Column 29 Covered CA payment options

Another payment deadline for individual health plans was announced last Sunday morning.   The new deadline for payment to is now close of business on 1/15/2014. The Anthem phones are open M-F and Saturdays in January from  8 am to 4 pm.  My press deadline for this column makes it a bit tricky to be timely with this kind of information in addition to the fact that they keep changing the deadlines.  I guess we have to give the companies credit for being flexible on these dates.

The reality of the situation is still that the process needs to be completed.  So if you pay your premium and it doesn't post for several days, don't be alarmed.  Humans have to review these transactions, downloads and uploads need to be completed.  It's not instant.

There are other issues that continue to be a problem if you need to access care or need a pre-authorization.  Extended hold times and not showing up in the system yet will continue to be a problem. 

The most important advice I can give you is to apply as soon as possible.  Do not wait until 3/31 to apply for individual coverage.  I expect that date is going to be a nightmare.  Contact your favorite agent and review your options.  Remember it does not cost you anything additional to work with an agent.  Chances are you will need service after the enrollment as well.

I am pleased to report that Covered Shasta, our local stakeholders group is looking to set up a date for an enrollment blitz.  Watch for an announcement.  This will include multiple locations that will be staffed to do enrollments on a particular date prior to March 31.

Do you wonder how they developed the subsidies levels in the Affordable Care Act (ACA)?  In 2011 there were just under 50 million uninsured in our country.  Of those individuals, 90% were at incomes under 400% of the Federal Poverty Level.  So the concept was to attempt to help those folks obtain and afford health (sickness) care coverage.  This is about 16% of our total population.

In the same year, about 49% were insured in employer sponsored plans, 18% in Medicaid (MediCAL in CA) and other public programs, 13% in Medicare and 5% had individual insurance.  It will be interesting to see the breakdown of our population after the end of this year. 

Question:  I didn't change my Medicare prescription drug plan, but now some of my medications are not covered by my 2014 plan - even though they were covered by my plan last year.  What can I do?

There are three steps you can take if your medications are not covered by your 2014 Medicare Part D plan.  (1) If your medication is still a part of the Medicare program, you can ask your Medicare prescription drug plan for a one-time 30-day transition or temporary supply of your medication.  (2) While you are using the temporary supply, you and your physician can seek an alternative drug that is included on your plan's formulary.  (3) You can file a formulary exception (or coverage determination) with your Medicare Part D plan requesting that your non-formulary medication be covered under your 2014 Medicare plan.

Remember that if your formulary exception request is denied, you have the right to appeal your plan's decision a number of times and you can contact your vendor  for an overview of the appeals process.

*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.