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Topics of interest to both consumers and agents related to Covered California and the ACA biased in favor of the successful implementation of the Exchange and deliberately apolitical.


Covered California is Not for Everyone

By on | 3 Comments

Covered California is open for business, more or less, but many Californians won’t go there if they need health insurance for themselves or their families. Instead they’ll turn to health insurance agents and buy coverage directly from insurance companies.

The On-Exchange Plans

For the roughly two million Californians who currently buy health insurance on their own, only about a third will qualify for government tax subsidies - and to get the subsidy, people must buy through Covered California.

Subsidy Eligible vs Ineligible.jpg

The Off-Exchange Plans

Without a subsidy to offset rates, there’s no compelling reason for the majority of individual health insurance customers to shop on the exchange. People who earn too much to expect government help will be shopping for off-exchange plans, where they’ll have more options and the process is much faster.

What are Off-Exchange Plans?

Off-exchange plans will still be required to meet 10 benefits standards outlined in the health care law. People shouldn’t make any rushed decisions. Many of the off-exchange plans are not yet available because government regulators still need to approve them. So you are still not seeing all the options that are going to be available.

There’s No Rush

The ACA plans will go live on Jan. 1. People have until Dec. 15 to enroll in a plan that will start on the first of the year. And they can enroll as late as Mar 31, 2014 for guaranteed-issue coverage.

Most people with existing individual policies in California will get new plans by the end of the year. That’s because those individual plans don’t meet the standards outlined in Obamacare and must be upgraded to comply with the law. So when that letter from your insurance carrier shows up in the mail, pay attention.Grandfathered vs Non-Grandfathered.jpg

If the plan you have now is grandfathered, you don’t have to do anything. If it is not grandfathered and you do nothing, you health insurance carrier will transition you to a ACA compliant plan that is closest in coverage and rate to your current plan.

All new plans will have to cover a minimum set of medical costs and include standardized benefits. That means that the more than one million California residents who now have individual plans, and are not eligible for subsidies, will very likely be paying a higher monthly premium.

3 Comments

The most important thing to do right is to shop around, not only to save money, but to make sure you can still see your doctor. A blue shield PPO will not be the same next year, in fact, the network is about 1/3 of the size it used to be. Contact a broker to help you figure this out. You are already paying for it so might as well.

wow what a mess. we had a private plan for my son that will not be grandfathered. My wife has been on the phone for close to 3 hours to try and get my son a new policy that will start the first of the year so we do not loose coverage. We also tried to register on the web and nothing works. Please be sure to thank the board for me. I can't wait to vote next year, as I hope all of our wonderful reps will be looking for new jobs.

I am not sure how the OBAMACARE Insurance will go from here, it is not looking too good in Tennessee because many are falling below the subsidy level therfore they get no subsidy nor medicaid assistance.

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