are based on Expected Claims Payment – actuarial value (AV). (FAQ) This is one way (Scroll down to Standard Benefit Designs) Health Care Reform hopes to make shopping and comparing easier. So, if you get a lower priced plan with less or fewer benefits, co-pays, deductibles you simply pay more when you have a claim. Don’t worry, there is a stop loss – maximum out of pocket OOP, of say $7k so that you won’t break the bank. All plans cover the 10 essential benefits.
- What are the four metal levels?
- Steve Explains Enhanced Silver – CSR Cost Sharing Reductions
- How to find plan that fits budget
- what plan to take if you know you will have a BIG surgery or expense coming up
- Maximum OOP Out of Pocket?
- View our webpage on OOP Maximum Out of Pocket
- Understanding Health Care Costs Health Net
Resources & Links
2017 Plan Booklet – Metal Tiers
One chart for Metal Levels and Enhanced Silver Cost Share Reductions
CMS said it will enforce the Affordable Care Act’s cap on annual out-of-pocket health care spending for individuals, regardless of whether consumers have an individual or family health plan. the rule capped maximum out-of-pocket costs at $6,850 for individual plans and $13,700 for family plans annually. Learn More⇒ Our Rx Page ♦ Modern Health Care 9.15.2015 ♦ Final Market Rules 45 CFR Parts 144, 147, 153, 154, 155, 156 and 158
Bronze – Co Insurance after Deductible?
Covering Costs of High Deductible Plan?
Did you just get a big rate increase on your Silver Plan
with Covered CA
and you make too much $$$ to get subsidies?
Californians who do not get financial help and buy individual coverage directly from their health insurance company with FREE agent support will not be charged the CSR (Cost Sharing Reduction – Enhanced Silver) surcharge.
In addition, Covered California consumers with Silver plans who do not receive financial help to pay their premium can also avoid paying the surcharge by switching to a different metal tier or buying near-identical Silver coverage directly from a health insurance company, with Free Agent Support. Covered California has approximately 65,000 unsubsidized consumers enrolled in Silver plans. Covered CA Press Release 10.11.2017
What are Covered California standard benefit designs?
Health insurance plans must follow Covered California’s standard benefit designs. With standardized benefits, consumers can accurately compare health insurance plans, because the benefits are the same for all plans offered in the Covered California marketplace. Additionally, standardizing benefits ensures that the selected health insurance plans define what the consumers get and limit the consumer’s out-of-pocket costs by type of service.
There is also a Catastrophic level, (high deductible) that one can qualify for, if they are under 30 or the premium is unaffordable as being more than 8% of income. Open Congress.org Blue Cross Blue Shield Blue Shield Catastrophic plan Email us for rates. [email protected]
AB 639 (Chaptered) would Prohibit any [Insurance] product from being offered other than those with a standardized product design [metal level] in the family market. Sounds like what we have with Medi Gap policies. Get the most recent status at http://leginfo.legislature.ca.gov/
I agree it will stifle innovation, so do you want same o same o or to be able to get a plan that fits your needs. On the other hand isn’t it just a mathematical calculation to see what the actuarial value and essential benefits is? Get a FREE quote for Medical Coverage. Term Life Insurance
§156.140 Metal Levels of coverage.
(a) General requirement for levels of coverage. AV, calculated as described in §156.135 of this subpart, and within a de minimis variation as defined in paragraph (c) of this section, determines whether a health plan offers a bronze, silver, gold, or platinum level of coverage.
(b) The levels of coverage are:
(1) A bronze health plan is a health plan that has an AV of 60 percent.
(2) A silver health plan is a health plan that has an AV of 70 percent.
(3) A gold health plan is a health plan that has an AV of 80 percent.
(4) A platinum health plan is a health plan that has as an AV of 90 percent.
(c) De minimis variation. The allowable variation in the AV of a health plan that does not result in a material difference in the true dollar value of the health plan is ±2 percentage points, except if a health plan under paragraph (b)(1) of this section (a bronze health plan) either covers and pays for at least one major service, other than preventive services, before the deductible or meets the requirements to be a high deductible health plan within the meaning of 26 U.S.C. 223(c)(2), in which case the allowable variation in AV for such plan is −2 percentage points and +5 percentage points.
New Amendment 4.18.2017
(c) De minimis variation. For plan years beginning on or after January 1, 2018, the allowable variation in the AV of a health plan that does not result in a material difference in the true dollar value of the health plan is −4 percentage points and +2 percentage points, except if a health plan under paragraph (b)(1) of this section (a bronze health plan) either covers and pays for at least one major service, other than preventive services, before the deductible or meets the requirements to be a high deductible health plan within the meaning of 26 U.S.C. 223(c)(2), in which case the allowable variation in AV for such plan is −4 percentage points and +5 percentage points.
[78 FR 12866, Feb. 25, 2013, as amended at 81 FR 94180, Dec. 22, 2016] ECFR.Gov
#Report changes as they happen - within 30 days!
10 days for Medi Cal
Our webpage on ARPA & Unemployment Benefits - Silver 94
- Our VIDEO on how to report changes to Covered CA
- Lost your job? How to keep your Health Insurance. Shelter at Home VIDEO
- References & Links
- Here's instructions.
- Our opinion & short cut * 6 pages of questions - way too complicated, easy to mess it up, lose subsidies and/or go into Medi-Cal - Just give the bottom line in MAGI Household Income
- If you've appointed us - instructions - as your broker, no extra charge, we can do it for you.
- Voter Registration
- Task Guide Phone - Voter Registration
- Denial of benefits and possible criminal charges if you don't report changes in income!
- Fudging Income?
- Visit our webpage on how to report changes
No extra charge for complementary assistance
- Appoint us as your broker
- VIDEO on ARPA Stimulus and more Covered CA Subsidies
- Set Consultation Meeting via Phone, Skype or Zoom
- Get Instant Health Quotes, Subsidy Calculation & Enroll
Videos on how great agents are
less than Bronze
One can qualify for the Catastrophic level, Health Care.gov (high deductible) if they are under 30 or the premium is unaffordable as being more than 8% of income, or possibly a hardship exemption. Blue Cross Blue Shield . See the Federal Hardship Exemption Form for more information.
Learn more on HealthCare.gov
- Right-click this exemption application form (PDF) link for hardship exemptions, like homelessness, bankruptcy, eviction, or foreclosure.
- Right-click this exemption application form (PDF) for affordability exemptions AND residency in:
- California, Colorado, District of Columbia, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, Washington
Child & Related Pages
- Enhanced Silver 94, 87, 73 Cost-sharing reductions
- Grand Fathered Plans What does that mean?
- HSA Health Savings Accounts
- OOP -Out of Pocket Maximum – Participating or Not? Deductibles & Co- Pays
- Provider – Doctor & Hospital Finder – no index follow
- Buy Travel & International Insurance – Geo Blue – Insubuy
- Cedar’s Sinai – Thipa – Optum – UCLA – stanford Insurance Plans Accepted
- Medicare Assignment – Doctor Participating or Not?
- Narrow Lists? Fewer MD’s than before? Mirrored Plans?