What You Need to Know for Special Enrollment

As many of you already know, there is a tax penalty for being uninsured that was supposed to go into effect in 2015. However, Covered California is now extending the deadline to enroll in coverage for people who did not know or realize they would be penalized in 2015 for being uninsured. Therefore, California is allowing consumers to apply for health insurance thru April 30, 2015 during the “Special Enrollment” period only if they they can prove that they did not realize there was a penalty.

How do you prove that you were unaware of the penalty? Consumers have to select “Informed of Tax Penalty Risk” on the dropdown menu when they apply for Special Enrollment here.

Typically, consumer can only enroll in Special Enrollment throughout the year if there is a qualifying life event. 

Qualifying Events:

  • Marriage
  • Having a Child/Adopting a Child/Foster Care
  • Moving Homes (ie: you move into a different state of coverage options or a different city of providers)
  • Loss of Health Coverage (job, divorce, etc.)
  • Change in Income (must prove that the change in income makes the cost of current coverage unaffordable)
  • Change in Citizenship
  • More Qualifying Events

How do you apply for Special Enrollment?

  1. Within the first 60 days of the qualifying event, you must enroll in a Covered California health plan or change your existing plan. If you don’t sign up for health coverage within those first 60 days, you could be facing a tax penalty and you have to wait until the next open enrollment period.
  2. You can apply online or call the Covered California Service Center.
  3. Typically, coverage starts on the 1st or 15th of the month so it’s important to plan ahead to avoid any periods without coverage. If you enroll in coverage before the 15th of the month, it will become active on the 15th. If you enroll in coverage after the 15th of the month, coverage will start on the first of the following month.

If you have any questions regarding the Special Enrollment period, qualifying events, or the 2015 tax penalty, please feel free to contact us.

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Covered California Does Not Hit Goal of 1.7 Million Enrollments

As of February 17, 2015, Covered California executives released a statement that they may consider expanding the enrollment deadline for people who did not purchase 2015 insurance plans. This comes shortly after they did not hit their goal of 1.7 million sign ups (they were short by 300,000 according to ABC 7 News). However, according to the executives, the consideration is so that they can help individuals avoid the tax penalty. The government run exchange (healthcare.gov) is also contemplating extending the enrollment period.

Then the question remains: Are people choosing not to enroll because of the issues with Covered California plans including narrow provider networks, a shortage of participating doctors, high costs, etc.? Or are people choosing not to enroll because they think it’s cheaper to pay the penalty than to enroll in coverage? (Or are people not enrolling because the deadlines keep getting extended?)

Penalties for not enrolling in coverage in 2015 are $325/adult or 2% of one’s income (whichever is greater). These penalties will not be applied until Americans start doing taxes and once that time comes, it will be too late to enroll in coverage. Hence, why Covered California is considering offering a special enrollment period to help more Americans get covered prior to paying penalties.

However, if Covered California does open a special enrollment period, will these “deadlines” even matter in the future? If they extend the window, this will be the second year that many Californians will get another chance to enroll before facing a penalty. This may encourage people not to enroll on time since the deadlines/penalties aren’t being enforced by officials.

What do you think? Should Covered California offer a special enrollment period?

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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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