Column 22 Updates

Update on the option to continue coverage on Non-Grandfathered plans.  Covered California announced that it is upholding the original deadline for ending health plans that are not compliant with the Affordable Care Act (ACA).  Application deadline for effective date of 1/1/2014 has been extended to December 23, 2013 and payment must be received by January 5, 2014.

The carrier deadlines are unchanged.  Blue Shield: Deadline to request the extension is 12/6/2013.  This can be done by calling 855-836-9703.  To obtain more information  you can check their website:  

The Anthem Blue Cross offer has only gone to about 9% of their individual insureds.  Blue Shield will not give credit for deductibles or out of pocket expenses met on the existing plan when you do change plans. If you qualify for subsidies due to your income, those are not available on these plans as the process currently stands.

Note that while they may not cancel your coverage until that time for other than lack of premium payment or fraud, you may cancel your coverage should you find a better option in the interim. 

This means that it is critical that you make decisions regarding your non-grandfathered plans.  If the company is migrating you to a new plan, be sure it is the best plan for you. Consult your agent to review the new plans.  For example, Anthem is migrating a lot of the Lumenos H.S.A. plans to a CACF plan that is not H.S.A. (Health Savings Account) eligible.  For a few dollars difference you may have a plan that has a lower deductible and allows you the option to contribute to an H.S.A. Further note that the new H.S.A. plan is an aggregate family deductible.  So if you are insuring only two people, you are likely better to "unbundle" your plan.  Discuss this with your agent.

There has been another interesting development in this area as well.  According to the National Association of Insurance and Financial Professionals, on November 19, the Centers for Medicaid and Medicare Services (CMS) made an important announcement. It stated that insurers will now be allowed to verify premium tax credit data, and directly enroll individuals eligible for a subsidy outside of federally-facilitated marketplaces (FFM). Individuals who are not eligible for subsidies have been able to enroll directly with insurers since the October 1 launch, however the Affordable Care Act states that individuals eligible for these subsidies must apply through a marketplace also known as Exchange or Covered CA in our state. In CA an agent may assist the individual and many are doing so, even though the site is not particularly agent friendly.

This revised method allows carriers to interface with Exchanges to verify subsidy eligibility, sell plans made available on Exchange, and then application data will be sent to the Exchange for processing in order to remain compliant with the law. The impact of this decision is a potential game changer, as for the first time it will allow agents to assist all consumers with enrollment-even those eligible for subsidies-outside of the government websites such as CoveredCA or

However, barriers remain. The CMS fix puts the impetus on carriers to develop ways to interface with the Exchange to access subsidy eligibility data, pathways which will not be developed overnight. Moreover, many carriers are wary, having faced countless glitches while interacting with Exchanges thus far. Consequently, carriers are treading lightly, as there is no guarantee that the data, once accessed, will be 100 percent reliable. Finally, the CMS decision only applies to the 34 states with FFMs, or state-federal partnership marketplaces. States running their own marketplaces must establish their own rules pertaining to external subsidy availability.

Q. My wife is registered BIA.  She is Choctaw but we still get admission into the Rancheria clinic, does this change anything for me regarding the ACA.

A.     Members of federally recognized tribes are exempt from the penalty for not having insurance. This is from the Covered CA application: Federally recognized American Indians and Alaska Natives can get services from the Indian Health Services, tribal health programs, or urban Indian health programs. They also may not have to pay out-of-pocket costs (such as co-pays) and may get special enrollment periods.

You must complete a form and send it in with your application and your proof of Native American or Alaska Native heritage. You may send a document from a federally recognized Indian tribe that shows you are a member of the tribe or affiliated with the tribe (such as a tribal enrollment card or certificate of degree of Indian blood.) If you think you qualify for Medi-Cal, you do not have to send proof of your Native American or Alaska Native heritage.


*Information provided in this column is "to the best of my knowledge based on press deadline