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Thursday, May 30, 2013

Covered California Announces Health Plans & Rates

 

CoveredCAAnnouncementCalifornia Broker Magazines Insurance Insider News: Thirteen health insurance plans will offer health care coverage through the Covered California health exchange in 2014. The plans are a mix of large non-profit and commercial plan leaders, along with well-known Medi-Cal and regional plans.

The rates for individual plans through the exchange vary from 2% above to 29% below average 2013 premiums for small employer plans in California’s most populous regions. Additionally, exchange plans limit annual out-of-pocket costs to $6,350. Covered California plans include the largest health insurers in the individual market as well as new entrants, regional plans, and local MediCal plans.

The following health plans will participate in the exchange:
• Health Net
• Kaiser
• Anthem Blue Cross
• Blue Shield
• Alameda Alliance for Health
• Chinese Community Health Plan
• LA Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage

Three of the nation’s largest players in the employer-sponsored insurance market – UnitedHealthCare, Cigna, and Aetna – will not be selling plans through the California exchange.
Brokers will be able to sell any plan in the exchange, according to Michael Lujan of Covered California who spoke at the LAAHU conference in Los Angeles last week. He urged brokers to get familiar with the plans in order to be ready for open enrollment in October. Renee Casserly of Blue Shield said that, as a broker, you should maintain contact with your clients and let them know that you are able to help them purchase plans under the exchange. She noted that carriers will begin sending out information about the exchange to individual policyholders in September.
Consumers will have a choice of HMOs, PPOs, and exclusive provider organizations (EPOs). Plans that were chosen for the exchange agreed to reduce profit margins down to 2% and 3% and embrace ACOs and medical homes.

In Los Angeles, Orange, San Bernardino, San Diego and Riverside counties, Health Net expects to offer its new tailored-network HMO exchange product, “CommunityCare,” which will be built around local health care providers. Steve Sell, president of Health Net’s Western Region Health Plan said the company will work to ensure that the medical groups, individual physicians and hospitals are committed to comprehensive care coordination and offer freedom of choice in selecting eligible in-network primary care physicians. Health Net Life expects to offer individuals PPO exchange products in the Northern California counties of Contra Costa, Kern, Marin, Mariposa, Merced, Monterey, Napa, San Benito, San Joaquin, San Francisco, San Mateo, Santa Clara, Santa Cruz, Solano, Sonoma, Stanislaus and Tulare.

Molina Healthcare will participate in Los Angeles, San Diego, Riverside, and San Bernardino counties. “Our goal is to work with low-income or uninsured,” said J. Mario Molina, MD, president and chief executive officer for Molina Healthcare.
Kaiser Health news reports that nearly three dozen health plans submitted bids to sell their products in the competitive marketplace, and 13 were selected. Exchange officials rejected bids that were priced too high or failed to have robust networks of doctors and hospitals.

Premiums vary depending on the geographic region, the consumer’s age, and the richness of benefits. For example, a 25-year-old in Los Angeles could choose a Health Net catastrophic plan for $117 a month or choose a Bronze plan for $147 a month from L.A. Care, the nation’s largest public health plan. If the 25-year old earns less than about $45,600 per year, they would qualify for a subsidy to bring the cost of the premium down further.

More than half of Californians will be eligible for federal income tax credits for exchange plans. A 40-year-old in Los Angeles who earns $1,915 a month, or 200% of the federal poverty level, would pay a monthly premium of $90 for a Health Net HMO Silver plan in 2014.
The monthly premium would be $332 to $476 for a Silver plan for a 40-year-old individual in Sacramento. That includes federal subsidies, on a sliding scale, for a man or woman with income up to $45,960. Individuals who are eligible for the highest subsidy ($276 per month) would have out-of-pocket premium costs as low as $56 per month. Californians would receive federal subsidies on a sliding scale, extending to a family of four earning up to $94,200. For more information info@amsinsure.com

Wednesday, May 29, 2013

What happens when a loved one in a nursing home is not receiving proper care?

