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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Recently in Health Insurance Coverage Category


No Income Coverage?

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Question: I am not working and have no other income. I need to keep my hematologist. Can I receive Covered California and choose a plan which I would pay out of pocket or do I have to take MediCal since I believe I fall into the poverty level.

Answer: If you have no income, you have two options for health insurance coverage. (1) you qualify for Medi-Cal coverage which has $0 cost for both the insurance and out-of-pocket expenses, but your current doctors may not accept Medi-Cal. Ask you doctor if he will continue treating you if you switch to Medi-Cal. (2) You can purchase individual coverage directly from any California licensed insurance company that your doctor accepts, but not Covered California. You will face significant expense both in monthly insurance premiums and out-of-pocket medical expenses that will probably be unaffordable. I recommend going with Medi-Cal even if you have to change doctors.


Question: My wife petitioned her mother who lives in Mexico to live come to the US to live with us as a resident, but I heard there is a new immigration law that's going to be in effect starting November 3rd for all new immigrants have to have health insurance before or within 30 of entering the US. But they can not use the exchange's or Medi-Cal assistance. Where can we purchase health insurance for her. She won't have Medicare either.

Answer: Right. The White House issued a presidential proclamation on October 11, 2019 requiring many future immigrant visa applicants to show they can afford health care. The action, which is set to take effect in 30 days, would require immigrant visa applicants, including people with ties to family members in the U.S., to show they have health insurance or prove their financial ability to pay for medical care before being issued a visa that could lead to a green card.

The most affordable option for health insurance coverage for a visa applicant is international travel insurance for foreign nationals traveling to the United States. Shop Patriot America® Plus. The policy can cover up to two years with renewals for additional two years at a time. Monthly rates as low as $300 per month. Option number two is individual health insurance from a California insurance carrier at a minimum of $600 per month. Immigrant visa applicants are not eligible for premium assistance through Covered California or Medi-Cal.


Question: I have my health insurance with Blue Shield through Covered California. If I want to keep my current plan do I have to do anything during Open Enrollment?

Answer: Blue Shield will automatically renew you for 2020 coverage in the health plan you have now. If your current plan is no longer available, Blue Shield will automatically enroll you into a similar health plan. Even if you have been automatically re-enrolled you can still make changes to your health plan coverage until January 15, 2020.

If you receive premium assistance for your health insurance coverage through Covered California you should validate your enrollment online at or by phone at 800-300-1506 between October 15 and December 15, 2019 to maintain your financial assistance.


Have you ever stepped up to the pharmacy cash register only to learn your new prescription will cost you hundreds of dollars — instead of your typical $25 co-pay — because your insurance doesn’t cover it? Or received a painfully high bill for a medical test because your health plan didn’t think it was necessary? Most people have, but only a tiny fraction ever appeal such decisions. In 2017, for example, enrollees in federally run Affordable Care Act marketplace plans appealed fewer than one-half of 1% of denied medical claims, according to an analysis by the Kaiser Family Foundation.

If you do appeal, your chance of getting the health plan’s decision overturned is a lot better than you might think. “About half of appeals go in favor of the consumer,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a healthcare consumer advocacy group.

There’s no sugarcoating it, though: Getting to “yes” with your health plan can be an ordeal, and you may need help from friends, family members, your doctor, insurance counselors, even legal aid societies. In California, health plans are supposed to help facilitate the appeals process. When they deny coverage, they must inform members in writing how to appeal. And when they receive enrollee complaints, they are required to acknowledge them formally, which sets the clock ticking on a series of steps to resolve the dispute.

Regardless of the type of insurance you have, you can do several things to strengthen your position even before you file an appeal.

Get organized You will need up-to-date medical records, as well as all communications with your doctor and health plan and any other paperwork that might bolster your case. “Don’t do anything over the phone. Do everything in writing. You need a paper trail,” says Maria Binchet, offering her hard-earned wisdom from the trenches. Binchet, a resident of Napa County, has a rare, disabling illness called myalgic encephalomyelitis, or chronic fatigue syndrome. Because none of the doctors in her Medicare HMO network has expertise in the disease, she says, she has requested referrals to outside specialists on numerous occasions over the last 22 years, been turned down each time and appealed nine times. After one of those appeals, the health plan allowed her a single visit to a specialist — but he wasn’t taking new patients.

“You have to be persistent and resilient,” she says. Binchet also advises that you request from customer services the unredacted notes of the health plan’s internal discussion about your case. The notes can help you determine how extensively your case was considered, who made the decision and whether that person was medically qualified to do so. A letter or phone call from your doctor to the health plan can provide valuable support. “It’s important that you get someone involved who can talk about the medical evidence, because that’s what this is really about,” Fish-Parcham says. Clock is ticking When your paperwork is ready, you must appeal first to your health plan. For most private plans, your deadline for filing the appeal will be 180 days after care is denied. The insurer then faces a deadline — usually 30 days — to render its decision. If it upholds its initial decision or doesn’t meet the deadline, you can take the matter to the agency that regulates the plan within 180 days. If your health is in imminent danger, you can generally get an answer in a matter of days rather than weeks. Unfortunately, different plans have different regulators, with varying appeal procedures. If you don’t know who regulates your health plan, call customer services and ask. A large majority of Californians have policies regulated by the Department of Managed Health Care, but millions of others are in plans regulated by other state agencies, such as the California Department of Insurance or the federal government. A good place to start is the Department of Managed Health Care (888-466-2219 or HealthHelp.ca.gov ). Even if it is not your regulator, it can direct you to the right place, Rouillard says. If you are one of the 26 million Californians in plans regulated by the department, you can request a free review of your case by outside medical experts if your appeal to the health plan failed or was not answered by the deadline. These independent medical reviews are for cases in which a health plan doesn’t think a type of treatment is medically necessary or refuses to cover it because it is experimental — or won’t pay for emergency medical services after the fact. An archivewebsite on the department’s allows you to search past decisions for cases like yours. The summary language in those decisions might help you frame your arguments. You can also request an independent medical review through the California Department of Insurance (800-927-4357). If you are one of the 5.5 million Californians in a federally regulated employer plan, your regulator is the U.S. Department of Labor’s Employee Benefits Security Administration (866-444-3272 or askebsa.dol.gov ). Help is available As you wade through this process, there are organizations that can help. One of them is the Health Consumer Alliance (888-804-3536 or www.healthconsumer.org ), which can assist people in public and private health plans. It offers free advice, can help you get your documents in order and provides legal services. Medicare enrollees can receive free assistance from the Health Insurance Counseling and Advocacy Program (800-434-0222 or cahealthadvocates.org /hicap ). Wolfson writes for Kaiser Health News, an editorially independent publication of the Kaiser Family Foundation.


