Obamacare Enrollment for 2014

Open enrollment starts October 2014.  You can enroll online, by phone, in person or by mail.  The cost is the same if you choose a Licensed Agent or Broker, or go direct to the Covered California website.  Agents and Brokers will help consumers enroll through an exchange website and assist in securing an eligibility determination and in selecting a plan.

Have the following ready before you start to enroll:

• Number of people being enrolled
• Birthdates of each person
• Home zip code
• Most recent income tax filings, including dependent tax information and head of household status (if any)
• Legal immigration information, such as your immigration number (if applicable)
• Information about your status as a member of a federally recognized tribe

Are all Insurance Companies offering the same?

If a carrier participates in Covered California, they must also offer the same plans or “mirror” those plans off-exchange.  But participating exchange carriers can also offer some alternative plans.  For example, Anthem will offer 8 Bronze plans and 4 Silver plans off-exchange that do not mirror the exchange plans.  Of course, they still have to be ACA-compliant and conform to the actuarial values for each level.  Blue Shield, on the other hand, will be offering no alternative plans off exchange, only mirrored plans.  Cigna, who does not participate in Covered California, will be offering only alternative plans off-exchange.

H S A’s and the Subsidies

We have not seen anything definitive as to how the H S A plans will qualify for a subsidy for the premiums.  We doubt the IRS will allow for a double tax benefit and they may come to some accommodation for a partial reduction of the H S A contribution.

How soon can you get a quote for the ACA compliant plans?

Insurance Companies are taking steps to handle this.  Blue Shield announced recently that they will stop accepting online applications for their current portfolio of plans on September 25^th and will begin displaying and quoting ACA-complaint metal plans on September 26, 2013 with October 1st the first day to submit applications for ACA-complaint plans.  Only paper applications for the existing portfolio will be used between 9/26/13 through 11/15/2013 with the last effective date of 12/1/2013.

Husband and Wife with 2 children in college.

The husband is on Medicare and the wife is not.  The children live at home and currently have student health insurance through the college.  The household income is about $ 50,000.  The household income is used regardless of the number of members to be covered and you can enter only one person to be covered.  The children can stay on their college insurance because it qualifies as minimum essential coverage.

Pediatric dental coverage in 2014

Covered California announced today that insurance companies will be offering pediatric dental coverage in 2014 in both the Exchange’s individual and the small-group employer markets. They offer stand-alone plans for children’s dental coverage in the first year of the new health benefit exchange, which will open for enrollment Oct. 1.

Dependent in Another State

Covered California has yet to publish comprehensive guidelines for “household” determinations, but we will go out on a limb for you.  If you child is a full-time resident of another state, he or she may apply for that state’s exchange coverage and be eligible for premium assistance.  You would not count this childe as part of the household in California regardless of tax status.  Your child must be a full time student or disabled to be claimed as a dependent over the age 18 and that expires in the year he or she turns 24.

If your income changes after you get a Subsidy-

You can avoid advance tax credit repayments by reporting income changes as soon as possible.  The government figures if no families report income changes during a single year, 30% of those receiving subsidies would owe the government a median of $857.00 each.  If families report income changes in a timely manner, only 23% would owe money to the government and those that do would pay a median of $ 343 each.

Can we see the Provider Networks being offered in Covered California plans?

The provider networks are not expected to be published prior to the start of open enrollment.

1.  What it covers:  A homeowners insurance policy will cover damage to your property and your personal property in the event of certain storms, fire, theft or vandalism.  Provides liability coverage if someone is injured on your property and decides to sue.  It will also provide coverage in the event you need to rent a hotel if you are temporarily displaced from your home due to a covered loss.  It can also protect your personal belongings outside of your home too.  If your car is broken into and your personal items were taken, your homeowners insurance will most likely provide coverage.  Most homeowner’s policies will cover your belongings when you are traveling as well.
2. What is does not cover:  Earth movements such as, earthquakes, landslides, sinkholes, power failure, war, nuclear hazard, government action, faulty zoning, bad repair or workmanship, defective maintenance and flooding.   In some high risk areas, windstorms damage such as tornadoes or hurricanes will be excluded.
3. Water damage can be confusing; as a rule, water from above, such as rainwater, burst pipe in an upstairs floor is normally covered however, water from below such as backed-up sewer or ground flooding generally is not. If you live in an area prone to earthquakes or floods you should consider supplement coverage.
4. Get Replacement Cost Value:  You want to be able to replace everything you lost with similar new items.  Make sure your policy spells out that both your home and its contents are covered by replacement-value insurance.  Look for extended or guaranteed-replacement-value coverage.  This will cover rebuilding no matter what the cost.
5. Understand the claims process: Insurance companies are vastly different when it comes to making you whole again after a loss.  Know the timetable on replacing and how and when claims are paid.
6. Take inventory:  Take photos or video of your home, walking through each room.  Don’t forget storage areas also. Keep the photos or video in a safe place, one for your home and another in a fireproof safe or safety deposit box.
7. Buy Floaters: Typically your homeowner’s policy limits the amount they will pay in high-valued items, things like computer equipment, jewelry, furs, collectibles, sound equipment, etc.   You may want to consider purchasing a special “floater” policy.
8. Purchase Inflation Guard protection: This will cover the increasing cost of rebuilding to meet the current cost to replace your home.   When making improvements to your home, this is an important factor to consider and your policy needs to be updated.
9. Consider Flood and Earthquake Insurance: Maybe not everyone needs it, however if you live in an area prone to floods or earthquakes these are highly recommended.
10. Think about purchasing an Umbrella Policy: Your Liability coverage will payout if someone sues you however, most lawsuits will be in the millions.  If you have assets, purchase an umbrella policy which will add the extra liability coverage to your home and auto policies.  These are relatively cheap, normally around $ 200 – $ 400.00 per year.

