Anthem Blue Cross INDIVIDUAL policyholders (not group or senior) whose plans were effective before October 1, 2010, have recently received a mailing advising them of an opportunity to change their policies to any other open plan within Anthem Blue Cross, and to some closed plans, depending on the plan they currently have. The ability to move to other plans was made possible through a class-action lawsuit filed last fall, following the decision to close plans due to their grandfathered status.

To move to another plan, forms must be completed and received by Anthem between March 1 and March 30, 2011. Premiums for the current plan must be paid to April 1st, at which time the new plan will take effect.

For those who are not sure what to do, this is not the only opportunity. You can keep your present policy and still make a change between now and December 31, 2013, at any future rate increase. Once you have made one policy change, any future changes would require evidence of good health. And remember, you will never have the opportunity to return to your present plan.

What to do?
The best thing to do is to have a 15-minute face-to-face appointment. This is the best option and will guarantee you the best result. These appointments can be made with Susan, with Laurie, or with Steve.

The second best thing is to make a telephone appointment with an agent. Your 15 minutes can be scheduled by calling Pauline at (805) 547-7022. Please tell her that you are an Anthem Blue Cross client and that you need help in choosing a new plan or deciding if moving from your present plan would be beneficial to you. We will then pull your file and have it ready for your call.

If you have a friend or family member who has a Blue Cross plan not through our office, feel free to give him/her our phone number and offer our assistance. This is a very confusing opportunity, and we want to make sure that everyone receives good advice.

We expect rate increases on most Anthem Blue Cross plans to occur on May 1, 2011. Because rate increases now require a 60-day notice, this may be postponed unless you have already received notice.

Please be patient with us during these very turbulent times. We are doing our best to keep up with all the changes and will keep you posted via our website/blog. Please check in to www.susanpolk.com and read our blog for the most recent updates.

Blue Shield of California has announced a rate increase effective March 1, 2011. Rate changes for most plans will average 15%, although the amount of your rate increase will depend on your age, gender, the plan you have, and the area you live in.
Why is this happening, and why is Blue Shield not deferring this rate increase as requested by Dave Jones, California Insurance Commissioner?
First, let’s give you some background on the way rate increases have been handled in the past. Typically, California health insurers have increased rates once a year, with Blue Cross raising rates in March and Blue Shield raising rates in July. These are the “trend increases,” or what you would call increases for medical inflation, new technology, and increased utilization. You may also receive a rate increase based on your migrating from one age category to another. So, for example, if you turn 50 in March, you could see a rate increase in April in addition to the annual rate increase that would happen in July.
Second, let’s review what happened last year in regards to California insurers. As you may recall, Anthem Blue Cross was in the news in early 2010, due to a large rate increase, which was as high as 59% for some plans. In fact, many attribute the successful passage of the Patient Affordability Act (PPACA) as backlash to the furor over this rate increase. Blue Cross was asked to defer their rate increase for 60 days while an independent actuary reviewed the statistics. They found that there were indeed some errors in their calculations, and they revised their rate increase accordingly. Their rate increase was deferred from March until it went into effect on September 23, 2010.
Because of this, Blue Shield proactively engaged independent actuaries in the summer, and they deferred their July rate increase until October 1, 2010. So—the rate increase which should have happened in July happened in October. Then, there was another rate “adjustment” in January, which was intended to make all plans gender-neutral. This adjustment was required by Health Care Reform, as beginning January 1st, health insurers could no longer charge more for females than males. In many cases, premiums went down, depending on your age and gender.
Now, Blue Shield is requesting another rate increase, to go into effect March 1, 2011. The California Insurance Commissioner has requested a 60-day delay, but Blue Shield is adamant in its intent to move forward with the rate increase. This tells me that they not only feel that it is necessary, but that they have thoroughly reviewed their statistics and have concluded that it is justified.
You may be asking yourself, “Didn’t Health Care Reform promise that health insurance costs would go down?” There’s been a whole lot of debate over that issue. I can tell you, after reading the entire bill this past summer, that I found little in the bill that would decrease health care costs. Theoretically, just increasing the number of people insured could have a dampening effect on medical inflation, as those insured would not have to subsidize the uninsured. But there’s little in the bill that would decrease the cost. Instead, the Patient Protection and Affordable Care Act (PPACA) primarily increases access and ensures quality. Here’s a blurb just this last week about the cost of health care—
WASHINGTON (AP) — Two of the central promises of President Barack Obama’s health care overhaul law are unlikely to be fulfilled, Medicare’s independent economic expert told Congress on Wednesday.
The landmark legislation probably won’t hold costs down, and it won’t let everybody keep their current health insurance if they like it, Chief Actuary Richard Foster told the House Budget Committee. His office is responsible for independent long-range cost estimates.
So—that brings us back to the present rate increase looming just ahead. Are there still ways to manage rate increases? Should I change plans? Are you still there to help?
Yes, we’re here to help you manage your rate increase and help you decide what to do. Our mission continues to be to help you get the most out of your health care dollars. We’re committed to doing that! Let’s break it down for you—
1. Are you still in the optimal plan? As a rule of thumb, you could benefit by changing plans every two to three years. So, if you haven’t changed plans in the last couple of years, let’s look at doing that. We might move you to a more economical plan in the same company. Sometimes, we can do that without significantly cutting your benefits. Or, we might consider moving you to a different company. Keep in mind, though, that any changes you make might be temporary, as the new plan or new company might have another rate increase shortly.
2. Do you qualify for state programs, such as Healthy Families, for your children? For a complete explanation of the Healthy Families program, including an income chart, visit healthyfamilies.ca.gov.
We have a quoting system on our website to get you started. That address is www.susanpolk.com. You can visit the website and then call us to get our input, or simply call us directly. Here are the direct lines of our individual sales agents—
Laurie Tonegato Customer Service /Agent – 547-7021
Steve Polk Sales Associate– 544-6230
Susan Polk Broker/Owner – 544-6454