Question: I have enrolled in Blue Shield Trio 70 HMO for 2019. How can I choose a primary care doctor?

Answer: Blue Shield will issue a member ID number as soon as they receive your initial payment. Once you have an ID number, you can register on the Blue Shield website (blueshieldca.com) and select or change a Primary Care Physician. If you can't do it online, call Blue Shield member services.


Question: My dependent daughter goes to college out of state. How would coverage for her work?

Answer: If she's covered under your family health insurance policy, he will have out-of-network coverage while out of state. That means a lot more out-of-pocket costs for her routine medical expenses compared to in-network coverage at home. Ideally, she would enroll in the student health insurance coverage offered by her school. That way she get's routine care at school for low or no out-of-pocket expense and major medical coverage under your plan.


Question: My son, age 23, got hired and enrolled in a PPO health plan at work, because they told him had to. He is still our plan. Can he drop his insurance through work and stay on our plan?

Answer: Your son can be included in your household health coverage through Covered California until age 26, even though he is employed. However, if he is included with your family coverage, your household is not eligible for premium assistance or cost sharing enhancements from the time he was offered health insurance at work.


Question: I was told today by a person from Covered California that if we purchase private insurance for our kids while they are eligible for Medi-Cal, we could lose our premium assistance. Is it true?

Answer: No. You will not lose your premium assistance if you follow these directions. Update your Covered California account to remove your children from coverage by answering "no" when asked if the child wants coverage. This will drop your kids from the Medi-Cal roles. If you don't do this, you could have problems in the future because your children's social security numbers will continue to appear in the Medi-Cal database.


Question: I am under Asylum Processing for about 90 days now ,and I want a medical insurance, However right now I dont have SSN or a ID ,just passport from China, how do I get a medical insurance?

Answer: I recommend International Travel Insurance which you can purchase as a Chinese citizen. You can get coverage for a limited period of time while in the United States. You select the length of time, but 90-days is no problem. The plan covers pre-existing conditions only in the case of acute onset. You can pick your deductible and coverage limits depending on your budget. Cost of overage is very reasonable. Click here for a quote Under Patriot Travel Medical Insurance, select Patriot America


Question: I'm 17, I'll be having my baby late July. As a minor, how can I apply for health insurance for me and my kid? Im currently unemployed and wont be able to work until next year. I also wont be turning 18 until 7 months after my baby is born. Im under my moms health insurance at the moment.

Answer: You can stay on your Mom's insurance and your newborn can be insured independently for about $150/mo with any health insurance company in California. If that rate is unaffordable, Medi-Cal is free if you qualify. Click here for ways to apply for Medi-Cal.


Question: I work the the State of CA and my Wife works for the County. We both have covered HMO coverage, Kaiser, which is offered through our work. We filed our taxes and received a response from the IRS asking for a 1095-A. Why are we getting this and how do we get our taxes filed?

Answer: ​I​f you received coverage through a fully insured employer-sponsored health plan, you'll receive a Form 1095-B from the insurer​ (Kaiser)​. If you received coverage through a self-insured employer-sponsored health plan, your employer will complete Part III of Form 1095-C. You need to file the Form 1095-​B or 1095-C with your individual federal income tax return to prove compliance with the individual mandate.


Question: My daughter who is single, doing online college, living at home, and who is on her dad's company insurance is expecting a baby in July 2017. My insurance and my husbands insurance will not cover the baby. What do we do?

Answer: The baby will have his or her own policy. You can apply for an individual health insurance plan for the baby as soon as he or she is born. For a preview of available plans and rates click here. (Use today's date for date of birth.)


Republican Healthcare Plan?

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Question: What is the plan to replace Obamacare?

Answer: The House of Representatives is presenting their health plan today. Here are the highlights:

  • Eliminate insurance marketplaces 2018.
  • Eliminate insurance mandate and penalties 2018.
  • Eliminate some “essential” benefits 2018.
  • Eliminate taxes on $250K+ households, insurance companies, medical devices makers 2018.
  • Phase out consumer subsidies based on income 2018.
  • Provide consumer subsidies based on age 2018.
  • Phase out federal aid for Medicaid expansion 2020.
  • Provide block-grants to states for Medicaid funding 2020.

Adding Out-of-State Children?

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Question: My kids mother and I are divorced. I live in California and she lives in Tennessee. As part of our child support agreement she would like for me to add our kids to my covered California insurance even though they live with her for most of the year. I currently have Kaiser. Will it be possible to add them to my plan even though they live in another state?

Answer: No. (1) Your children are not California residents. (2) Kaiser Permanante has no doctors or facilities in Tennessee.


Need PPO Insurance?

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Question: I recently lost my disability income and therefore lost my subsidy for PPO. I was given Medical but they only cover 4 out of my 15 medications and my doctors are not in their network. How can I purchase a PPO insurance on my own? It has taken my doctors 3 years to get me stable, I can't go back to near death over insurance dilemmas. I need to get my medications and the cash cost is over $2k per month! Please help!

Answer: You can shop, compare, and buy California individual health insurance at https://www.cahba.com.


Visitor Insurance?

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Question: My parents will be visiting me for 4 months this year. Can I purchase health coverage for the duration of their visit through Covered California?

Answer: No. Your parents will not be eligible for coverage through Covered California while they are visiting. California residency is required. The best option for your parents is International Medical Insurance.


Free Women's Preventive Services?

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Question: What are the free preventive services for women with #CoveredCalifornia?

Answer: All Covered California plans offer preventive services for women without cost sharing. For example, these include counseling and screening services including prenatal and preconception care; breast and cervical cancer screening; genetic counseling and testing for women at high risk of breast cancer; Chlamydia and Gonorrhea screening and counseling for high risk women; at least one well woman visit a year; contraceptive counseling, services and supplies including prescriptions for FDA approved contraceptives; breastfeeding counseling and support services including breast pump rental; and intimate partner violence screening and counseling. So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service will be covered by the insurer without cost-sharing.


When Will Coverage Take Effect?

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Question: How long after I enroll in a #CoveredCalifornia plan will coverage take effect?

