2015 PPACA plan regs released | LifeHealthPro

The public exchanges are giving commercial carriers a chance to sell subsidized qualified health plan coverage to moderate-income consumers.

Now the Obama administration is working on rules that could help some states create major new nonprofit competitors, as well.

The Centers for Medicare & Medicaid Services is getting ready to publish the rules – proposed funding methods for a “Basic Health Program” program – in the Federal Register next week.

The Patient and Protection and Affordable Care Act lets people with incomes from 133 percent to 200 percent of the federal poverty level use new tax credits to pay for coverage bought through the exchanges.

Consumer groups that thought the commercial exchange plan system would be too expensive persuaded Congress to put a basic plan system provision in PPACA, in Section 1331.

PPACA Section 1331 lets states set up health insurance programs for residents with household incomes between 133 percent and 200 percent of the federal poverty level who aren’t eligible for Medicaid, the Children’s Health Insurance Program or employer-sponsored health coverage.

A state with a basic plan system could either run its own basic plan plans, or it could hire outside companies, such as WellPoint Inc. or UnitedHealth Group Inc., to run the plans, just as many states now hire commercial carriers to run their Medicaid plans

A state with a basic plan system could collect premium payments from the insureds, while receiving cash from the U.S. Department of Health and Human Services. The amount would be based on the tax credits the basic plan enrollees would have received if they had signed up for commercial exchange plan coverage rather than signing up for coverage from a state-run basic plan.

The new proposal talks about the rules CMS might use when calculating how much funding states would receive for its basic plan system.

CMS failed to set up the basic plan system in 2014. Some said CMS waited on developing the basic plan system because it was afraid starting the system in 2014 would have frightened insurers away from selling commercial plans through the exchanges.

See also:

2015 PPACA plan regs released | LifeHealthPro.



PPACA gets blame for out-of-pocket cost increases | LifeHealthPro

WASHINGTON (AP) — Many Americans who already have coverage are blaming rising premiums and deductibles on the Patient Protection and Affordable Care Act (PPACA).

There are signs that the HealthCare.gov federal PPACA exchange enrollment system is working better, but about half of the Americans with private coverage who participated in a new Associated Press-GfK poll said their policies will be changing next year — mostly for the worse.

Employers were already moving toward leaner coverage before PPACA along, but 77 percent of the poll participants blame the upcoming changes on PPACA.

Sixty-nine percent said their premiums will be going up, and 59 percent said annual deductibles or co-payments are increasing.

Only 21 percent of those with private coverage said their plan is expanding to cover more types of medical care, though coverage of preventive care at no charge to the patient has been required by the law for the past couple of years.

Fourteen percent said coverage for spouses is being restricted or eliminated, and 11 percent said their plan is being discontinued.

Political leanings seemed to affect perceptions of eroding coverage, with larger majorities of Republicans and independents saying their coverage will be affected.

More than 60 percent of the participants said they disapprove of President Obama’s handling of health care.

But, when the survey firm asked participants which party they trust more to handle health care, 32 percent named the Democrats and just 22 percent named the Republicans.

The AP-GfK Poll was conducted Dec. 5-9 and involved online interviews with 1,367 adults. The survey has a margin of sampling error of plus or minus 3.5 percentage points for all respondents.

The poll was conducted after Obama administrations said they had greatly improved the HealthCare.gov website and states said they had greatly improved their enrollment systems.

About 11 percent of the participants said they or someone in their household had tried to sign up for health insurance through the exchanges.

Among the people who had applied for coverage through the exchanges or knew someone else who had, about one-quarter said the applicants had managed to enroll in coverage, half said the would-be applicants had not succeeded at enrolling in coverage, and one-quarter weren’t sure what the result was.

Phyllis Dessel, 63, of Reading, Pa., made 50 attempts at getting enrolled online and said she believes she is finally enrolled.

The retired social worker, a political independent, currently has her own private insurance.

When Dessel described her experience, she jokingly asked, “Do you mind if I cry?”

Thanks to tax credits available under PPACA, she was able to save about $100 a month on the monthly premium for her new coverage. But she had to switch carriers because staying with her current insurer would have cost more than she was willing to pay. She hasn’t gotten an invoice yet from her new insurance company.

The premiums she found on the new insurance marketplace were “not at all” what she expected, said Dessel. “They were much, much higher.”

A supporter of PPACA, she said she believes changes are needed to make the coverage more affordable.

“I think with a lot of amendments or updates, it could be very, very helpful and beneficial,” said Dessel. “I know a lot of people who don’t have insurance. My hairdresser, my plumber don’t have insurance, and they’re not going to get it if it’s not affordable.”

AP News Survey Specialist Dennis Junius and Associated Press writer Stacy A. Anderson contributed to this report.

