Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

Our daughter’s Blue Shield policy is going up 105 percent beginning in January.

She’s on her own and working (no group plan) but we may have to help her financially with this huge unexpected increase.

I went to another company’s website to shop around for her, but it wouldn’t let me go forward without a “qualifying event.”

I thought we were in the “open enrollment” period starting Oct. 15?

Puzzled

Tom: I’m right there with you, Puzzled. My Blue Cross is going up 35 percent. That got me shopping for 2017 also.

The open enrollment you and I have to wait for begins Nov. 1 this year and goes through Jan. 31.

Those pesky qualifying events came up because you were looking outside of Affordable Care Act’s (ACA) annual free-for-all.

The law says anybody and everybody (almost) can get covered during open enrollment. However, from February through October, unless you’ve lost group coverage, moved from a different state, got divorced or married or a few other exceptions, you’re out of luck.

Al: The “open enrollment” you were thinking of is the Annual Enrollment Period (AEP), which began just last Saturday.

Each year from Oct. 15 to Dec. 7, people who are on a Medicare Prescription Drug plan or on a Medicare Advantage plan can switch and/or enroll in a different plan.

This is why our phones start ringing every Oct. 1, even though we are forbidden to sign up anyone until Oct. 15.

Typically, it’s those looking to check on drug prices through different companies, but sometimes it’s people looking to enroll in an Advantage plan like SCAN or Kaiser Senior Advantage.

Tom: OK, back to the original dilemma.

Blue Cross, Blue Shield and Health Net are not only raising their rates, they’re narrowing their provider networks so that there are even fewer doctors to choose from.

Kaiser and Western Health Advantage are also increasing rates, but apparently not as drastically as the first three. The latter two seem to be in the 10 to 11 percent increase range.

You are probably aware that medical plans are divided into metal tiers: the least expensive, of course, is the bronze tier; next is silver, then gold, then platinum.

You may want to verify your daughter’s tier. If she is in good health and on one of the higher tiers, she may want to explore one of the lower and less expensive tiers.

Al: The irony, to me anyway, about the ACA is that if one is on a lower tier, like bronze, for example, and has a large deductible and a larger out-of-pocket maximum, it’s perfectly fine to go to a top-of-the-line plan if one’s health deteriorates and more medical care is needed. No pre-existing condition restrictions!

Submit questions or reach the Health Insurance Guys at Schrette Insurance, 1556 First St., Suite 105, Napa, 94559; 255-9511; schrette@gmail.com; or alancash@gmail.com

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