Author Archives: Carole Spinak

  1. Finding the Best Health Insurance

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    Covered California, is one of the state health insurance exchanges that have recently been launched to serve as health insurance marketplaces under the Affordable Care Act. It is considered to be one of the more better, more accessible exchanges. Nevertheless, as many will attest, it is, nonetheless, an arduous experience to get through the application and enrollment process. Considering the amount of time and frustration needed to complete an application and chose a health plan, there are many who will, instead, pay the mandated fine for not having health insurance and hope for the best. A much wiser alternative for anyone shopping for health insurance is to work with a certified licensed health insurance agent.

    Only Licensed Health Insurance Agents are Lawfully Qualified to Advise Buyers

    Unlike the Covered California enrollment counselors available through the exchange, licensed health insurance agents are the only ones lawfully qualified to advise health insurance buyers of the best plans available for them both on and off the exchange. As a certified Covered California agent as well as a licensed health insurance agent, they’re also able to guide people through the subsidy qualification process as well as the insurance enrollment procedure; and there is no extra fee for their services. As the federal deadline looms closer, working with a certified licensed health insurance agent has other advantages as well.

    Over 7000 licensed health insurance agents have been certified by the Covered California exchange to help applicants determine if they qualify for subsides and guide them through the application process. Licensed health insurance agents are trained to advise people in choosing the best plan for their family’s health conditions, life style and finances. Agents must also maintain their license by undergoing continuous mandatory instruction. Equally important, given the amount of personal information required of applicants, it’s significant that no one can become an agent without undergoing rigorous background checks and training in security and the  proper procedures designed to protect the privacy of their clients.

    Availability of Enrollment Counselors

    Enrollment counselors, available through the exchange, are paid $58 for each person they help enroll in Covered California. They’re temporary workers whose job essentially ends when the 2014 enrollment period officially ends next March.  They’re not experts in health insurance. They have just a text book understanding of health insurance terms like co-pays, coinsurance, deductibles, HMO, PPO, PPP. etc. This is language that health insurance agents use every day. They have an intimate understanding of  how these terms affect their clients in real life situations.

    The biggest hurdle of Covered California’s applicants right now is the wait time to get help through the Covered California counselors. Thirty-six minutes is the current average and it’s going to get worse as health insurance deadlines approach. December 23 is the last day people can complete the purchase process for heath coverage to start January 1, 2014 and  March 31 is the last day to enroll for health care coverage in 2014. Unless there’s a qualifying life event, people who don’t enroll by March 31 must pay a fine and cannot apply for 2015 coverage until November 15, 2014. It’s estimated as many as five million people will want to apply between now and these deadlines.  Calling a certified licensed health insurance agent at California Health Plans, 1-866-657-8222, can begin the process.

    Most people who need health insurance will not qualify for subsides. While Covered California is the only place to get subsidies, it’s not the only place to go for health insurance. This gives  people who don’t qualify for subsidies an even better reason to look to an agent for health insurance. That’s because, depending on the area, there are other health care plans available off the exchange.

    Health Plans are Available Both On and Off the Exchange

    All plans sold to individuals on or off the exchange have the same health care benefits.  Plans on the exchange are grouped into bronze, silver, gold, or platinum categories which cover, respectively, 60, 70, 80, and 90% of the plan holders medical expenses. Plans sold off the exchange are said to be “mirrored” if there’s plan identical to it offered on the exchange. “Non-mirrored” plans have no counterpart on the exchange and can cover different percentages of medical costs.

    They also have another important advantage. To keep costs down, many of the plans on the exchange reimburse medical providers at lower rates. As a result, fewer medical providers will accept these insurance plans. Many plans available off the exchange have larger networks of medical providers, doctors, hospitals, clinics and labs, that might better serve an applicant’s medical needs. It means that certified licensed insurance agents often have more health insurance options available to offer applicants, options that may better fit their needs than are available on the exchange.

    Health Plans Can Change From Year to Year

    Maybe the best reason for going with an agent to purchase health insurance is that an insurance agent is someone who is not only uniquely qualified to help you chose the right plans, they are there for you. Buying health insurance is not a one-shot deal. The truth is every year, you’ll need to check your insurance plan. It may change or your needs may change; and other plans may become available that better suit your needs. Partnering with a licensed certified health insurance agent this year is a relationship for the future as well.


  2. Grandfathered Health Care Plans: Why the Lie?

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    Millions of Americans who purchased their own health insurance have had their plans cancelled and learned replacements will cost them much more. It’s been proved now that the administration knew that existing health insurance plans would not be grandfathered; but continued to state unequivocally that, under ObamaCare, people could keep their current plan.

    How could they do this? Why did they lie?

