ACA Obamacare California Update
Limit of $2,000 deductible removed on group health plans
On April 1, 2014, President Barack Obama signed into law the “Protecting Access to Medicare” act. The main purpose was to prevent 2014 cuts to doctor’s reimbursement levels for Medicare patients, but a significant feature for all small group employers was the repeal of the limit on group health insurance deductibles. All plans must still conform to the “minimum value of 60%” rule but can do so without any deductible limit. Maximum out-of-pocket limit remains at $6,350 in 2014 ($100 higher in 2015) for individuals and $12,700 for families ($200 higher in 2015).
Latest CA update: CoveredCA is still waiting to review many of the documents submitted to it as early as November. We are checking for our own Marketplace (individual) clients and are updating them regularly.
Unfortunately, the update is regularly “the documents are received but not yet reviewed.”
1. Between April 15 and the Presidential election, you cannot enroll in individual coverage without a Special Enrollment Period (also known as “Qualifying Event”). These events include losing group coverage, marrying someone who has coverage and going on with the spouse, having a baby, getting a divorce, etc. Open enrollment this fall will allow coverage to begin Jan 1, 2015.
2. The Small Group SHOP plan has deleted its online enrollment capability since it was not working correctly. Instead, our SHOP clients are enrolling with traditional paper applications. We do not consider this much of an inconvenience at all.
3. THE NEW BENEFITS ARE CONSISTENT AMONG CARRIERS. Remember how hard we worked to figure out which carrier to choose? Remember after the carrier was chosen how difficult it was to select from the 25+ plans available? Do you remember how frustrating it was when the carrier made changes every few years and we had to do this all over again? At the very least, from now on you will be able to select the carrier based on price and doctor network because the Bronze, Silver, Gold, and Platinum benefits are standardized among carriers. The important consideration is the network of doctors: which carrier has your doctors?
4. THE NEW BENEFITS HAVE SUPERIOR FEATURES, BUT CONFUSION REIGNS when it comes to claims. For example, Pediatric dental and vision are required, but carriers have STILL not published how the claims will be handled when there is existing dental coverage (e.g. which plan will pay first and how will benefits be coordinated between the plans). Plus, pediatric dental seems to be structured with an HMO type of network, so very few clients find their dentists to be members of the accepted network.
5. PRICING is surprisingly comfortable. Carriers predicted very high group rate increases last fall, but have re-evaluated their losses and already are dialing back the premium jumps.
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