A Lesson In Patience: Healthcare Update

Thank you for being so patient with the Affordable Care roll out. We have been preparing for this for six years (mostly emotionally and mentally) and it is finally here! The grand entrance is less than we had hoped, but we have faith that it will all come together so that we can get you on a new plan as of January 1, 2014.

At this point, you can go onto the California exchange, www.CoveredCA.com , to see what plans are available and if you qualify for a subsidy. If you are eager to enroll on the exchange, you will need to fill out a 25 page paper application, which we can supply to you.

The online enrollment process should be much simpler. We expect this to be up and running soon – ideally well before November 1, 2013! We, as well as all other agents, are waiting for our ID numbers with the exchange. We cannot officially sell a policy on the exchange until we have those IDs.

What to do in the meantime? Let us help you figure out a preliminary plan!  We are currently talking to people and having a basic consultation on whether they will be qualified for a tax subsidy on the exchange or if they should buy their policy off the exchange. We then review the current plans that are available to see which one they will most likely obtain.

One source of confusion is whether you should get a plan on the exchange or off the exchange. The only reason you would get a policy on the exchange (www.CoveredCA.com) is if you qualify for a subsidy.

The subsidy is based on your income on line 38 of your Form 1040 tax return from 2012.  See the income guidelines at:

www.CoveredCA.com/fieldcalc/#incomeGuidelines

If you clearly do not qualify for a subsidy, then we recommend getting a plan off the exchange. Currently, we can only quote Blue Shield and Kaiser. We expect Anthem’s plans and rates to be available by October 15. Cigna’s rates will not be available until November 1.

Another big issue will be each plan’s network of doctors and hospitals and determining if your doctors are in the network.

For example, many of you like PPO plans and appreciate seeing doctors at Cedars-Sinai and UCLA. At this point, Blue Shield has the least expensive PPO plans in Los Angeles, but on their individual plans both of these hospitals are outside of the network. This is quite frustrating.

In Los Angeles, Anthem is only offering an EPO – Exclusive Provider Organization – which is a modified PPO plan that will not allow you to go out of the network. Cedars-Sinai and UCLA are currently in this network.

Making sure your doctors are in the network is one of the most time-consuming parts about picking the right plan. It would be ideal if you talked to your doctor’s billing department to find out which plans they will be contracted with in the new era of health insurance, starting in 2014. The main carriers are:

Blue Shield PPO
Healthnet PPO and HMO
Cigna PPO
Anthem EPO and PPO

Please call us if you would like the initial consultation. Hopefully we will be able to start enrolling you soon!

Investment advice is offered by Horter Investment Management, LLC, a Registered Investment Adviser. Insurance and annuity products are sold separately through TWP Financial. Securities transactions for Horter Investment Management clients are placed through Pershing Advisor Solutions, Trust Company of America, Jefferson National Monument Advisor, Fidelity, Security Benefit Life and FC Stone.