Answer: If you enrolled in a #CoveredCalifornia health insurance plan by December 17 and make your first premium payment by the due date specified by your plan, your new health coverage starts January 1. After that, if you enroll between the 1st and 15th day of the month and pay your premium by the due date, your coverage begins the first day of the next month. So if you enroll on January 10, your coverage begins February 1. If you enroll between the 16th and the last day of the month and pay your premium by the due date, your effective date of coverage will be the first day of the second following month. So if you enroll on January 16, your coverage starts on March 1.


Question: Can you discuss how an HRA (not HSA, but HRA) account affects the plans you can select and any financial assistance it may affect.

Answer: A health reimbursement arrangement (HRA) is an agreement between employer and employee to reimburse out-of-pocket medical expenses. The idea being that the employer can save money on insurance costs by purchasing a high-deductible (cheaper) health plan. Then compensate the employees for the loss in benefits by reimbursing their out-of-pocket expenses not covered by the group health plan or expenses subject to the deductible. HRA's are very flexible. They can be all-inclusive to cover any tax-deductible medical, dental, or vision expense or very limited - for example only covering the first $100 in expenses annually. As a IRS approved employee benefit plan, HRA's deliver tax benefits for both employer and employee, that is: the employer's payments are tax deductible and the employee reimbursements are pre-tax benefits.

The IRS requires that the HRA be combined with a fully-funded group health insurance policy. You cannot receive the tax benefits associated with an HRA if you create a stand-alone HRA - one designed to work with individual health insurance coverage. Only HRA plans that are attached to a conforming group plan can be used going forward.


Did I Make the Obamacare Deadline?

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Question: I just completed the application and asked me to upload a form for the manage verification page, which I did. After it does not ask me anything else and says someone will contact me after reviewing my form. My question is, today is the last day to enroll, if someone does not review my form by today, can I not get anything? Or did i do everything already on my part for the deadline.

Answer: As long as you started your application today - 31 January 2016 - you made the deadline for a 1 March 2016 effective date of coverage. However your application may not be complete. You have until 6 February 2016 to get a Certified Agent of Covered California representative to finish it for you.


Question: We lost our employer coverage June 1 but were out of the country from early May until mid August. Are we just out of luck as far as buying insurance through Covered California until the next open enrollment?

Answer: You are entitled to a special enrollment period of up to 60 days following the termination date of your employer-based coverage. Your SEP expired on August 1st. Your should be able to get covered however. I suggest you contact a Covered California certified agent. The agent will help you request an enrollment "exception" due to the fact that you were out of the country during your SEP.


Question: I will need to buy health insurance due to job loss. I am going to be completely self-employed. I understand there is a regular Bronze plan and a HSA Bronze plan. Which is better for a healthy couple who expect little medical care? Please consider that self-employed deduct medical insurance paid on their income taxes.

Answer: ​Yes. I recommend the HSA compatible Bronze plan for healthy self-employed people because you can take advantage of the added tax benefits. Your premium payments are tax deductible to the business and any money you contribute to your HSA account is also pre-tax - up to $6,750 per year for a couple. You can use your HSA savings to pay for out of pocket medical expenses - copays and deductible - with pre-tax dollars.


Question: I have heard of the limit to tier 4 drugs. Can you elaborate on this as well any other changes like deductibles, co pays, coverage e passion etc?

Answer: In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket cost on specialty drugs (once the pharmacy deductible is met). For the Bronze Plans there is a $500 monthly maximum and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 after the pharmacy deductible is met. The other significant change in benefits for 2016 affects the Bronze Plan. The first cumulative three visits will not be subject to a deductible and can include a specialist visit in addition to primary care, mental health and urgent care visits. In addition, laboratory work is not subject to the deductible.


Question: My 82 year old mother is a recent immigrant, no job/income here. Covered CA Cost calculator asks for household income. If she put in 0 income, she's not eligible to CoveredCA but is referred to Medi-Cal, which we know she's not eligible for (5-year rule deeming because of the Affidavit of Support). Is she supposed to put in my income because I sponsored her legal permanent residence?

Answer: Yes. Your mother can apply for Covered California as part of your household. Your household income will determine if your mother is eligible for premium assistance. Because your mom has no income and she lives in your home, she is a dependent for tax purposes.


Private Insurance for my Child?

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Question: I am self employed. Acceptance by physicians for Covered CA plans are different for me and for my 8-year-old child: my child's physicians do NOT accept ANY Covered CA plans, while mine do. Can I stay on my Covered CA plan and purchase an off-exchange plan for just my child? We don't qualify for a subsidy.

Answer: Yes. You can do that during open enrollment - November 1, 2015 through January 30, 2016 - when you may update your Covered California account to indicate that your daughter, though part of your household, is not requesting coverage. Then you can apply for coverage for her directly with an insurance carrier effective January 1, 2016.


Question: Husband on Medicare. Wife on CovCA. Income forecasts show we will be over the CovCA limit. Want to drop the Blue Shield plan (via Cov CA) and purchase new independent individual plan as wife's employer does not provide insurance. Can we do this? How? When? I assume deductibles won't be carried over (except for another Blue Shield plan maybe?)

Answer: Your question highlights a couple of common misconceptions about Covered California coverage. The fact is that you can keep your Blue Shield coverage through Covered California even though you are no longer eligible for premium assistance. Just change your income with CC so that your subsidy gets turned off. During open enrollment, November 1, 2015 through January 30, 2016, you can drop your CC coverage and apply directly with an insurance carrier, like Blue Shield. However, there is no real benefit in doing so, as the rates and plans are the same when you go directly to the carrier. Additionally, should your income drop again, you would have to reapply with Covered California to get subsidized.


Change Insurance Plan Now?

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Question: I am not happy with my Blue Shield of CA Platinum PPO insurance plan and I want to change to a less expensive plan and/or a different insurance company. I signed up for my plan directly with BlueSheild of CA not through the Covered California website (because it wasn't letting me due to computer glitches). I know you can terminate your plan through Covered California, but I'm not sure how to do it if I'm outside that system? Also, if I'm allowed to terminate my coverage with BlueSheild can I do so outside of the open enrollment period(now), and can I then enroll in some kind of other insurance through covered CA (also outside of open enrollment). Thanks so much for your help!

