Dear Tom and Alan: I understand our new tax bill has some specific details for health insurance.
I’m on Blue Shield individual, not through Covered California, age 53, with very few visits to the doctor.
Do I have some new (maybe better) options?
Ready to Save
Tom: There are definitely some new rules. In the recent past (like, last month), the rules governing “creditable” health coverage under the Affordable Care Act (ACA, Obamacare) were very detailed.
All policies had to contain the “10 Essential Health Benefits” and were categorized under four tiers: bronze, silver, gold and platinum.
In California, you could go directly to the insurance company or to Covered California (the Marketplace) to apply for a plan.
Each plan, in or out of the Marketplace, would have exactly the same benefits.
You would have to apply during the open enrollment period unless there was some “qualifying event” like moving, losing group coverage, etc.
This part hasn’t changed except that Covered California is accepting applications until Jan. 31, while the insurance companies stopped last month.
The main reason all of the above was so important to individuals is that the ACA contained increasingly larger penalties for those who did not get coverage.
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Al: As I’ve snidely remarked before, “A government mandate enforced by the IRS…what could possibly go wrong?”
Anyway, in a previous column. we talked about temporary insurance that is available online. The problem is that this insurance doesn’t even come close to complying with the ACA. So it seems an individual with this type of policy would be liable for penalties from the IRS for not having “creditable coverage.”
Tom: According to what I can find on the Internet, President Trump’s executive order of Oct. 13, 2017 was intended to remove the individual mandate, and, consequently, the penalties.
However, on Oct. 20, 2017, the Internal Revenue Service said they would be enforcing the penalties.
At this point, I’m not clear on when the new rules apply this year or what would happen to the old penalties.
The executive order was also intended to make plans available across state lines. Another part of the order specified that temporary, non-ACA compliant plans could go up to 12 months.
Al: For our reader’s question, I went on ehealth.com to see what was available.
Please note we cannot recommend any of these plans because they are not ACA-compliant and they have no track record we’ve seen as far as provider networks, claims payments or customer satisfaction.
For our 53 year-old male in Napa, I found a plan for $564.68 per month through a company called Independence American Insurance.
I printed out three pages but couldn’t determine the deductible, maximum out-of-pocket per year, or maximum lifetime benefit.
It did specify that outpatient pharmacy is not covered. Also, there seems to be a membership requirement.