California Health Care

by John Hansen

The Blue Shield of California dental plans offer a variety of benefits and services for adults and children enrolled in their Medicare Supplement plan. Unlike other carriers, Blue Shield Dental Insurance California offers unique dental PPO plans. This allows patients to visit dentists within the Blue Shield of California network along with limited coverage from dentists outside their network.

Two types of DPPO plans are available through Blue Shield.

Currently, the PPO plan costs $37 for an individual, but from April 1st, 2018, the rates will be as follows.

With any of these plans, you may visit any dentist you want. But your out-of-pocket expenses will be much lower when you visit a dentist that’s part of the Blue Shield provider network.

Call us now for a free quote on all Blue Shield dental plans. We provide additional guidance on how to choose dental and health plans from any of the top health insurance companies in California.

by John Hansen

The big question is, “Do you qualify for a subsidy?” If yes, then you go where the money is, and that’s on health benefit exchange through Covered California. If you make less than 400% of the Federal Poverty Level (FPL), then you qualify for government assistance if you enroll on the California Health Insurance Exchange.

If you make too much money, usually you want to enroll off of the California health insurance exchange. When you enroll in health insurance in California through an agent or directly through a carrier, there are three main benefits:

As an agent, I enrolled a family with a household income of over $250,000 per year through the Covered California marketplace. My client had extra red tape and hassles to deal with because I enrolled him through the California Health Insurance Exchange. In hindsight, I would have enrolled him directly through the carrier, and that would have saved him some frustrations.

Are you a Native American or are you Medi-Cal eligib...

by John Hansen

Before the implementation of Obama Care in California, health insurance enrollment lasted all year long. There was no Open Enrollment Period. Consumers could purchase health plans and Agents could sell them throughout the year. However, since the Affordable Care Act (ACA), a three month Open Enrollment Period has been established.

For consumers, this means you have to be on your A-game. No longer can you purchase health insurance throughout the year. If you do not apply during the Open Enrollment Period, you will have to wait until next year to get coverage, or you will have to find a way to get health insurance through an employer sponsored plan.

For Open Enrollment 2016, the three month period was from November 1, 2015 to January 31, 2016. In 2017, we expect the enrollment period to be the same. These dates match the time frame for the Healthcare.gov enrollment period as well. At some point, leaders in the health care industry expect the Open Enrollment Period to decreas...

by John Hansen

If a group has under 50 employees, there is no penalty for not offering small business health insurance. With subsidies available and no denials for the individual and family plans, many expected a mass exodus in the small group health insurance California market. Many feared that a lot of small groups would cancel their health plans and send their employees to the exchange to get subsidies. However, far fewer groups have departed from the small business market than anticipated.

Some groups have left the small business health insurance market, especially the ma and pa groups who had group plans with under enrolled employees. Some of these smaller groups left to get the tax credits offered by Covered CA in the California Health Exchange. Others, due to increased requirements by the Affordable Care Act (ACA) were forced off their small business medical insurance plans.

In California, the Obama Care requirements said that to qualify for group health insurance, you had to have...

by John Hansen

In 2017, Blue Shield will be adding a Silver Insurance Plan to their Covered California for Small Business (formerly SHOP) plan offerings. Consumers have been frustrated that Shield has not included a silver health care plan on the California Exchange for groups. It has made SHOP less appealing, and it has made Blue Shield less attractive to consumers considering enrolling in group health insurance for California through the State Exchange.

With 63% of consumers choosing silver insurance, these plans have been the most popular in the market. Whether people went with Covered California Blue Shield or with another carrier, the silver health care plan was most often the plan of choice.

Many small businesses were a bit disenchanted with the California Health Exchange when they found out there was no Blue Shield silver insurance plan offered. This often led them to go with another carrier (like Anthem Blue Cross) or to purchase coverage outside of the California Health Exchang...

by John Hansen

In 2015, Blue Shield, California’s largest non-profit health plan, acquired “Care First”. Currently, the medical insurance carrier is working to integrate Care First into the company.