Starting in 2014 all plans sold to individuals, families and small businesses will be classified as one of these four (4) levels of coverage:

Bronze

Silver

Gold

Platinum

The Bronze and Silver plans will have a lower monthly premium, but when you need medical coverage, you pay more out of your pocket.

The Gold and Platinum plans will have a higher monthly premium, and you will pay less out of pocket for medical coverage.

The Insurance Companies who will be offering plans inside Covered CA (The Exchange):

Blue Shield – Individual, family and Group

Health Net – Individual, family and Group

Kaiser – Individual, family and Group

Anthem Blue Cross – Individual and family only

Alameda Alliance for Health

Chinese Community Health Plan

Contra Costa Health Plan

L.A. Care Health Plan

Molina Healthcare

Sharp Health Plan

Valley Health Plan

Western Health Advantage

Insurance Companies who will be offering plans outside Covered Ca (The Exchange) are:

Anthem Blue Cross – All

Blue Shield- All

Health Net- All

Kaiser – All

United HealthCare- Group

Aetna- Group

Cigna – Group

And others

Every American Citizen and Legal Resident will be required to have Health Insurance.  If you currently have an individual or small business plan it will change starting January 1, 2014.  Every member will receive notification sometime in September 2013-October 2013 indicating which of the (4) four plans your current plan will be mirrored to.  You do not have to stay with the insurance company recommendation; you will have a choice to select one of the other plans.   Any questions, contact our office and we will be able to assist you.  We suggest contacting us immediately when you receive your notification from the insurance company, because we anticipate thousands of people wanting to make changes or have questions.

Covered California is the state agency operating the new exchange.   It is where you and your family may get financial assistance to make health coverage more affordable and where you will be able to compare and choose health coverage that best fits your needs and budget.    Licensed agents can sell exchange-listed plans only if they have been certified by Covered California.

Training is necessary because the new exchange offers the subsidized rates to some uninsured Californians, and small businesses, based on their economic status.  Plans offered from a dozen different private insurance companies also are tiered with corresponding precious metals from bronze to platinum levels.   Brokers have an important role in helping Californians make sense of the options.

Our brokers are preparing for the open enrollment beginning in October 2013, they will be able to assist and enroll our clients as well as anyone else needing to apply for health insurance for 2014, once the certification has been completed.

Contact us for more information. (909) 392-5535 or info@brokerswhocare.com

Huge losses related to weather events and other natural causes are triggering higher premiums for homeowners and businesses along with the loss of coverage availability.

Just how much are these events costing the insurance companies?

Hurricane Sandy, according to the U.S. National Oceanic and Atmospheric Association (NOAA) is more than $ 50 billion and still climbing.  Hurricane Katrina came in at $108 billion.

The most recent storm in Oklahoma is set at $3 billion.

Flood insurance rates are expected to increase an average of 25 percent over the next 5 years.

Deductible minimums are expected to increase starting at $5,000 for states where these events occur most often.

Then there is Drought.  Last year, a severe drought plagued nearly half of the US, killing crops and herds across the country.  The cost to the insurance companies: $15 billion. With all the dryness comes a large threat of fires and those figures have not come in as of this blog.

These are just some of the factors resulting in the increases.  Although you may not live in New Jersey or Oklahoma, you as a business owner and homeowner are feeling the punch to your bottom line.

The cost to rebuild has also increased which is driving premiums up.  Just about everyone will see an increase on their property insurance bill this year.