Answer: If you were to cancel your Blue Shield coverage you would notify Blue Shield (customer service number on your insurance card) since you bought directly from them. But you cannot get replacement coverage until open enrollment, so you are pretty much stuck with what you've got until January 1, 2016.


Question: Is income between 138-150% of FPL is the only condition? Would there be a problem that the person is 68 years old and does not qualify for Medicare? How is the 138% calculated ? Is it based on raw income or after tax income or else?

Answer: If the person in question is not eligible for Medicare at age 68 and has legal status, then this individual is eligible for Covered California coverage. The income calculation is an estimate of 2015 adjusted gross income (AGI) (see line 37 of last 1040 tax form to help estimation). If the estimated AGI is over 138% federal poverty level (FPL) and less than 400% FPL, this individual could be eligible for premium assistance. Whether, he or she can buy coverage now or wait for open enrollment is dependent on other factors.


Question: Can a Self Employed person continue to deduct INDIVIDUAL Medical Insurance Premiums in 2014? Does it matter if they got their coverage ON or OFF the exchange?

Answer: Yes. If you are self-employed, a tax deduction generally available for medical (on-exchange or off-exchange), dental or long-term care insurance premiums for yourself, your spouse and your dependents. (The insurance can also cover your child who was under age 27 at the end of 2014, even if the child was not your dependent.) You must have a net profit from self-employment. You would report this on a Schedule C, Profit or Loss From Business, Schedule C-EZ, Net Profit From Business, or Schedule F, Profit or Loss From Farming. You had self-employment earnings as a partner reported to you on Schedule K-1 (Form 1065), Partner's Share of Income, Deductions, Credits, etc. You were paid wages reported on Form W-2, Wage and Tax Statement, as a shareholder who owns more than two percent of the outstanding stock of an S corporation.


Question: My husband and I are both self employed. We pay $2200.00 out of our pocket for health insurance. It is breaking us. I have a number of pre-existing conditions. Please what are our option. We are going to have to drop our insurance because we can no longer afford to pay the premiums.

Answer: I hope to answer your heartfelt plea with some actionable advice. I’m not sure I can, but I’ll give it a shot anyway. The first move is to talk to your insurance company about another plan with a lower premium. But if $2200 per month for 2 people is the lowest you can get it, I’ll take your word for it, you “can no longer afford to pay the premiums”. If that is truly the case, here’s an option (I would not recommend this except in extreme circumstances). You will have to go without health insurance for 6 months, so stock up on prescription drugs and get any necessary medical care out of the way before you quit. It will cost you a lot less than currently and it’s adequate coverage. If you can’t afford to get both you and your husband covered, the person with the highest health risks or most expensive prescription drugs drugs should get covered first. In January 2014, you will be able to buy Obamacare at the same price as everybody else and probably get a federal subsidy to help pay the premium. I wish you the best of uck.


HSA Money

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Question: I have unused HSA account money. Do I have to do anything?

Answer: HSA money can be used to pay for many eligible medical expenses beyond what is covered by your insurance plan. These expenses include dental, vision, alternative medicine, long-term care services, prescription drug and certain over-the-counter drugs. Click here for a complete list of qualified medical expenses. If you use the HSA money for anything else, you’ll have to pay income tax and a penalty on the money you take out.


Primary vs Secondary Stalemate

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Question: I am employed and have health insurance through my company. When my wife and I got married I added her to my policy. Apparently since she’s under 26 she’s allowed to be on her parents insurance as well. We had a baby and now the bills are starting to roll in. The problem is my insurance is refusing to pay because it’s their “policy” to make her secondary since she’s been with her moms insurance longer. Now her moms insurance is saying that since I married her she’s my responsibility and they become secondary. Both insurance claim to be secondary and neither will pay. My question is ..who is my wife’s primary health care? I don’t care which it is I just want the bills paid

Answer: Sorry, I don’t have a direct answer for you. All states have adopted a specific set of rules, called Coordination of Benefits (COB) Guidelines to determine which health insurance plan pays first when double covered. In your case each insurance carrier is interpreting the guidelines differently and you are at a stalemate. It looks like you will have to go to your state’s Department of Insurance to resolve this. I know, it’s a hassle but your medical expenses will eventually be paid. Incidentally, your mother-in-law’s coverage of your wife will not cover your child going forward, so once this claim is satisfied that policy should be cancelled. Of course, you must add your newborn to your group coverage right away. As you can see, double coverage can cause more harm than good and somebody is paying for the extra coverage.


Employee Wants Dependent Coverage

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Question: My father and i work for the same company and same corporation, i currently am 22 years of age.i should be able to stay on my fathers plan untill im 22 years of age but because we work for the same company they are denieng me to stay on his policy and making me pay for my own medical insurance. which doesnt make since because he has to pay the same amount whether im on it or not, basically my question is do they have the right to deny me benifits provided by my father as i being 22. because we work for the same company.

Answer: The Affordable Care Act (ACA) (Obamacare) extended dependent health insurance coverage to age 26. Since September 23, 2010, insurance companies nationwide have had to comply with this aspect of the law. However, employers are free to define their employment contract with their employees. They can make it a condition of employment that workers and their dependents choose to be insured by their own employers if available. So yes, your employer has the legal right to do just that. While your out-of-pocket costs may be higher, you are not being denied coverage.


Child Only Preexisting Condition

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Question: We have a child-only policy for our daughter. We have had the plan for about 5 months now. I took her into a new patient well check appointment where the dr found something that he wants to refer her to a pediatric neurologist for. She has not been diagnosed with anything during or prior to this appointment. Will my insurance look at this as something pre existing and deny anything if the specialist finds something to diagnose?

Answer: One of the earliest implemented - September 23, 2010 - consumer benefits of Obamacare was the removal of preexisting condition exclusions from child-only policies. What that means to you is, you never have to worry about coverage for preexisting conditions on your daughter’s insurance. All consumers will have the same benefits starting Jan1, 2014.


Multi-State In-Network Coverage

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Question: An adult needs to buy insurance in Georgia, but plans to be back in California in a few months. Can we get a policy that covers both states?

Answer: Most national health insurance carriers have multi-state networks, so as long as you select a PPO plan you’ll be OK. You have to have a residence in a given state to purchase health insurance, so you will probably be buying your coverage in Georgia. If you maintain a residence in California, I recommend that you purchase coverage in CA. It’s cheaper and you won’t have to change when you move back.