For adults that line is at 138% of the Federal Poverty Level (FPL). When the household income goes above 138%, the adult consumer qualifies for a Covered California plan with a subsidy. When the income goes below 138% of FPL, the consumer qualifies for free or cheap health insurance coverage through Medi-Cal.

For children the FPL line is at 250% of FPL, and for pregnant women who get AIM (Access for Infants and Mothers) the line is at 300% of FPL. For a family of three with a pregnant mother, all three Federal Poverty Lines may apply. And, when income fluctuates, you can see how it becomes an absolute nightmare to keep track of which family members qualify for Medi-Cal and which ones qualify for Covered CA at any given time.

Care First was designed to manage the “Toggle Market,” which...

by John Hansen

Blue Shield of California knows that dropping grandfathered plans is not the most popular thing to do. It goes against the spirit of the Affordable Care Act (ACA). It makes consumers angry. People instantly hear echoes of the Obama Care promise, “You will be able to keep your current plans.”

But will I? Well, maybe. Yes, you can keep your current Blue Shield plan. That’s true as long as the California health plan keeps offering your grandfathered plan. If they terminate the plan, then you’re out of luck.

Blue Shield of California has lots of older, grandfathered plans that maintain very little enrollment. Some of these Blue Shield plans have less than 50 people currently on them. It becomes very difficult and costly for the medical insurance carrier to manage an excessive amount of health plans that have very few members.

The carrier has made the decision to terminate all grandfathered Blue Shield plans that currently have under 200 people on them. To see if your gra...

by John Hansen

Blue Shield of California calls the new plan “Trio”. This will be an ACO plan. ACO stands for Accountable Care Organization. This health benefits package will operate much like an HMO, and it might even be labeled an HMO. Top Blue Shield representatives said they were unsure at this time whether or not it would get the HMO label. However, they seemed certain that this plan would help them compete with California’s top HMO, Kaiser Permanente.

The Trio ACO plan will have a Primary Care Physician (PCP). This PCP will act as “gatekeeper”, just like on a typical HMO. A health plan member will need to see their doctor first and then get a referral in order to see a specialist. That means the California health insurance plan gets to do more babysitting, and they can make sure their clients get their checkups and labs done.

Blue Shield expects to offer comparable or even better pricing than Kaiser Permanente with their Trio ACO plan product line. They will include compe...

by John Hansen

Kaiser Permanente’s integrated model requires not only the building of new facilities, but also a steady influx of qualified medical personnel. Toward that goal of acquiring the most qualified staff, Kaiser Permanente has gotten into the business of hiring medical groups.

Also, Kaiser Permanente, a leading California health plan, has contracted with medical students who have not even graduated yet. Kaiser has agreed to pay to put top students through school when these future physicians commit to working for Kaiser Permanente upon graduating.

By doing this, Kaiser Permanente is able to grab sharp medical students right away before they ever enter the job market. This guarantees the influx of doctors and medical staff that they need in order to keep building their HMO network. Also, this helps Kaiser Permanente snatch up the brightest and best future doctors going into the medical field before other providers even have a chance to compete.

This way future physicians do not...

by John Hansen

The State Exchange is expected to start offering Covered California agency contracts in 2017. Since the beginning of Health Care Reform, the California Health Exchange has been offering agent contracts, but as of yet they have not offered brokerages the ability to have their own contract or to have an agency online account with Covered California. The State Health Exchange is expected to offer agency contracts within the next 12 months, possibly even in time for Open Enrollment 2017.

The California Exchange has received many complaints from larger Covered California agencies regarding this issue. This makes it difficult for larger brokerages to make sure the agency (and not the individual agent) gets credit for the sales from their agents. Also, it leave agencies open to the risk of an employee leaving and taking a block of business with them.

Not having Covered California agency contracts creates a hug dilemma for larger brokerages when they can’t have individual sales t...