Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

This may be a little different letter from most you receive.

I bought my health plan in January 2015 through Covered California and chose Anthem Blue Cross as my insurance company.

My reason for writing is that I have had a good experience with Covered California. I had finished my taxes and my tax preparer said that a form 1095A was required because my income (or, lack of income!) qualified me for a monthly subsidy to help pay my premium.

Anyway, I called Covered California and they walked me through my “consumer portal” and I was easily able to print out form 1095A.

Also, at the end of 2015, I called them to increase my subsidy for 2016 due to anticipated lower income level for 2016. Easy!

So…the Covered California portion has been great, but the Anthem Blue Cross part has been a little more difficult to negotiate. That conversation may be another letter to you guys in the future.

Happy Camper

Tom: Thanks for writing us, Happy.

Great to know Covered California did its job. You called them at the right time, too. Anytime outside of Open Enrollment (Nov. 1 through Jan. 31) there is much less wait time and the customer service representatives seem to have more time for callers.

Generally speaking, Covered California participants have had a much smoother experience recently. The rollout year 2013 was a nightmare due to the website often being down, dropped applications and phone wait times frequently longer than two hours.

Al: Of course, the “unhappy” side of the Affordable Care Act (ACA) as it works in California is that the federal boost that has helped hold rates steady is soon going away.

Covered California announced this week that the average increase for 2017 will be 13.2 percent. Blue Shield has warned us that their rates will be up to 19.9 percent higher.

Tom: Our reader mentioned the Anthem Blue Cross side not being as pleasing as Covered California.

The individual network of physicians and hospitals for Anthem is called the Pathway network.

Whether through Covered California or directly to the company, individuals and families have run into providers who simply do not accept the Pathway network.

Doctors have been hesitant to contract with this network because, we’re told, the reimbursement rate was reduced as much as 20 percent when compared with the earlier Prudent Buyer network.

For those on an employer’s small or large group plan, the network is still the Prudent Buyer.

Al: I just quoted a young person one of the Kaiser plans on Covered California.

She makes $35,000 per year, but was shocked to discover that her monthly subsidy will only be $29. For the Silver plan, she would be paying about $300 per month, or, about 10 percent of her pay. I haven’t seen Kaiser’s rates for 2017.

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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