Let's look at the some of the most visible impacts to date from Health Reform
We're slowly starting to see some clarity on what Health Reform will mean for the California health insurance market and we expect this to accelerate going into the summer of 2013.
Let's look at the bigger ticket items that have already been implemented and try estimate what to expect Jan 1st, 2014 when the Exchange is fully functional.
We're going to steer clear of politics and just look at what the California
consumer can expect.
One very big implementation already available (which we can definitely get behind) is the PCIP plan or Pre-existing Condition Insurance Plan. PCIP is the high risk plan created at the Federal level as interim stop gap for people who are unable to qualify for individual family health insurance due to health. The pricing is very competitive for pretty strong benefits. In order to qualify for the PCIP plan, you must not have had coverage in the last 6 months and need to be declined coverage by a carrier at the most. The 6 month of no prior coverage has been the biggest stumbling block but if you can't qualify for health insurance due to health and you have been uninsured, this is a good interim fix. Again, this is really a temporary plan designed to fill the gap until Jan 1st 2014 when all coverage will be guaranteed issue but we'll take what we can get.
Underage dependents on family or group plans
This is another aspect of Health Reform that we like and it has helped many underage dependents find and keep coverage. Basically, up until age 26, a dependent child can remain on his or her parent's policy.
This is great news for kids in college and for many plans, there's a flat "family" rate whether it's 1 child or 5 children so the rate might be the same by having that 23 year old stay on board.
We can always run a quote to see if it makes financial sense to roll a child onto their own Individual health plan in California.
Guaranteed issue for children
Effective 3/23/2010, children will be guaranteed issue on the individual family market. The roll out of this part of Health Reform was complicated by each carrier's different interpretation of the rules but it has since settled down.. For the most part, children up to age 18 will be guaranteed issue for individual coverage but the rates can be increased (sometimes significantly) based on health.
Maternity health insurance in California
Effective July 1st, 2012, all plans on the California individual market will
cover maternity and this applies to both old and new plans (even grandfathered
plans). This is a pre-cursor to the Health Reform changes coming to the rest of
the country.
Preventative coverage is covered at 100% now (in-network and on newer plans after 9/23/2010).
This is quite a big perk although the rates have increased as a result so make sure to take advantage of these benefits since you're paying for them.
The follow up to this was for women's preventative benefits which took place
summer of 2012. Birth control covered at 100% is the big ticket item here.
At this point, the next big item will be baseline benefits levels for the
Platinum, Gold, Silver, and Bronze options which will be based on the Kaiser $30
Copay no-deductible plan. The benefits are rich but the premiums will reflect
this so we're curious to see how proceeds. Please let us know if you have any
questions going forward. We're happy to help.