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George Beach Insurance Services LLC Blog

Insurance News Roundup for 10/11/2021

10/11/2021

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1. Medicare open enrollment starts soon. Here’s why you should pay attention: https://www.cnbc.com/2021/10/09/medicare-open-enrollment-starts-soon-why-you-should-pay-attention.html
Medicare open enrollments starts October 15th and runs through December 7th. This is your chance to make changes to your Medicare coverage for the upcoming year. If you’re happy with your current plan and coverages, you do not need to do anything but it is still recommended that you at least look at the changes and review your Part D (prescriptions) to see if there are any formulary changes.

2. Some California parents can now join their kid's health insurance plan: https://www.abc10.com/article/money/some-california-parents-can-now-join-their-kids-health-insurance-plan/103-3fccf935-f54c-42a7-9e89-b92187101d9b
The ACA allowed children up to age 26 to remain on their parents’ health insurance plan. Now Governor Newsom signed a law allowing some parents to join their kids’ health insurance. The new law only applies to plans purchased on the individual markets, such as direct buys or through Covered California and not plans available through an employer.

3. Covered California Opens Special Enrollment Period: https://www.escalontimes.com/news/covered-california-opens-special-enrollment-period/
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Covered California has announced a new special enrollment period for individuals who lost federal financial assistance towards their COBRA coverage. It is estimated there are 138,000 California eligible for the new special enrollment period. Coverage can start as soon at November 1st 2021.

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Covered California Welcomes New Carrier - Bright HealthCare!

10/4/2021

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Covered California members in Contra Costa County will have a new carrier to choose from when picking their 2022 health insurance. 

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​Bright HealthCare, while not new to health insurance, is new to Covered California and Contra Costa County. Members who pick Bright Healthcare will have full access to the John Muir Health and Hill Physicians Networks.

Bright HealthCare is offering 7 plans in 2022: Bronze 60, Silver 70, Gold 80, and Platinum 90. There will also be 3 Cost Sharing Reduction plans available for those who qualify: Silver 73, Silver 87, and Silver 94.

Bright HealthCare is an HMO (Health Maintenance Organization) that truly puts the members' needs first. Bright HealthCare uses smart tools and technology to simplify health insurance for all of those involved. Their goal is to take the confusion and chaos out of the process and build benefit-packed plans that still deliver surprisingly low rates, so the member can focus on staying happy and healthy…and paying less for their healthcare.

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Can Covered California Be Retroactive?

9/27/2021

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​No, coverage bought through Covered California will start the first of the following month. Individuals who sign up for Medi-Cal (California’s Medicaid program) can have coverage that is effective retroactively to the first day of the month from when they submitted their application.

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Anthem Blue Cross Is Expanding!

9/23/2019

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​Anthem Blue Cross of California
 
Anthem Blue Cross is one of the largest managed health care companies in California. It is an independent licensee of the Blue Cross Blue Shield Association based in Thousand Oaks, California. Anthem and its affiliates serve over 8 million Californians and have offered Covered California plans since 2014.
 
2020 Expansion
Anthem is pleased to announce that we are expanding our participation in an additional six regions for 2020. In addition to currently offering plans in regions 1 (Northern California counties), 7 (Santa Clara County), and 10 (San Joaquin, Stanislaus, Merced, Mariposa and Tulare counties), Anthem will also offer plans in regions 9 (Santa Cruz, San Benito and Monterey counties), 11 (Fresno, King and Madera counties,) 12 (San Luis Obispo, Santa Barbara, and Ventura counties), 15 (Los Angeles County East), 16 (Los Angeles County West), and 17 (Inland Empire).
 
Innovative Programs
Anthem is working with doctors and hospitals that share responsibility for increasing access to appointments, improving the member experience, and providing a more coordinated treatment plan to patients.
 
We also want to help our members spend more time focused on their health and less time managing the ins and outs of health care. That’s why Anthem is driving meaningful change through technology to deliver an easier to use, more complete web and mobile health care experience.
 
Introducing IngenioRx
Anthem’s new pharmacy benefits manager, IngenioRx, not only manages Anthem drug plans, it also offers better support to our members. This means members will have around-the-clock access to teams of specialists, online tools that can be used at home or on the go, and the ease of managing health and drug plans in one place.
 
