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California COBRA recipients now eligible for CoveredCA individual health insurance during short-term Special Enrollment Period May 19, 2014

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April 15th, 2014 marked the end of the first round of open enrollment for the Affordable Care Act.  However, if you are still in the market for health insurance, you may not be out of luck. CoveredCA, the California state-based health insurance exchange, recently announced that they would extend a one-time Special Enrollment Period to those individuals who are still on COBRA coverage.  COBRA coverage is offered to individuals who leave their jobs but would like to continue their health insurance coverage. It’s a temporary arrangement, usually lasting 12-18 months, allowing the individual to get back on their feet and get coverage either from their new job or via the individual market.

Until now, those who were on COBRA would have to exhaust their COBRA benefit before being eligible for CoveredCA plans and subsidies.  With this announcement, CoveredCA extends the option to get covered to those currently on COBRA without having to exhaust the coverage.  So who might benefit from this open enrollment period?

  • Individuals who earn less than 400% of the Federal Poverty Line– about $46k for an individual or $95k for a family of four.  These folks can obtain a subsidy to help pay for their coverage
  • Individuals who are close to the expiration of their COBRA coverage and would like to get a jump on their new programs, allowing them to maximize the time they are on the new policy in the 2014 calendar year.
  • Individuals who would like to change their provider network, perhaps from HMO to PPO or vice-versa. 
  • Those who have used some or all of a particular benefit on the COBRA policy that resets yearly, like a physical exam. Switching to a new plan via CoveredCA would reset these benefits.

What might be the downside of taking advantage of this SEP?

  • Just as the good benefits of the plan reset, so do the bad.  This means if you have already satisfied your deductible/OOP for the year, it will reset when you start a new plan- even if you stay with the same company.
  • If you earn over 400% of the FPL, you don’t qualify for a subsidy. Unsubsidized coverage might not represent a discount on what you are currently paying for COBRA coverage
  • If you currently enjoy a wide network or have a doctor that doesn’t accept the networks assigned to the plans under the CoveredCA umbrella, and you don’t want to switch providers, you will want to avoid taking advantage of this CoveredCA SEP.
  • If someone is contributing funds toward your COBRA plan as per the terms of a severance, you may lose those additional funds if you switch to CoveredCA. Check with the person with whom you made this agreement with in the first place, as it may be advantageous to them to see you switch from the COBRA plan on to the CoveredCA coverage.

For plans and pricing available during CoveredCA’s Special Enrollment Period, just call 800-783-0802.

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“It’s harder to… May 12, 2014

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“It’s harder to rehab your house while you’re still living in it”: How the state that inspired Obamacare failed to implement Obamacare

When the Affordable Care Act’s various exchanges opened for business in late 2013, millions flocked to take advantage of these new health insurance platforms. But for one state, this was old news.  Massachusetts had long before implemented their own version of healthcare reform- in fact, the major principles of Obamacare were largely borrowed from it.  These principles being:

  • expanding coverage to all citizens, regardless of pre-existing conditions
  • requiring all citizens to be covered, also known as the “individual mandate”
  • providing financial assistance to lower income individuals and families to help pay their premiums

Given that Massachusetts already had a program extremely similar to Obamacare, one might expect the transition would be smooth, if not flawless.  Nothing could be further from the truth. Last week Massachusetts announced it would be scrapping its exchange, in favor of either an entirely new contractor or merging with the federal Healthcare.gov site.  What went wrong?  Vox.com examines today. They found several issues

“It was a management failure. Like the federal system, the state should have thrown the best IT support into it.” says Don Berwick, a current Massachusetts candidate for governor and former Obama administration healthcare implementation overseer. Massachusetts went with contractor CGI to build the exchange- the same contractor behind the initial failure of Healthcare.gov.  The state had trouble converting its subsidy system, which was entirely paper-based, to comply with Obamacare’s requirement of a real-time subsidy determination.  

“In some ways it’s harder to rehab your house when you’re still living it,” says Jon Kingsdale, the Connector’s first executive director.  State exchanges with the opportunity to start from scratch may have found the process easier than adapting existing systems and technology to legislation that was largely similar but different enough to cause fatal issues.. On the other hand, Oregon had that opportunity and completely blew it.

So how can it be fixed? Right now, Massachusetts ranks 49th in the nation in the number of actual insureds vs. eligible insureds at 12.2%, well below the national average of 28%.  Much of this can be attributed to the failed exchange, as hundreds of thousands of individuals are insured in transitional programs meant to provide temporary coverage while the state refocuses its strategy.  The first option is to hire a new exchange builder- at an estimated cost of $121 million, in addition to the $175 million already spent on the failed exchange. The alternative is to default to the federal health exchange- quite the fall from grace for not only an early Obamacare adopter, but also its blueprint.

Obamacare enrollment numbers are in- but what do they mean? May 6, 2014

Posted by QUOTEBROKER in ACA, COBRA, Employee Benefits, Group Health Insurance, Health Care Reform, Health Insurance, Insurance Quotes, Obamacare.
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Obamacare enrollment numbers are in- but what do they mean?

The Obama administration has released a report detailing the enrollment numbers from the first enrollment period.  Note that these numbers are still incomplete, as final enrollments were still trickling in from the two week grace period given to consumers who had difficulty enrolling before March 31, 2014.  The big number that has been bandied about is “eight million enrolled” citizens into Obamacare plans- but what does that number actually mean?  Vox.com issued a nice summary at the link above.

The eight million figure comprises:

  • Consumers who created a marketplace account on an exchange, whether federal or state, and enrolled in a health insurance plan
  • “enrolled” in this case means “had their information sent to the insurance company
  • Some percentage of these folks have not and will not pay for their premium- an estimated 10-15%, based on numbers recently released by AHIP– America’s Health Insurance Plans.

The figure does NOT include:

  • Private enrollments made through carriers directly outside of the marketplace
  • Medicaid enrollments
  • Group enrollments
  • Those young adults under age 26 who were eligible to enroll in their parents’ health plan

Attempting to calculate Obamacare’s true reach is extremely difficult. We can count who signed up for insurance, but we can’t determine who only signed up because the legislation caused them to lose their plan in the first place.  We can count who signed up for Medicaid, but we can’t calculate who signed up that was newly eligible based on the new Medicaid expansion rules.

We will also see these numbers fluctuate throughout the “offseason” between open enrollments.  Special Enrollment Periods, unlocked with major qualifying life events, will be used to move into marketplace plans even now that open enrollment has closed. Marriage, birth, adoption and especially job loss are common triggers of Special Enrollment Periods. The individual health insurance industry always had some degree of turnover, much of it attributable to consumers getting new jobs and leaving the individual market to join their employer-sponsored group plan.  The same will continue under the ACA, as will the reverse scenario of consumers leaving their jobs with employer-sponsored plans and entering the individual market, as the lack of pre-existing condition exclusions will allow free movement between group and individual programs. These “final” enrollment numbers released by the administration are anything but.

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