Patient Protection and Affordable Care Act – HR 4872 – Amendments – pages 49-55 – October 15, 2010

Miscellaneous provisions

–Student loans are available for institutions outside the United States.
–$50 million in technical assistance is available for institutions to make loans to students.
–For grandfathered plans providing small group insurance, they still have to provide unlimited maximums and dependent care up to age 26.
–Increased allocation to community health centers over what was in the original Act.

Patient Protection and Affordable Care Act – HR 4872 (Amendments) – pages 37-48 – Day 101 – October 13, 2010

–For purposes of the fees imposed on medical device manufacturers, medical devices do not include eyeglasses, contacts, hearing aids, or any device sold directly to consumers for individual use.
–The formula for the tax imposed by the bill on health insurers is revised, with penalties imposed for underpayments.
–An allocation of $500 million per year is made for years 2011-2014, for the community college and career training grant program under the Act.
–$13.5 billion of federal Pell grants are allocated for provisions under the Act.
–$150 million is allocated for the College Access Grant Program for each of years 2010-2014.
–For students with multiple federal loans, there is a provision for consolidation.

Patient Protection and Affordable Care Act – Amendments pages 25-36 – Day 100 – October 12, 2010

Medicaid payments, Fighting Fraud and Abuse and Revenue Raising

–More about Medicaid payments for primary care and hospitals who provide care to the poor.
–Drug rebates are adjusted to extend the life of brand name drugs. Also, the fees on drug manufacturers are revised.
–To fight fraud and abuse, $55 million is allocated for 2011, $30 million for 2013 and 2014, and $20 million for 2015 and 2016.
–DME (Durable medical equipment) payments can be withheld from a supplier for 90 days if abuse is suspected.
–For purposes of a high cost plan for the excise tax, the premiums for an employee must exceed $10,200, and for a family, it must exceed $27,500.
–For unearned income over $200,000 for a single person or $250,000 for a couple, a 3.8% Medicare tax is imposed.

Patient Protection and Affordable Care Act – Day 99 – Amendments Day 2 – Pages 12-24 – October 11, 2010

–Medicare Advantage rates are adjusted from the original act. Rates are based on your rank compared to other states, among other things.
–Disproportionate share hospital payments are adjusted, as are market basket updates, and the payments to long-term care hospitals and inpatient rehabilitation facilities.
–Medicaid expenditures for newly eligible individuals now reimbursed 100% by the federal government for years 2014 to 2016, 95% in 2017, 94% in 2018, and 93% in 2019. For 2020 and beyond, the reimbursement of Medicaid beneficiaries is to be 90%.