Network coverage in another state works like this: You are insured by BCBS GA but need medical services in CA. As long as you choose a network provider of either Blue Cross or Blue Shield (separate companies in CA), you will get the in-network benefit your policy provides just as if you were in your home state of GA. This multi-state network benefit is exclusive to PPO plans offered by national carriers.


Married on Parents' Insurance

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Question: I am 21 years old and I have a 5 month old son. My fiance and I are ready to get married as soon as we understand our health insurance situation. I am currently covered under my mothers insurance. My fiance is covered by his parents, and our baby has Medicaid right now. What are the options for each of us. I have heard that once you’re married you can not be covered under parents. I have also heard that is not true and that until you’re 26 or graduate college you can be covered. Which is true? And what are the options for our son? I know the new act effective in 2014 will offer us insurance, but for one that is a while from now, and two, is it REALLY affordable? We do not make much money, and won’t for a while. We are still studying in order to get better jobs.

Answer: You heard wrong. You can both stay on your respective parents’ health insurance coverage while married until you reach age 26. Being a student is no longer a consideration either. As long as your son qualifies for Medicaid, you can leave that alone too. In Jan 1, 2014, Obamacare will provide your family with either Medicaid or federally-subsidized private insurance at little or no cost to you (if you are still in the low-income range). So you are good to go. Get married. You have my blessing.


Question: My boss had said that I could pick an individual health insurance plan and he would pay the premium, but his accountant told that there were tax penalties for doing that. Is that true?

Answer: Yes. Paying for your individual health insurance will put your employer out of compliance with federal regulations and increase the company’s tax liability and your’s also. There are two major reasons an employer should never pay for its employee’s individual health insurance plan:

  1. Federal Compliance Issues - Paying for Individual Health Insurance without a HRA Plan Causes the Employer to “Endorse” the Individual Health Insurance Plans
  2. Increased Tax Liability - Paying for Individual Health Insurance without an HRA Plan Causes the Payments to Become Taxable Income to the Employees.

When an employer pays directly for an individual health insurance plan, they effectively endorse each employee’s individual insurance plan as part of an employer-sponsored group health benefit offering. In other words, according to federal law, the employer is treating the individual plan as part of an employee welfare benefit plan regulated by ERISA. Because most individual health insurance plans, do not meet minimum ERISA group plan requirements, the employer is out of compliance.

Separately, an employer is not allowed to know the details of employees HIPAA-protected medical expenses. Because most individual health insurance costs are based on an employee’s health, the health insurance details must be HIPAA protected. When an employer pays for the individual policy, they can violate HIPAA-privacy requirements because they know the details of a HIPAA-protected employee expense.

The federal government has guidelines for employers who want to contribute to employee’s individual health insurance premiums without violating the HIPAA and ERISA regulations. An ERISA and HIPAA-compliant HRA health plan will ensure compliance with federal law. The IRS requires that legal plan documents be established in order for employees to deduct the individual health insurance premiums from taxable income on the annual W-2. An IRS-compliant HRA plan will ensure the tax deductibility of employee’s individual health insurance premiums as well.


Question: I had a chiro adjustment 4 times, and electric stimulus and my insurance paid. Then for the next three, exact services, they denied. Then 4 times after the denial they paid again for same service. I appealed but they denied. Why would they pay for a service, then not pay, then at later date pay again. I’m confused. If I bring this to their attention, can they go back and deny the previously paid claims?

Answer: The most frequent reason for claims payment variations is the service codes the provider enters when submitting the claim are incorrect. You can also have errors in the carrier’s claims department. That may account for the hit or miss nature of your chiropractor claims. First of all, you need to know your coverage. Call your member services hotline. The number is on your insurance card. Have them explain your chiropractic coverage so that you know it. If you have been paid for benefits you are not due, you will probably want to keep quiet. If they owe you, raise hell.


Question: I’m currently 24 years old and my parents include me on their health insurance. There insurance renews in October. If I get married after October, will I still be included on their insurance through October 2013?

Answer: Your marriage does not affect your parents’ right to include you as a dependent on their health insurance coverage to age 26. Your husband, however, may not be included on your parents’ coverage.


Question: Child with born with health issues. So this child already has preexisting conditions from birth and her parents can”t pay the bills.

Answer: A newborn with preexisting conditions has a couple of options to obtain coverage: child only individual coverage and the Preexisting Conditions Insurance Plan (PCIP). Neither of these options will help the parents pay the baby’s medical bills while uninsured, but will cover medical expenses going forward regardless of preexisting conditions.


Question: I have bariatric surgery scheduled for July 3rd under my Group Plan. Today I received notificaiton from my company this plan is being withdrawn and preplaced with 2 other options as of July 1st. I’ve had 6 months of workup prepration for this surgery and now I’m loosing the insurance. I’ve called my surgeon to see if we can move up the date. I have a few questions: even if I selected a new goup plan that my company is forcing me to pick from and different than what I have now, assuming this procedure will be coverd under a new plan, will I be forced to go through all the work up again for the new plan? Can I be denied for pre-existing condition - whether I have the surgury sooner and not be forced to the new plan or wait and have surgery under the new plan? What if I have complicaitons after the surgery on the new plan. Mindful, the new plan is not my choice, but my employer will drop what I have now and offer other plans. Please advise. (I live in CT, have a primary Dr. in CT, but my insurance company is out of Mass.)

Answer: The crux of your question is which insurance company is responsible for a claim when there is a change of insurers. In your case this change is taking place on July 1st, so the current insurance company is responsible for all medical services you receive prior to July 1st. These responsibilities are based on the dates-of-service not the date the claim is submitted or received by the insurer. The “new” insurance company would be responsible for your surgery assuming it’s done as scheduled on July 3rd. If you have the surgery done before July 1 you will need routine follow-up and if there are complications that require treatment, those claims will be the responsibility of the “new” company. No - you cannot be denied coverage for preexisting conditions under Massachusetts laws.

Your primary problem right now is that you don’t know if the new insurance plan will cover the bariatric surgery. You need to find that out right away. It either does or it does not. It’s not based on your circumstances. If the answer is “no”, you have to move up your surgery up. If the answer is “maybe”, I would still advise you get it done before July 1st.

Secondarily, you will have to find out if your surgeon is in the new insurance company’s provider network. If not and you have to switch surgeons, then it’s quite possible the new surgeon will require additional surgical workup and your surgery will have to be rescheduled.