PPACA gets blame for out-of-pocket cost increases | LifeHealthPro.


December 23rd is the last day to enroll in Covered California™ for coverage taking effect on January 1, 2014

coveredcaDecember 23rd is the last day to enroll in Covered California™ for coverage taking effect on January 1, 2014.  Covered California is sponsoring a variety of events in December to maximize enrollment for January coverage.

  • Special Sunday hours: Covered California will offer extended service center hours on Sunday, December 15th and Sunday, December 22nd to help consumers enroll before the December 23rd deadline.
  • “Give the Gift of Health”: Covered California is sponsoring this campaign to empower family members, particularly mothers and grandmothers, in urging young adults to enroll in affordable and quality health coverage through the agency’s health insurance marketplace. The campaign includes:
    • A Web page at https://www.CoveredCA.com/pledge where residents can make a pledge to get loved ones covered.
    • An e-card that can be sent to friends and family with a personal message and more information about their options for insurance through Covered California, including low-cost or no-cost Medi-Cal.
    • A pledge certificate that can be presented to loved ones during the holidays as a symbol of your willingness to help them get insured.
    • Tips for starting a discussion with friends and family about the importance of having health insurance.

The next two weeks are critical to Covered California’s efforts to maximize enrollment.  To maintain our focus on enrollment activities during this period, Covered California will not hold the Board meeting that was tentatively-scheduled for December 19th.  The Board will meet next on Thursday, January 23, 2014.  Click here for the 2014 Board calendar.

While open enrollment will continue through March 2014, we encourage you to talk to friends and family over the next two weeks to let them know about the important December 23rd deadline.

Thank you,



Covered California, Certified Insurance Agent, San Diego


Kelli A. Fletcher

Kelli Fletcher
Lic: 0H88596

Eric B. Fuller, Inc.
Life & Health Insurance Agency
CA Lic# 0D95539
562 Lomas Santa Fe Dr.
Solana Beach, CA 92075

Tel: 858.481.1925
Fax: 858.755.5040

email: kfuller@ericbfullerinc.com


This website is owned and maintained by Eric B. Fuller, Inc., which is solely responsible for its content.  This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content.  The e-mail addresses and telephone number that appears throughout this site belong to Eric B. Fuller, Inc. and cannot be used to contact Covered California.


Anthem Blue Cross Blue Shield News

Anthem Blue Shield Blue CrossNovember 27, 2013

Because Covered California’s exchange is up and successfully running, the governing board decided last week that there should be no delays in implementing the Affordable Care Act (ACA).

That means that the vast majority of non grandfathered Anthem Blue Cross individual policies will be transitioned into new ACA-compliant plans starting Jan. 1, 2014. The only exception is a group of approximately 104,000 Anthem Blue Cross Life & Health Insurance Company members who did not receive a timely notification of their transition. Pursuant to an agreement with the California Department of Insurance, this group has the option to continue their current coverage through Feb. 28, 2014, at which time they will be transitioned into an ACA-compliant product.

The Exchange Board, in recognition that there has been confusion in the marketplace, did take a number of steps to make it easier for consumers to obtain coverage by Jan. 1, 2014, including:

  • Extending the deadline for enrollment for coverage taking effect on Jan. 1, 2014, from Dec. 15, 2013, to Dec. 23, 2013, and extending the deadline for payments due from Dec. 26, 2013, to Jan. 5, 2014.
  • Establishing a telephone hotline for consumers to resolve enrollment questions. The hotline, (855) 857-0445, will be available beginning Monday, Nov. 25.
  • Sending information directly to nearly 1.13 million affected individuals that provides clear options for coverage. The information will be sent from Covered California and the individual’s current insurance provider.
  • Collecting and reporting data, on a regular basis, showing the impacts of conversion for individuals.
  • Engaging consumers in their communities through the thousands of Certified Insurance Agents, Certified Enrollment Counselors and Certified Educators now deployed statewide.

At Anthem Blue Cross, we have always focused on providing access to affordable, quality health care.  That’s why we’ve assembled a network that includes world-class academic institutions like the University of California, and that’s why more Californians have selected Anthem’s individual insurance on the exchange (based on data released on Nov. 21) than any other insurer.

While other carriers have chosen to sit out the launch of the exchanges, Anthem Blue Cross has and will continue to be an essential player.  The implementation of the ACA and open enrollment is an extraordinary opportunity for the uninsured and those who struggle to afford coverage — and transformational for our industry.

We look forward to continued collaboration with all of our partners, so that health care coverage works for all Californians.

This article applies to:

  • California
  • Small Group, Large Group, and Individual (under 65)

Anthem Blue Cross Blue Shield.