Why Healthcare Costs May Be Higher Than You Thought

While many Americans who enrolled in healthcare under the exchange will not see increases in premiums, there will be increases  in deductibles. A deductible is a specified amount you have to spend to receive full healthcare benefits. Many Americans spend hundreds of dollars a month on healthcare premiums and then have to pay the full price for medical visits until they reach their deductible when the benefits actually kick in.


Why is this an issue?

The problem is that the majority of plans sold on the exchange are Bronze and Silver plans (plans with higher deductibles and lower monthly premiums). Bronze plans are the cheapest medical benefits options and cover nearly 60% of the medical costs. Silver plans cover about 70% of the healthcare benefits and the most popular form of coverage on the exchange for individuals and families.

What’s the average cost of a deductible?

According to a recent report released by HealthPocket, the average deductible for an individual on Bronze plan is nearly $5,181 and $10,545 for families. The IRS states that the definition of a high deductible plan is $1300 for individuals and $2600 for families. The deductible cost for Obamacare plans is obviously much higher.

What should I look for in a health plan to avoid unexpected costs?

When choosing a health plan, make sure that you understand the benefits including the co-pays, deductibles, specialty visits, etc. That way you won’t be subject to pay more than you expected. For more information on healthcare premiums on and off the exchange, please feel free to give us a call.

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Kaiser Partners with Target

While Target is commonly known to offer certain medical and optical benefits, their recent partnership with Kaiser is somewhat of a surprise. Kaiser will begin opening smaller sized medical clinics in certain Target locations in Southern California. Just last week, there were three Kaiser locations that opened in Vista, Fontana, and San Diego.

What does this mean for healthcare?

  • Kaiser is known for its size and reputation. While expanding into retail stores, it could mean that this is the start of a new chapter for the way healthcare is delivered to patients.
  • Kaiser’s approach could lead to an increased dependence on “telehealth” technology where people don’t necessarily have to see a doctor to receive care
  • Senior Vice President of Business Development and Innovation at Kaiser, Chris Stenzel, states that this fits into their larger strategy of the “Care Anywhere” approach to healthcare
  • Retailization of healthcare makes it more convenient and accessible

How will the Kaiser retail locations work?

  • They will rely on telehealth technology for the nurse practitioners to communicate with the physicians
  • Nurse Practitioners will be the primary care givers which is a common trend in the healthcare industry today
  • Pediatric services, ob-gyn visits, specialty visits, and chronic illness management care will be some of the services offered at participating locations.

Why is Kaiser partnering with Target?

  • According to Stenzel, it’s less about selling the plan than it is about getting the exposure.
  • Target and Kaiser are both notably big brands with many consumers. Kaiser brings in its patients to Target and Target customers become exposed to Kaiser care in the store. It’s a mutually beneficial relationship for both brands.

What do you think about this new partnership? For more information, click here.

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Covered California Outpaces Last Year’s Sign Ups

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:

  • Service
  • 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.

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How Physicians Should Prepare for 2015 Covered California Changes

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?


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Health Insurance 101 Part 2

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!

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