Question: I am planning to retire soon. I been with the same company and on the same insurance plan for 25 years. Can I change my insurance from a company group coverage to an individual coverage. I was told recently that I could not. Can you help.

*Answer: * When you retire (assuming you are not yet 65), you’ll be offered COBRA health insurance. It’s the same coverage you had on the group plan but your employer will no longer be paying for it. It usually comes as a shock to most people when they find out just how much the full premium is. You can stay on COBRA for up to 18 months. Alternatively, you can decide to apply for individual health insurance instead of COBRA. Unlike COBRA, you may choose coverage that’s in line with your budget. Here’s the big obstacle - you must pass the stringent underwriting guidelines to qualify for individual health insurance. It’s been my experience that people of retirement age very often fail to qualify for individual coverage.

One way or another, if you can make it to January 2014, when the guaranteed issue and community rating provisions of the Affordable Care Act (ACA) take affect, you will no longer have to worry about preexisting conditions. You will be able to purchase individual health insurance coverage at the same rate as everyone else in your age and ZIP code demographic. In addition, you may qualify for a federal subsidy that will pay some of your premium. So do what you have to do to get through the next few months. Things will get better.


Question: My 24-year-old son is on my insurance. He gets married and stays on my insurance. His wife is covered on her father’s insurance. She gets pregnant. Her insurance has no maternity coverage. How do they get maternity coverage? How does the baby get insurance for post-delivery?

Answer: Getting maternity coverage for your daughter-in-law is impossible once she is pregnant. The baby is covered for the first 30 days after birth by her insurance coverage. Thereafter, the newborn can be insured under his or her own child-only health insurance coverage within the first month after birth.


Question: We own a small business and in Alaska and want to have a baby. There doesn’t seem to be any maternity insurance available though. We do not qualify for the state funded Denali Kid Care. Is there any options for us? Thank you.

Answer: You didn’t mention whether you had health insurance or not. If you do not, get some, that would be the first step. Major medical insurance coverage (without maternity) will cover any extraordinary costs connected with having a baby - pretty much everything beyond prenatal tests and normal delivery. Once you are insured against catastrophic loss, you need to start saving for the predictable costs associated with normal delivery, perhaps $10,000.


Question: I have been working for my company for 11 years I went on maternity leave and then my daughter had health problems and I developed post partum and couldn't return back to work, my company said no problem and continued to pay my full premium ever month I am now back to work and the health insurance company is fighting with my boss and wants to drop me from the plan are they allowed to?

Answer: I think I understand what happened and it's really bad luck for both you and your employer. The employer's health plan contract with the insurance company defines a specific length of time employees are to be covered while on maternity leave. Apparently you were out longer than the contracted time. Normally, this is something that would not come to light as long as your employer continued to pay your health insurance premium each month you were out. However, the insurance company will routinely re-certify a health plan and that includes a review of the most recent payroll tax records. If you did not appear on the payroll, you should not have been covered. The insurance company has the legal right not to pay your claim and rescind your coverage. It sucks, but it is what it is.


Question: My husband works for a large mechanic shop. He was offered insurance and was told that I his wife am ineligible for any plan cheaper than $500 a month. Individual plans are much cheaper than this and I find that amount preposterous and the reasoning even more absurd. The employer stated “26 is a time to have babies and thats why it is so elevated”.I have no inclination of having kids and find this frankly ridiculous. Other employee have family members covered for less and some are not covered at all and are not offered free coverage as my husband was offered (maybe due to the fact his been there 2 yrs?) Is this even legal what he is doing? Putting everyone in different groups and classifications of his morbid idealisms and basing his coverage on this?

Answer: I get a lot of these “is it legal” what my employer is doing and the answer is “yes” in most cases. So it is with your situation. First, the employer is allowed to make a greater contribution some employees’ health plan premium by classification. For example, a greater contribution to salaried workers than hourly workers, or management and non-management. Secondly, it is common for employers to make no contribution to the coverage of spouses and children. Finally, group health insurance is usually more comprehensive - includes maternity coverage for example. On average, group health insurance will cover 80% or more of your average medical expenses (actuarial value) versus 60% or less for individual health insurance. But that’s why individual health insurance can be cheaper and if you don’t need the extra coverage (maternity in your case) why pay for it. Click here to compare rates now. I think you’ll be surprised how much you can save.


Question: I moved my family from Virginia to Alaska last week. We have an individual family policy (not group) from Anthem BCBS Virginia. My intention was to keep the Virginia policy and apply for a new policy when we got here. Since arriving I have not been feeling well. It may be nothing but my concern is that if I visit a doctor and there is something wrong I may not be able to get a new policy. Is this a ligitimate concern and what if any recommendations do you have? Thank you!!

Answer: Your Anthem Blue Cross Blue Shield of Virginia policy covers you in Alaska. As long as you get medical services from a provider who is in the Premera Blue Cross of Alaska network, your coverage in Alaska will be the same as they would have been in Virginia. If you have something wrong, get treatment. It could be something that would become serious if not treated now. Go see a doctor!

Normally, your current policy will cover you in Alaska for months (six months is probably the limit). You should apply for coverage with Premera Blue Cross in Alaska if you live there on a more permanent basis. If you have developed a serious medical condition in the meantime and do not qualify for individual health insurance with a new carrier, there are other options like HIPAA and PCIP.


Maternity Coverage Required in CA

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Question: Can you opt out of mandatory maternity coverage in California if dont want it?

Answer: Not if you are covered by a group health insurance plan. California law requires all employer sponsored group health plans to include maternity coverage. While it seems illogical for a single male or an older female to be required to pay the extra costs associated with insuring for maternity coverage when they will never use the benefit, it is one of the basics that makes insurance work, that is: those with no claims finance those with claims. It makes the maternity benefit affordable for all those who need it.

In the individual health insurance market, many plans are available without the maternity benefit. This makes those non-maternity plans more affordable, but also makes those plans with a maternity benefit very expensive for the few who require it.


Maternity Care for Dependents

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Question: Does Obamacare provide maternity for married dependents?

Answer: The Affordable Care Act (ACA) includes several categories of essential benefits to set a benefits floor for all health insurance plans from 2014 going forward and maternity and newborn care is one of those categories.

But I think you may be asking another question. It sounds like your married son or daughter is covered under your health insurance policy and you have a grandchild on the way. We don’t know yet how that situation will be covered in 2014, but today, the maternity and delivery costs will not be covered by your health insurance.


