We are approaching the deadlines for both the Medicare Annual Enrollment Period on December 7th and for the Individual Open Enrollment Period which ends December 15th for a January 1st effective date and the Special Enrollment Period for Small Business . Many people have still not made a decision on their health insurance plans as they struggling with their limited choices combined with high insurance premiums.
For individuals and families looking to enroll in a health insurance plan for a January 1st effective date, the last day to enroll is December 15th. While insurance premiums are going up on average 12 percent statewide, we see increases of 27 percent on Blue Shield PPO health insurance plans and even higher on Molina health care. More families qualify for subsidies in 2018 especially families and adults over the age of 55. So even if you did not qualify in the past for a subsidy you should review your tax return line item # 37 to get the modified adjusted gross income figure and contact us at Solid Health Insurance Services to see if you qualify for a subsidy in 2018. Take advantage of the subsidy if you qualify, to offset the steep increase in the health insurance market.
On another note, Anthem is leaving the southern California area in 2018 for individual and family plans. Blue Shield of California, one of the largest carriers in California, is seeing some of the highest rate hikes. For existing Blue Shield members, you should ask yourself if Blue Shield’s large provider network is worth the higher premiums. Many healthy individuals will do just fine with a moderate provider network with carriers such as Oscar’s EPO, Health Net PPO or Kaiser’s HMO, all with more competitive premiums.
Members who are on a silver plan through Covered CA and are not applying for subsidies should apply off-exchange as the silver plans on-exchange are more expensive from the Cost Share Reduction surcharge to fund subsidized silver plans.
On another note, for members who use a PPO to go and see out-of-network doctors and specialists, please review your 2018 plan as PPOs, even the Gold and Platinum plans, have high deductibles for out-of-network services. For individuals, the out-of-network medical deductible is $5,000 or $10,000 for a family for the silver to platinum plans. Bronze plans have even higher out-of-network deductibles. This is extremely important to note, especially for individuals who have mental health providers or specialists who do not take insurance. People automatically think “I need a PPO to go to this doctor” yet the insurer will not cover these doctors until you reach a high deductible. Many of our clients also assume that the insurer will pay 50% coinsurance for out-of-network services. This is many times a misunderstanding as the insurers will pay up to 50% and may pay less if they decide to pay the provider to the in-network rates.
Many Californians who are not qualifying for the subsidy as their income is above the 400 % Federal Poverty level are struggling with the health insurance premium of 2018. As an example a family of 5 had in 2014 a Gold rate of $ 1200, the same plan now will cost $ 2800. This is a cost explosion who is not discussed in the media. But it is hurting the middle income earner. To avoid the high rates, more and more Californians are forced to use Bronze plans with fewer benefits and smaller networks. While the insurance carriers are part to be blamed, the real reason for the premium increases is based on the explosion of medical cost and lack of price transparency. Members and providers may point to the insurers as being too greedy yet the Affordable Care Act has mandated that 85% of our monthly premiums must go to medical costs. Did you know that, for example, it can cost as much as $100,000 for a one-day emergency appendix surgery? Complicated childbirths can cost as much as $250,000. It takes 3,800 insurance members to pay for one member’s kidney dialysis. These examples are just the tip of the iceberg. While no one likes regulation, medical cost needs to be controlled to avoid even higher insurance increases. At least start to publish rates for medical services and pharmaceutical drugs , so that consumers can be more active in choosing services and drugs which are affordable
With all of the noise around healthcare from the media and politician, it is important to focus on reality and find the right plan to fit your budget and your medical needs. At Solid Health Insurance Services, we are always here to help our clients meet their medical and financial needs. Please do not hesitate to contact us at 310-909-6135 or email us at info@solidhealthinsurance.com to finalize your plan for the coming year. Please make sure to enroll by December 7th for Medicare or December 15th for individuals applying for a January 1st effective date. Do not wait until the last minute, we cannot risk the possibility of a server overload which has surprisingly happened in the past.