    The President, in trips around the country to encourage passage of the Affordable Care Act (ACA), back in 2009 and 2010, assured people countless times that, under the health care reform bill, if they liked their current insurance plan, they could keep it. Then, in June, 2010, three short months after the bill became law, Health and Human Services (HHS), published Preservation of Right to Maintain Existing Coverage, a regulation that defined grandfathered health insurance plans so narrowly that an estimated 80% plans would be guaranteed to fail. Nonetheless, the President and his HHS appointees continued to guarantee that, under the new law, you could keep your health plan.

    How Could This Deceit Be Justified?

    How could they justify doing this? The President’s aides decided, at the time, that the President should continue to make this promise because, after all, only the people who purchased their own insurance would be affected, about 5% of the under-65 market.     But that’s over 15 million people. Several million people these past weeks have now learned that the health insurance plans they’ve had and have been happy with are being cancelled. Worse, replacement plans will cost more, in some cases, many times more what their insurance plans cost today.

    Instead of apologizing or, at least, explaining, officials are blaming the health insurers.  The President even refers to them as ‘bad apples.’ These ‘bad apples’ had sold what officials called shoddy and sub-standard health plans to the public. Never mind that the people who bought the plans were satisfied with them and felt the plans served their needs. Never mind that their government mandated replacements cost much more and covered benefits most people don’t need or want such as maternity care, drug and alcohol counseling, mental health treatments, and pediatric care in addition to normal medical coverage.

    Two Reasons Why the Deception Continued

    There are two reasons this lie was perpetuated. For one, the government needs people to purchase the new ObamaCare mandated plans on the state health insurance exchanges.  Unless those people purchase the health plans offered on the exchange, either at their inflated prices or with government-provided subsidies, the health insurance exchanges will experience what is known as a ‘death spiral‘ and fail. This happens when not enough healthy people buy insurance to cover the cost of medical expenses for the sick.

    Secondly, an antagonistic public had to be convinced that the law would be a good thing.  From the beginning, the health care reform law was unpopular. Members of Congress faced angry voters at town hall meetings and demonstrations.  Nevertheless, the law’s supporters including the administration, wanted this bill to pass. It was necessary to make people believe that nothing would change for them; that if they liked the health insurance they could keep it.

    Two decades ago, this very issue killed the health care reform law that President Clinton wanted passed. “Harry and Louise,” a television ad sponsored by the insurance industry featured a couple at their kitchen table dismayed that they’ve lost the health insurance they liked and now must chose from more expensive plans that government bureaucrats had designed. President Obama’s oft-repeated statement was meant to prevent another “Harry and Louise” moment from happening.

    Promise was One of Many Tricks Used to Pass the Legislation

    In actuality, that statement was part of a full-on strategy of deceitful contrivances and machinations needed to pass the ACA. The true cost of the bill was hidden behind accounting tricks and unrealistic sources of income. The content of the bill’s 2700 pages was never made public and few, if any, of the very people responsible for voting on it, were given the opportunity to read it in its entirety.

    That wasn’t all: Negotiations between Senate and House were done behind closed doors instead of public hearings. Arcane and questionable rules of order were used to force its passage. While no Republicans supported the bill, Democrats who wavered were literally bribed with legislation benefiting their state. Lying to the public about what would happen to them was part of the whole fabric of deception necessary to get this law passed.

    The best resource to help those whose plans have been cancelled is a local insurance agent who is qualified and certified by the state to discuss options available under the Affordable Care Act.  Call 1-866-657-8222 to talk to a licensed and certified agent at Terpening Insurance.

  3. Health Insurance Exchange Basics

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    Across the country, health insurance exchanges went live October 1 with mixed results, some nearly disastrous. At some point, you can bet, the technical issues will be resolved and Government Health Insurance Policy and Cashthese exchanges will become a fact of life.  The truth is that the health insurance exchanges are perhaps the single most important element of the Affordable Care Act (ACA).   Without them, the law doesn’t stand a chance.  Despite this fact, a large percentage of people still don’t understand what the health insurance exchanges provide, who will use them, or why they’re important.  But, we all need to know about them because whether we’re using them or not, we’re paying for them.  The following is everything you need to know in less than 10 minutes of your time.

    What Are State Health Insurance Exchanges?

    Each state has its own health insurance exchange.  Health insurance exchanges are online internet based market places where people who aren’t insured by their employer or the government can purchase health insurance plans that go into effect January 1, 2014.  Through the exchange, consumers can also apply for financial assistance in the form of subsidies and tax credits if they meet certain family and income requirements.  Depending on the state, some exchanges also process Medicaid applications for people making less than 133% of the federal poverty level (FPL), an expansion of state health care programs dictated by the ACA.