Question:  3 months ago my sisters and I reluctantly placed our mother (who is 81 years old) in a local nursing home.  Now she is about 30 pounds thinner, doesn’t speak, smells terribly and has bed sores.  We believe that this is the result of poor care provided by the nursing home.  Is there anyone we can contact to “check out” this nursing home and to help us resolve these quality of care issues?  Several of our friends have suggested that we contact the State Long Term Care Ombudsman’s office.  We are not sure what the role of the Ombudsman’s office is.  Can you please educate us on this elder care agency?
Answer:  The Long Term Care Ombudsman program is administered by the Administration on Aging (AoA), and each state (plus the District of Columbia, Puerto Rico and Guam) has a Long Term Care Ombudsman program. 
Long Term Care Ombudsmen are advocates for the residents of long term care facilities, including nursing homes, board and care homes and assisted living facilities.  They are trained to help residents (and the families of residents) resolve problems that they may be experiencing with long term care facilities.
Long Term Care Ombudsmen can help families address the following long term care concerns:
  • Violation of  the resident's rights or dignity
  • Physical, verbal or mental abuse
  • Poor quality of care
  • Inappropriate use of restaints

Tuesday, May 28, 2013

A Dun & Bradstreet study surveyed more than 12,000 failed businesses to find out why businesses fold.




What they found was that 97.5% of the failures were caused by factors involving the human element including incompetence, inexperience and human frailties such as death. The death of a Key Person can and most often will cause the following:

·         Disruption of management
·         Impairment of credit
·         Loss of profits
·         Loss of company confidence

Now is the time to review your businessKey Person coverage or put it in place if they do not already have it. We have a “turn-key” tool kit that will help you identify their need and walk you through the process.  

  
 
 

Wednesday, May 22, 2013

Small Businesses Hold Off On Hiring Due to the ACA

 

Forty-one percent of small business owners say they are holding off on hiring because of the Affordable Care Act, according to a Gallup poll. Thirty-eight percent have pulled back on plans to grow their business; 19% have reduced their number of employees; 18% have cut employee hours; and 24% have thought about eliminating healthcare coverage for employees.

Forty-eight percent say the ACA will be bad for their business, compared to 9% who say it will be good, and 39% who expect no impact. Fifty-two percent say the ACA will lower the quality of healthcare; 13% say it will improve care; and 30% say it will have no impact.

Fifty-five percent of small business owners expect to pay more for healthcare as a result of the ACA. Five percent expect their healthcare costs to decline while 37% say the health law will have no effect on what they pay for healthcare. For more information, visit www.gallup.com.

Life Combo Products See Double-Digit Growth

 

GraphUp More than 86,000 life combination policies were sold in 2012, an increase of 19% over 2011, according to a LIMRA report. Consumers under 59 held more than half of in-force polices in 2012. Sixty percent of life combination policies are insuring women. Life combination products accounted for 11% of new premium for individual life insurance.
Sales of life combination products continue to grow at a remarkable rate as new carriers enter the market and existing players refine products to remain competitive, said Catherine Ho, LIMRA product actuary. “This segment of the market weathered the storm pretty well during the recession when individual life sales declined significantly. Now that sales growth has returned for individual life, we anticipate life combination products to continue their steady growth,” she said.

All life combination product lines experienced growth in 2012, with whole life (WL) and universal life (UL) combination premium each growing 10% and variable combination premium growing 3%. Whole life combination policy count rose 23%; UL policy count rose 19%; and variable policy count rose 4%.All but one distribution channel experienced double-digit growth in 2012 (independent RIA). Banks and savings institutions posted the largest premium growth, rising 21%; affiliated agents recorded 30% growth in policy count.

Wednesday, May 15, 2013

Consumers Are Not Prepared for a Critical Illness

 

Ninety percent of middle-income Americans say they are not financially prepared for a critical illness diagnosis, according to a study by the Washington National Institute for Wellness Solutions. The study surveyed 1,001 Americans ages 30 to 66 with annual household incomes of $35,000 to $99,999. The following statistics reveal that many have little, if any, savings to fall back on in the event of a critical illness:
• 75% have less than $20,000.
• 50% have less than $2,000.
• 25% have no savings.
To pay for out-of-pocket critical illness costs, middle-income Americans say they would need to use credit cards (28%) or loans from family/friends (23%) or financial institutions (19%). Another 23% don’t know what resources they could use to pay their expenses. Millennials and Gen Xers anticipate greater reliance on credit cards and loans to pay for critical illness expenses. Thirty-eight percent say they might never recover financially from a battle with cancer and 45% believe they would never recover financially from an Alzheimer’s/dementia diagnosis.
Eighty-eight percent of middle-income Americans have had no conversations with loved ones or advisers about potential care-giving options and 60% have not discussed financial planning for critical illness. Only 12% have explored care-giving options.