Deductible Roll-Over at Year End

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Question: If you are treated for an illness in the last few days of December and have to have additional treatment in January of the following year for the same illness do you still have to meet your deductible again.

Answer: Generally, the annual deductible resets on January 1st. But you may want to contact your health insurance company to ask about “fourth-quarter roll over.” Some health insurers will allow dollars paid toward your deductible in the final months of 2011 to “roll over” or count toward your 2012 annual deductible. This can give you a head start toward meeting your deductible in the new year.


Pre-Tax Health Insurance Premiums

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Question: Do you have to have a cafeteria plan for health premiums to be pre-tax?

Answer: Yes. A version of the Section 125 “cafeteria plan” can be designed for premiums only. This single purpose plan is referred to as a Premium Only Plan or POP plan. With a POP plan in place employers may deduct the employee’s portion of the company-sponsored group health insurance premium directly from said employee’s paycheck before taxes are deducted. POP plans cannot be used to pay individual health insurance premiums.


Question: If a person is in the process of addressing a health problem at the end of the year and his insurance changes in January which is responsible for the health coverage?

Answer: It sounds like your employer-sponsored health insurance coverage has changed insurance carriers. It you have ongoing treatments that continue from 2011 into 2012, the old insurance is responsible for all medical services received in 2011 even though you may not be billed until 2012. Conversely, the new insurance plan will be responsible for all medical services with dates of service in 2012.


Question: I am very confused by the deductibles on my family’s health insurance. Does the whole family meet the deductible or just one person?

Answer: I don’t blame you for being confused. There are differences in how health plans work for families versus individuals. The main difference between individual and family coverage is how the annual deductible is computed.

Individual Deductible Family Plans: Some family insurance has separate deductibles for each individual and then a family deductible limit. For example. a plan might have a $5000 deductible for each family member and a $10,000 deductible limit for the whole family. What that means is that any given individual in the family must reach $5000 in covered medical expenses before the health plan begins to pay. Also, let’s say that this family has 3 individual members and that the total in family expenses exceeds $10,000, from this point on through the end of that calendar year all family members will have been deemed to have met their deductible. Statistically, only one family member usually has major medical expenses in a given year, so the individual deductible plan is generally recommended.

Aggregate Deductible Family Plans: Some family health plans have one deductible for the whole family. For instance, a plan might have a $10,000 deductible for the family and each family member’s covered medical expenses are combined to meet the $10,000 family deductible. Statistically, only one family member usually has major medical expenses in a given year, so the $10,000 family aggregate deductible is usually harder to reach. We generally recommend family health plans with this type of family deductible, but there are situations when an aggregate deductible is preferable, for instance a large family would have a greater chance of meeting the family deductible with no single individual accounting for $5,000.


Question: I read in the newspaper that the Preexisting Conditions Health Insurance Plan was a bust. What happened?

Answer: It's not a failure by any means, however enrollment is less than expected so far.

Several months ago, the special insurance pools became one of the earliest facets of the new health-care law to take effect. They are intended as a temporary coping mechanism for people with preexisting medical conditions that traditional insurance companies do not want to cover. The program is temporary, because, starting in 2014, the law will forbid insurers to reject customers based on whether they are healthy or sick.

One must be a resident of California, have a pre-existing condition as shown by a
Rejection letter from a health insurance company in the last 12 months, or coverage offered with premiums higher than those of the state risk pool, be a U.S. Citizen, U.S. National or lawfully present foreign national, and have been uninsured for 6 month prior to application for the plan.

A fundamental problem is that insurance for people with existing medical problems remains too expensive for many. Monthly premiums range from $350 to $600 for a middle-aged individual in California.

Another hurdle is the requirement that an applicant must have been uninsured for 6 months prior to applying for the special risk pools. The thinking behind this requirement is to prevent a wholesale migration of insureds from existing state major risk pools to the new pools where rates and coverage are better. HHS needs to take a look at removing that requirement.


Question: I have been diagnosed with breast cancer and I am covered under my husband's current COBRA coverage. What happens to me when the COBRA coverage ends in November?


Today, the six month anniversary of the enactment of the Affordable Care Act, some of the law's key provisions go into effect. Here's a look at how the law affects people who get their health insurance at work, people who buy their own individual health insurance or are enrolled in Medicare.

Q: I get my coverage through work and the "open enrollment" period for next year is approaching. I'd like to keep my current health plan. Will it be affected by the new law?

A: Your plan will feature some new consumer protections. For example, your plan won't be able to set a lifetime limit on coverage. And if you have an adult child up to age 26 who can't get health insurance at a job, you'll be able to keep him or her on your health plan. These changes kick in for plan years beginning on or after Sept. 23. If your employer makes significant changes - like cutting benefits or raising your out-of-pocket costs beyond a specific amount - the plan is considered a new plan (rather than an existing "grandfathered" one) and must include a wider set of consumer protections.

Q: Like what?

Patients will get, for example, certain preventive services such as breast cancer screenings and cholesterol tests without paying deductibles or co-payments. In addition, they'll be able to see obstetricians and pediatricians without getting prior authorizations. Recommended immunizations also must be provided at no cost.

Q: What if my employer offers a new plan and I want to switch to that?

A: In that case, your coverage would include the wider set of protections.

Q: Will my health insurance cost less?

A: Probably not. Health insurance premiums have been increasing steadily over the last decade and that trend is continuing. According to a new report from the Kaiser Family Foundation and the Health Research & Educational Trust, workers nationwide on average are paying 14 percent, or $482, more for family health insurance coverage in 2010 than in 2009. Employers, struggling with the recession, aren't increasing their share. Instead, they're shifting more costs onto employees, according to the survey. A recent study by the National Business Group on Health found almost two-thirds of employers planned to ask employees to contribute more toward their premiums.

Q: I'm a small business owner. Do I have to offer coverage to my workers this fall? And if I do, will the government help me pay for it?

A: No business owner - small or large -- is required to offer coverage. But small businesses with 25 or fewer full-time employees who earn an average yearly salary of $50,000 or less will qualify for a tax credit up to 35 percent of the cost of premiums. The credit increases to 50 percent in 2014 for most small employers. To qualify for the credits, businesses must cover at least 50 percent of the cost of workers' insurance. Starting in 2014, businesses with 50 or more employees that don't provide health care coverage and have at least one full-time worker who receives subsidized coverage in the health insurance exchanges will have to pay a fee of up to $2,000 per full-time employee. (The firm's first 30 workers would be excluded from the fee.) Businesses with 50 or fewer workers would be exempt from the requirement.