Mobile and Online options Meet Sydney, Anthem’s new mobile app designed to provide members a more personal, simplified experience. Along with quick access to their Digital ID card, Find a Doctor, and a Personal Goal Setting tool, members can also use the new ChatBot to help guide them on the app, and try the new Care Team set up feature, too. And at anthem.com/ca, members can find all the same features built with easy access and personalization in mind as the mobile app and much more.
 
24/7 Access with Telehealth Anthem’s LiveHealth Online telehealth program gives members access to real-time, face-to-face visits with a choice of doctors across a range of specialties via computer, tablet or mobile phone 24 hours a day. Available in both English and Spanish, doctors can answer questions, diagnose common problems, and even prescribe some medications.
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What's a Deductible?

8/12/2019

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A deductible is the amount that you have to pay for your health care each year before your insurance starts paying for your care. Similar to car insurance, many health plans require you pay a certain amount out-of-pocket before the coverage kicks in. For example, if you have a deductible of $1500 you have to pay the first $1500 of your medical costs before your insurance starts paying. In some plans the deductible applies only to services that you get outside of the provider network. Also, some plans have a separate deductible for prescription medications. Usual deductible does not apply for preventive services.
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What is the co-payment? What is coinsurance?

8/5/2019

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The money that you pay out-of-pocket for the services that you receive. This could include anything from an office visit to the doctor, prescription medicine, an x-ray, or even a hospital stay.
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Now if the money you pay is a set amount that would be called a co-payment or a copay. If the money that you pay is a percentage of the cost then that would be called coinsurance. Now depending on the plan that you have it dictates whether you have a co-payment/copay or coinsurance.

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What is a Metal Tier/Category?

8/2/2019

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​Health insurance is divided into four main categories. Each category has the name of a metal, the more expensive the metal the more expensive the premium but the richer the benefits. Bronze for example covers 60% of your medical expenses it is also the least expensive premium. Silver covers 70%, Gold covers 80% and Platinum, the most expensive tier, covers 90%.
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What is a Health Insurance Premium?

8/1/2019

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A health insurance premium is the amount of money you pay per month to the health insurance carrier. Now, you either pay by the month of you pay it per pay period depending if you get it through your employer or not.
 
If you get it through your employer, your employer most likely covers a portion of your premium.
 
If you get your insurance through either Covered California or through the exchange in another state then you most likely get an Advance Premium Tax Credit, that's where the Federal Government pays a part of your health insurance premium for you.
 
If you are not on the exchange and you buy directly through the carrier then you're paying 100% of the premium yourself.

Have an insurance question? Drop it in the comments and it might become the next video!
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HMO – PPO – EPO: What’s The Difference?

3/26/2019

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HMO - Health Maintenance Organization
An HMO is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage. You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays. All healthcare services are managed in-network through your Primary Care Physician.​

​In California, the popular HMOs are Kaiser Permanente, Sutter Health Plus, Western Health Advantage, Health Net of California, Sharp Health Plan, LA Care, Molina Healthcare, and Valley Health Plan.
George Beach Insurance - HMO Diagram
You will usually need a referral from your Primary Care Physician to see a Specialist, resulting in multiple co-pays.
PPO - Preferred Provider Organization
A PPO is a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. PPOs do not require you to select a Primary Care Physician. One of the benefits of a PPO is you usually can self-refer to a Specialist.
 
In California, the popular PPOs are Blue Shield of California, Health Net Life Insurance Company, and Oscar.
George Beach Insurance - PPO Diagram
One of the benefits of a PPO is you usually can self-refer to a Specialist.
EPO - Exclusive Provider Organization
A managed care plan where services are covered only if you go to doctors, specialists, or hospitals in the plan’s network (except in an emergency). Under an EPO plan you do not choose a Primary Care Physician. You can receive care from any of the in-network doctors and self-refer to in-network specialists.
 
In California, the popular EPOs are Anthem Blue Cross, Health Net Life Insurance Company, and Oscar.
PictuGeorge Beach Insurance - EPO Diagramre
You can receive care from any of the in-network doctors and self-refer to in-network specialists.
If you want to discuss options about your health insurance, we recommend speaking with an independent insurance agent like George Beach Insurance Services. We work for you the client, and not a particular big company.
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George Beach Insurance Services LLC​
Modesto, CA 95355
(209) 353-2330​
Click Here to Email Us
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