Other factors which can cause an increase in your premium:

1.  Pools
2. Dogs
3. Trampolines
4. Treehouses
5. Guns
6. Big-ticket jewelry
7. Home businesses
8. Heating fires (wood-burning stoves, fireplaces, etc)
9. Sewer backup
10. Zip lines (backyard zip lines)
11. Exotic pets

There are also discounts you may be eligible for an opportunities to lower your premiums:

1. Be a faithful customer or having good credit.
2. Have multiple policies with the same insurance company can sometimes save you up to 30%.
3. Increase your deductible to instead of $ 500 or $1,000, homeowners who can afford a big out-of-pocket  may be willing to gamble that nothing will happen to their home might choose a $ 5,000 or higher deductible and can save as much as 35%.
4. Install an advanced alarm system can save you an average of 10%

Disaster-prep your home and business.  Sealing roof beneath the shingles and pruning trees away from the building or home.  For more information see the Insurance Institute for Business and Home Safety, or IBHS. http://www.disastersafety.org/

RenterRenters insurance can help ease your worries

You come home late to see fire trucks streaming water into your apartment building as black smoke pours out. Hours later you finally get inside where you discover severe fire damage and most of your possessions have been destroyed.

You ask your landlord or property management company about covering your costs and learn the truth…If you rent your home; your landlord/property management insurance policy generally covers only the structure of the building. Damage to your personal property is usually your responsibility.

If you had renters insurance the policy provides coverage for your personal possessions.

Other reasons to consider Renters Insurance:
1. While you are away, a burglar steals all your valuables from your home.
2. The pizza delivery guy trips on your son’s skateboard and breaks his ankle on the walkway leading to your rented home. His employer sues you for his medical bills, contending that it was your fault that the skateboard was left out.
3. A major gas line in your neighborhood has a leak and the fire department orders an evacuation. You are not allowed to return for two weeks while repairs are made.
Renters Insurance Policies provide liability, loss of use and personal property coverage.

These plans are guaranteed to provide basic levels of coverage and provide consumer protection.  Here are the ten Essential Health Benefits:

1.  Ambulatory patient services

2.  Emergency services

3.  Hospitalization

4.  Maternity and newborn care

5.  Mental health and substance use disorder services, including behavioral health treatment

6,  Prescription drugs

7.  Rehabilitative and rehabilitative services and devices

8.  Laboratory services

9.  Preventive and wellness services and chronic disease management

10.  Pediatric services

Covered California has selected 13 insurance plans which will be available starting in October 2013.   These health plans meet all the state and federal requirements.

1.  Alameda Alliance for Health

2.  Anthem Blue Cross of California

3.  Blue Shield of California

4.  Chinese Community Health Plan

5.  Contra Costa Health Plan

6.  Health Net

7.  Kaiser Permanente

8.  LA Care Health Plan

9.  Molina Healthcare

10.  Sharp Health Plan

11. Valley Health Plan

12.  Ventura County Health Care Plan

13.  Western Health Advantage.

Penalties for Individuals

In 2014, Legal U.S. citizens who do not have a minimum amount of health coverage will receive a penalty of $ 95.00 or 1% of their taxable income, whichever is greater.

Penalty Timeline

Penalties will increase each year through 2016. In future years, the penalties will adjust annually.

2014 Greater of $ 95 or 1% of taxable income
2015 Greater of $ 315.00 or 2% of taxable income
2016 Greater of % 695 or 2.5% of taxable income
2017 And beyond – Annual adjustments

Small Group Employers –
Less than 50 employees

Small businesses also can use an exchange to find insurance for their employees. These are call Small Business Health Options Programs or SHOP’s for short. The individual and SHOP exchanges may be separate or combined.

Three options for health insurance in 2014 –

1. Offer a full insured plan through either:
a. A Shop exchange
b. The traditional market
2. Offer an ASP plan, if allowed by state law, where essential health benefits are metal level requirements don’t exist.

3. Stop offering coverage and let employees buy an individual plan on or off the exchange.

Individuals –

Three options for health insurance in 2014 

1. Get coverage through their employer, if available.
2. Buy a plan through either:
   1. The individual market exchange.
   2. The traditional market 
3. Go uninsured and pay a penalty, unless exempt.

 Subsidies and credits for individuals –

Those who do not have access to affordable, minimum essential health coverage can buy a health plan from the exchange and get a credit or subsidy if they meet income requirements.  Credits and subsidies help with the cost of premiums and out-of-pocket health care expenses. 

Income requirements –

100% to 400% of federal poverty level

1. For an individual that equals $ 15,282 to $ 45,960 per year (in 2013)
2. For a family of four that equals $ 31,322 to $ 94,200 per year (in 2013)

 Those that meet the income level can get a tax credit that may be applied to any level exchange plan (bronze, silver, gold or platinum).

 The cost-sharing subsidy is available to those who earn up to 250% of federal poverty level and enroll in a silver exchange plan only.  

Individual’s share of premium is no more than 9.5% of income.