Q: I buy my own health insurance coverage. How will the health law affect my coverage?

A: For policy years starting after Sept. 23, all health insurance policies in the individual market will be barred from cancelling coverage once you get sick -- a practice known as "rescission" - unless you committed fraud when applying for coverage. Insurers will be prohibited from setting lifetime limits on your coverage. The plans must allow you to keep an adult child up to age 26 on your health plan. New policies can't deny coverage for children up to age 19 based on a pre-existing medical condition. But "grandfathered" plans can; they can also set annual dollar limits and require cost-sharing for some preventive services. Most people in the individual market are expected to move to a new plan by 2014. Other provisions of the law will kick in later. For example, as of 2014 insurers won't be able to refuse to cover adults with pre-existing medical conditions. That same year, individuals whose incomes are up to 400 percent of poverty -- $88,200 for a family of four at the current poverty level - will qualify for subsidies to help purchase health insurance on exchanges, marketplaces where consumers can shop for coverage. At that point, most people will have to have health insurance or pay a fine.

Q: I'm on Medicare. Will my benefits change?

A: Your basic package of Medicare benefits won't shrink and in fact will expand under the law. But if you're in a Medicare Advantage plan - a private plan that offers Medicare benefits - you might lose some extra benefits at some point. In terms of the overall Medicare program, let's start with prescription drugs. As of late August, one million Medicare beneficiaries received a $250 check to help cover prescription drug costs in what's known as the doughnut hole. That's the gap in coverage where beneficiaries must pay the full cost of their prescriptions until catastrophic coverage kicks in. Starting next year, beneficiaries will receive a 50 percent discount on brand name drugs and a 7 percent discount on generic drugs while they are in the coverage gap. The health law closes the gap entirely by 2020. In addition, beginning next year, Medicare beneficiaries won't have to pay co-payments or deductibles on many preventive health care services, including diabetes and cervical cancer screenings. Medicare will also pay for an annual wellness visit to the doctor. To help pay for the health overhaul, Congress is cutting payments to Medicare Advantage plans, beginning the year after next. Beneficiaries won't lose any of their basic Medicare benefits as a result of the reductions but some Medicare Advantage insurers could decide to stop offering additional benefits, such as coverage for eyeglasses or gym memberships.

Q: Many Republicans have criticized the health care law as too intrusive and too expensive. If they pick up seats in the November election, how could the law be affected?

A: Some Republicans have threatened to block funding for the implementation of the law; others have called for its outright repeal. But accomplishing either would be tough unless they win large majorities in both the House and Senate. President Barack Obama would likely veto any legislation to gut the law, so Republicans would need a veto-proof majority - two-thirds of both chambers - to override such an action. Also, some Republicans might be reluctant to repeal provisions of the bill that are popular with the public, such as keeping a child up to age 26 on their parents' health care plan or outlawing rescissions and lifetime and annual limits.


QUESTION: I am a juvenile type 1 diabetic, have a heart condition called Torsades de Pointes, and I have celiac sprue. I dont get Medicaid anymore and I have a child. I'm not able to afford my diabetes supplies nor my other supplies for the other problems. I need an affordable insurance company to get coverage through.


Question: My daughter will finish her MBA in Ohio, and plans to stay from October to December (3 months),in CALIFORNIA,and maybe extend the residence for a longer period. We would like us to suggest what health insurance she should take and the cost.


Question: What is the low income insurance program with pre-existing illness that the gov.has now besides medicaid or Medicare. Heard on the news and they said you must sign up on 7-1-2010.


I have a preexisting condition and recently lost my job -- and with it, my health benefits. What does this law do for me?


Cadillac Tax in 2018

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I have a great insurance policy through my employer, and I don't want it to change. But my friends at work say that the government will be taxing our plan. What's up with that?


Rate Increases Going Forward

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Question: So what's to stop my insurer from raising my health insurance rates between now and 2014?


Question: I have a high deductible health insurance plan. I recently found out I am pregnant (We've been trying). I also found out that my insurance does not cover maternity--at all. Out-of-pocket payments do not go towards my deductible. I've looked into Medicaid. I make too much. What are my options?


Question: I hear that most of the Health Reform changes won't happen until 2014. What, if anything, changes right away?


New Government Insurance Coverage

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Qustion: I can't get health insurance because of my pre-existing conditions. Will I be covered by the new healthcare plan next year?


Question: Hello. My maternity rider became effective March 1 but I found out I am pregnant and based on my last period and the ultrasound I got at the free clinic it looks like I might have conceived the third week in February (just a week shy). Since it is so close to my effective date and there is no way to be 100% sure, how will the insurance company determine my conception date? If they go by the due date then what if the baby ends up being late? How is all this determined? Please help!


Bipolar insurance coverage

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Question: My son has bipolar and was in an auto accident a few months ago and hasn't been able to work. He was on his company insurance but lost his coverage. He is looking for a new job but needs health insurance for his monthly therapy and prescriptions. We were going to put him on an individual policy until he gets a job with employer insurance again. The companies we looked at will not cover the bipolar, what can we do? With so many people suffering from mental health issues , it is amazing to me that they don't consider it like any other physical condition.


Question: I have recently changed jobs where the health insurance is very cheap for me but very expensive to add my wife. I'd like to get a private plan for her, but she takes several medications that could make it prohibitive. Is there some obvious option for this situation? She's otherwise healthy and I would consider high deductibles.


Court Ordered Medical Coverage

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QUESTION: I am required by court order to provide insurance for my child. Do I have to go on my group's policy or can I just enroll my child?


Question: I'm over 50 which means that I need a bone scan. My doctor says its not necessary but will give me an Rx if I really think I cant live without it. How do I know if its covered on my plan?


Which Plan Should I buy?

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Question: When I ran a quote on the website it wasn't clear about bills that the insurance company would pay and what bills I pay . What happened the last time I had insurance was I went for some blood work and I ended up paying for the whole thing! The plan I was looking at was the Unicare performance 2000 in Texas. I can afford it ok. but does it cover the things I need?


Question: I live in Texas and my wife and children are currently in Oklahoma and will be there through the end of the year. I'd like to be covered when I visit them and vise versa. Is there such a thing as an insurance plan that will cover all of us?

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