product offerings, and coverage options for plans on the Covered California exchange. For example, if a patient says that they are covered by Health Net, the staff member should ask what plan or policy that individual has because it may not be covered in the provider network
80% of respondents to a Covered California survey mentioned that they were unsure of their participation status in Covered California. With so many changes to provider network, policies, and information, physicians feel that this confusion is negatively impacting their healthcare offerings. The California Medical Association is trying to help physicians transition through this unfamiliar process by providing a guide to help them better understand patient participation status.
How are you planning to deal with the changes in your practice in 2015?
To help you better understand healthcare and your insurance policies, we are breaking down common terms related to the health insurance industry in a series called Health Insurance 101. Part 1 of the series can be found here.
Cost Sharing, Co-pays and Coinsurance are commonly confused forms of payment. While cost sharing refers to splitting certain costs with a healthcare provider, co-pays are typically set payments for services. For example, your health insurance plan may require you to pay a specified amount for a physicians visit, a generic drug, or a hospital stay. The healthcare provider is then responsible for the rest of the cost.
Cost-sharing, however, is when you agree to pay for a portion of the services in your health plan. Common cost-sharing services include deductibles and co-payments. Therefore, co-payments are a form of cost-sharing between an individual and a provider network. Charges from physicians that are not in your provider network are not included in cost sharing (meaning your insurance provider won’t help pay for that bill).
Coinsurance is usually a percentage of the healthcare bill for services that you are required to pay. For example, if your insurance carrier agrees to pay 80% of your healthcare costs for specified services (after satisfying and deductible or co-pay specifications), then you may be required to pay the other 20%.
Therefore, a co-pay is a specified form of cost-sharing between you and your healthcare provider as established in your insurance plan. Coinsurance is the percentage of cost-sharing that you agree to pay after reaching all deductibles and co-payments stated in your health insurance plan.
Still have questions? Feel free to give us a call to learn more!
The next open enrollment period is only 4 days away (November 15, 2014). To learn how to prepare for the next open enrollment click here. If you are deciding on whether you would like to enroll in a Covered California Health Plan or enroll in COBRA, continue reading.
COBRA (also known as the Consolidated Omnibus Budget Reconciliation Act of 1985 states that employers who offer employees group coverage must give employees the opportunity to continue that coverage in the event that the employee is laid off or there is a change in his or her employment status. However, the employee will likely have to pay the full cost of the premium. Employees do have the choice to enroll in COBRA or decline coverage. If an employee declines coverage and chooses to be uninsured, they could face tax penalties under Covered California’s guidelines. An employee can look into Covered California coverage since termination of employment would qualify them for special enrollment as long as they apply within 60 days of the former health plan end date. *It is important to note that an employee cannot enroll in a Covered California health plan and then later decide to enroll in COBRA.
What should you consider when deciding whether to enroll in COBRA or Covered California after termination or a change in employment status?
- Premium, Copay, and Deductible costs
- Provider Network
- Current Health Status
- Tex Credit Eligibility
To avoid a tax penalty for being uninsured, make sure to enroll in coverage within that 60 day qualifying period after the employer sponsored coverage ends. Either health plan will suffice but consider the factors above when deciding which plan to enroll in.
Tuesday night’s election may mean a shift in health care reform initiatives moving forward. The House of Representatives and Senate are now both dominated by Republican control of the seats which may mean that the President will have a more challenging time fulfilling his agenda. This is especially true when it comes to matters involving health care reform.
What do Republicans want to accomplish with the Affordable Care Act?
Many of the Republicans campaigning would like to remove and repeal Obamacare altogether. Many of the new electors feel that the Affordable Care Act is doing more harm to small businesses and the American people by initiating an increase in taxes and regulations. They feel that Americans will be receiving less benefits at an unaffordable cost if healthcare continues in its current direction. While the newly elected officials would like to change the current health care system, they haven’t offered solutions yet as to how they recommend fixing it.
Why do Republicans want to repeal the law?
Health care has been one of the biggest challenges and debates between both political parties as each argues why it will work and why it won’t for the future. Republican officials had a slight advantage in this campaign as they brought up more recent and pressing issues facing many Americans including the federal exchange website crashes, the plan cancellations for many individuals and families, and the increase in plan costs along with the decrease in coverage. There were even officials that signed a pledge stating that they would support any legislation attempting to repeal the federal healthcare laws signed in 2010.
Now, more than ever, it is extremely important to become educated on health care reform legislation and how it may affect you, your family, and your business. If you have any questions, please feel free to give us a call.