HR 4872 – Amendments to Patient Protection and Affordable Care Act – Day 98 – pages 1 – 12 – October 7, 2010

TAX CREDITS AND SUBSIDIES

–The amount of the tax credit is spelled out. It depends on one’s percentage of the federal poverty line.
Up to 133%, the initial premium percentage is 2%
133% to 150%, it is 3% to 4%,
150% to 200%, it is 4% to 6.3%
200% to 250%, it is 6.3% to 8.05%,
250% to 300%, it is 8.05% to 9.5%
300% to 400%, it is 9.5%.
–For those who make less than 250% of the federal poverty line, plans must pay a higher percentage than for other folks. For some, the 90% is increased to 94%; the 80% is increased to 87%; the 70% is increased to 73%. For those who make 250% to 400%, the maximum cost sharing is 70%-30%.
–The penalty for not having health insurance is reduced to $695 for an individual and $325 for a family member.

EMPLOYER RESPONSIBILITY

–For employees who work less than full-time, the number of total monthly part-time hours is divided by 120 to calculate the number of full-time employees.
–When calculating penalties for employees in the Exchange, the first 30 employees are not counted.

ADJUSTED GROSS INCOME

–Adjusted gross income includes income adjusted under Section 911 plus tax-exempt interest.
–Allowance is made for deducting health insurance premiums for dependents even for children under age 27 who are not actually dependents of the parents.
–5% leeway in income allowed for qualification in government programs.

IMPLEMENTATION FUNDING

–$1 billion in implementation funds is allowed.

MEDICARE

–Coverage gap is slowly closed over several years, with a $250 rebate mailed in 2010 for those who reach their coverage gap.
–Beginning in 2011, brand-name drugs are discounted 50% while in the coverage gap.
–Beginning in 2011, a 7% discount is allowed for generic drugs, increasing by 7% each year, until generic drugs will be covered at 25% by 2020.

Patient Protection and Affordable Care Act – paes 2401-2407 Day 97 – October 5, 2010

ADOPTION DEDUCTIONS INCREASED

–The income tax deduction for adoption expenses is increased from $10,000 to $13,170, which will be adjusted annually for inflation.

THIS IS THE END of the Senate Health Bill.
We will start reading and reporting on the Amendments tomorrow.

Patient Protection and Affordable Care Act – pages 2351-2375 – Day 95 – October 3, 2010

–Physicians who receive scholarships or loans may provide their contracted service on a half-time basis.
–$100 million is available to any State who has but one medical and dental school, for the purpose of debt service, construction of, or renovation of a health care facility that provides research, inpatient tertiary care, or outpatient services. The state must provide 60% of the funds.
–Community health centers are to be expanded and sustained, with federal funds as follows:
2011 – $700 million
2012 – $800 million
2013 – $1 billion
2014 – $1.6 billion
2015 – $2.9 billion
–Enhanced funding for the National Health Service Corps is provided enhanced funding as follows:
2011 – $290 million
2012 – $295 million
2013 – $300 million
2014 – $305 million
2015 – $310 million
–In addition, $1.5 billion is to be used for the construction and renovation of community health centers.
–A 3-year demonstration project in up to 10 states is to be funded to provide access to conprehensive health care services to the uninsured at reduced fees. $2 million is available for this purpose.
–Health Care fraud is to be penalized to a greater extent. Sentencing guidelines are to be increased by 2 levels for defendants whose offense is between $1 million and $7 million; by 3 levels for $7 million to $20 million, and by 4 levels for more than $20 million.
–Demonstration grants are available for states wishing to develop an alternative to current tort litigation. Programs must allow for the resolution of disputes while promoting a reduction of health care errors.

Patient Protection and Affordable Care Act – pages 2326-2350 – Day 94 – October 2, 2010

–A Task Force to assess and improve access to health care in the state of Alaska is to be appointed within 45 days of enactment and is to include a representative from the Department of Health and Human Services, Medicare, Indian Health Services, TRICARE, Army, Air Force, and the Department of Veterans Affairs and the Veterans Health Administration. Within 180 days of enactment, the Task Force was to report to Congress on the findings and recommendations and then disband.
–Family Nurse Practitioners are to be trained to perform as primary care providers, and grants are available for that. Preference is to be given to bilingual candidates.
–The Center for Disease Control and Prevention is to establish a national diabetes prevention program aimed at adults at high risk for diabetes.
–The HHS Secretary shall develop a prospective payment system (PPS) for federally qualified health center services, which should equal 100% of the payments under the traditional system.
–A state may award grants to health care providers who treat a high percentage of medically underserved folks.
–Rural physician training grants are available to medical schools who recruit, train, and place doctors in rural and underserved areas.