    Who Can Use Them?

    All citizens as well as lawfully residing immigrants who don’t have health insurance through the government or an employer can purchase health insurance through the exchanges and apply for financial assistance.  Besides citizens, only immigrants who’ve lawfully resided in the US for more than 5 years can have access to Medicaid benefits.  The health care exchanges are also open to workers whose employer-provided insurance costs them more than 9.5% of their income or if the employer-provided insurance is intended to cover less than 60% of medical expenses.

    What Does the Health Insurance Cover?

    Exchanges offer 4 main types of health insurance plans, Platinum, Gold, Silver and Bronze.  They all cover the same benefits:

    • ambulatory patient services
    • emergency services
    • hospitalization
    • maternity and newborn care
    • mental health and substance abuse (drug and alcohol) services
    • prescription drugs
    • rehabilitative facilitative services and devices
    • laboratory tests and services
    • preventive and wellness services and chronic disease management
    • pediatric services, including vision and dental care

    bigstock-Aca-Affordable-Care-Act-Metal--51911344They differ in how much the insured person pays for monthly premiums relative to the out-of-pocket costs for each medical treatment.  A Bronze health insurance plan, for example,  is intended to cover 60% of medical costs.  As a result, it will carry a less expensive monthly premium but require the insured to 1.) pay a higher deductible and once that deductible is met and coverage begins 2.) pay a higher co-pay for each medical treatment.   Platinum plans, intended to cover 90% of medical costs, will charge a higher monthly premium but require low or no deductible and lower or no co-pays.  Gold plans cover 80% and Silver, 70%.  A  bare-bones catastrophic health plan is offered as well;  but it is available only to adults under 30 years-old and cannot be subsidized. Like all health insurance plans sold beginning 2014, coverage cannot be denied to anyone because of age or medical condition; and starting 2015, annual medical cost limits will be eliminated.

    Who Qualifies for Subsidies and How are They Given?

    Citizens and legal residents with incomes between 100 and 400% of the Federal Poverty Level (FPL) who purchase health insurance through the exchanges may qualify for tax credits to reduce the cost of the premiums.  Tax premium credits, often referred to as subsidies throughout  the ACA, come in two forms: refundable and advanceable.  Taxpayers are refunded their premium subsidies at the end of the year through a reduction in their taxes.  However, advanceable credits are paid directly to the insurance company, thereby directly reducing the cost of insurance premiums each month.

    There is also another form of financial assistance available to people with incomes at or below 250% FPL.  These are cost-sharing subsidies that reduce, not the premium, but the insured’s share of costs for medical treatments: the deductible and co-pays.  These are paid directly to the insurance company.

    People who qualify for Medicaid in their state are ineligible to purchase health insurance or apply for subsidies in the health insurance exchanges.

    How are the Subsidies and Tax Credits Calculated?

    Eligibility depends on one’s 2014 household income, specifically, one’s Modified Adjusted Gross Income. (Supplemental Security Income (SSI), veterans’ disability payments, workers’ comp and child support, however, are not counted as income here.)  Obviously, this is an estimate. Come 2015 tax time, if there’s  a significant difference in the 2014 estimation, either the government or the insurance purchaser needs to be reimbursed.

    Subsidies are calculated by assuming that the health insurance sold on the exchange should cost purchasers no more than a certain % of their household income.  This percentage goes up proportionally with income.  Someone with income at 150% FPL would pay no more than 3-4% of their income for health insurance while those at 400% FPL, would pay up to 9.5%.  Using the cost of the Silver Plan as the basis, the subsidy becomes the difference between the cost of the insurance and the calculated % of income. It should be noted that insurance costs vary by state and areas within each state, causing subsidies to be significantly higher in areas with more expensive health insurance.

    Are Exchanges the Only Way to Apply for Health Insurance & Subsidies?

    Accepting and processing applications for health insurance and subsidies is not limited to the state exchanges.  Most states offer applications by phone; and applications in person are available through public service organizations and state offices.  But going through a certified licensed health insurance agent may be your best bet.  They are the best qualified to advise and explain the health insurance plans offered by the exchange and are certified by the state to accept and process applications for the health insurance and subsidies offered through the exchange.  Most importantly, as licensed insurance agents, they’ve already undergone state security clearances designed to protect your privacy.

    The 2700 pages of the ACA and the 1000+ pages of detailed regulations issued so far specifically about the exchanges have much more to say about them than can be covered in 10 minutes.  Future blogs will cover the most relevant ones.  Our next blog will focus specifically on Covered California, the crown jewel of the ACA exchanges, serving the largest number of uninsured and receiving the lion’s share of federal exchange development grants.