Individual Rates to Soar In California

 

soaringhealthcostsExpanded enrollment of a sicker population will drive up rates for individual health plans in 2014, according to a study by Milliman for Covered California, the state’s health exchange. The average premium increase will be an astounding 30.1% for people who make too much to receive the subsidy (more than $93,700 for a family of four or $45,960 for an individual).

However, Californians who will qualify for the highest premium tax credits, due to their income, will see an average drop of 85% in what they pay for health coverage. Depending on the individual’s choice of health plan, this premium tax credit could cover a higher percentage of the premium. There are 1 .6 million people uninsured and eligible for subsidies. Many of them could have 100% of their premiums covered through the Affordable Care Act. Those who make less money will be eligible for larger federal tax credits to make their health care more affordable. Households earning from 138% to 250% of the federal poverty level will likely see an average drop of 85% in what they pay for health coverage. Households earning 250% to 400% of federal poverty level will pay on average 45% less, for more coverage with lower copay and deductibles, than what they would have paid for an individual plan in 2013. The hope is that, in future years, Californians will see decreases in their health care costs as they no longer pay for the burden of the millions of uninsured and benefit from improvements in how care is delivered, according to Covered California.

Saturday, May 11, 2013

Good Health Can Be Fun; Teach Your Children

 

Become the hero of your own health story! Habit Heroes like Agent Dynamo can show you how to practice healthy habits. Eating well, exercising and having a positive attitude can turn you into a Habit Hero too — and Anthem can be your helpful sidekick. Choose one of our wellness programs to help. And be the BEST YOU that you can be!
           
Go To Habit Heroes
Habit Heroes

Anthem is proud to bring the message of good health to people of all ages by co-sponsoring the Habit Heroes exhibit in the INNOVENTIONS Attraction at Epcot® in the Walt Disney World® Resort. Promoting healthy habits is the goal. And you do it with healthy foods, exercising, and a positive attitude.

As to Disney artwork/properties: ©Disney.

Wednesday, May 08, 2013

What bothers patients most when visiting the doctor?


A U.S. survey of 1,000 people found the top complaints of patients included long wait times to see physicians, unclear descriptions of problems, slow test results and billing issues. The Consumer Reports study found women were more bothered than men when physicians used electronic devices to record notes and when conversations were held within earshot of other patients. PhysiciansBriefing.com/HealthDay News

Monday, May 06, 2013

Certified Care Manager answers family's question on ElderCareMatters.com

 

Question: Will my parents’ long term care insurance policies pay for day care for my father. Mom is the primary caregiver and needs this “time off” from dad in order not to become totally exhausted. Please advise.

Answer: Without seeing your parent’s specific policy, it is impossible to know what is or is not covered. Some policies only offer payment for specific services such as a non-medical caregiver in the home, a Geriatric Care Manager or the monthly cost for a facility. In addition, many companies sell riders to the basic policy to cover additional types of services beyond what the basic policy covers. Some of the newer policies pay a flat amount of money each month and allow the insured to determine how the money is spent. I recommend you review your parent’s insurance policy to determine the specific benefits allowed to them under their policy. 

It may also be helpful to talk with the agent directly to ensure you are taking full advantage of the benefits they are entitled to receive.
ElderCareMatters.com – America's National Directory of Elder Care / Senior Care Resources for Families.

Wednesday, May 01, 2013

ACA Will Test Consumers’ Loyalty to Their Doctors

 

Half of consumers would switch their doctor if they could save a certain amount in annual health care costs, according to a survey by HealthPocket. Thirty-four percent would switch if they could save $500 to $1,000; eight percent would switch if they could save $1,000 to $2,000; and 8% would switch if they could save $3,000 or more.

Consumers and small employers will face an array of new health plan choices in 2014. Other than cost, one of the key factors in consumers’ selection process is whether their doctor participates in a plan’s provider network. Cost pressures are moving insurers to limit their provider networks. They are seeking to negotiate lower rates to healthcare providers in exchange for a larger volume of patients.

HealthPocket is offering a physician search component on its site at http://www.healthpocket.com/doctor-finder. It allows consumers to compare all commercial health plans, Medicare plans and Medicaid programs that their doctor may accept.