Thanks to Obama’s Health Care Reform laws and the confusion between grandfathered and non-grandfathered plans, things are a-changing and are difficult for everyone to understand… even for The Insurance Mom!
If you have an individual/family plan with Anthem BC, you recently received a huge mailing full of documents, jargon, pamphlets and choices, oh my!
The documents you’ve received talk about the pre-ObamaCare plans (grandfathered) versus the new ObamaCare plans (non-grandfathered) and what happens if you move from a grandfathered plan to a non-grandfathered plan.
You can stay on your existing policy as long as you like. However, the grandfathered plans don’t include the new federally mandated free preventive care services (your annual check-up). You have the option of moving to a non-grandfathered plan if you want to be able to take advantage of this new benefit (and one or two others). But moving to a different plan could increase your monthly premium. And if you move to a new plan and don’t like it, you can’t have the old one back.
And that, in a nutshell, is what all of those pages say. It boggles the mind, doesn’t it?
Your safest move is to call or e-mail The Insurance Mom for help and guidance.
178 comments
I have Anthem BC/BS KeyCare Health Smart which is grandfathered. Moving to a new plan Smartsense with same deductible would save me approx. $85 / month. Is it wise to move from the grandfathered plan since the new plan is cheaper?
Ron
Hi Ron… Apologies for the delay; The Insurance Mom has been unplugged for a glorious 5 day vacay! Although I am unfamiliar with the plans of insurance in your state, as a general rule I recommend that you always choose a plan that’s easiest to pay for. In my opinion, it’s the monthly budget that’s most important. If you can’t pay the premium, then you won’t have the policy. But, medical expenses — if and when you have them — can be paid off over time. (Not something the providers will necessarily tell you!) If you do wind up having medical expenses, making monthly payments that work for your budget is something over which you have control. Do NOT let a provider’s billing office take control of your money! He who writes the checks has the power… and if making monthly payments on a medical expense works better for you, then that’s what you do. Without asking permission!
I have Anthem BC/BS KeyCare Health Smart which is grandfathered. Moving to a new plan Smartsense with same deductible would save me approx. $85 / month. Is it wise to move from the grandfathered plan since the new plan is cheaper?
Ron
Hi Ron… Apologies for the delay; The Insurance Mom has been unplugged for a glorious 5 day vacay! Although I am unfamiliar with the plans of insurance in your state, as a general rule I recommend that you always choose a plan that’s easiest to pay for. In my opinion, it’s the monthly budget that’s most important. If you can’t pay the premium, then you won’t have the policy. But, medical expenses — if and when you have them — can be paid off over time. (Not something the providers will necessarily tell you!) If you do wind up having medical expenses, making monthly payments that work for your budget is something over which you have control. Do NOT let a provider’s billing office take control of your money! He who writes the checks has the power… and if making monthly payments on a medical expense works better for you, then that’s what you do. Without asking permission!
I’m “grandfathered” with Anthem. I’ve talked 3 times to them and they suggest I stay in my plan. Which is expensive monthly and has a $8,000+ deductable.
To change over they just informed me that “all” coverages will again be raised in 6 mo from today 1-7-13, with no telling the % rate known. I nor does anyone else seem to know what these rate changes will be if we stay Grandfathered or move, much less after the Health CAre Refoem takes place. Is it best to leave the “grandfathered” or stay.
I do not feel Blue Cross is actually telling me enough to make a prudent decision. All web sites on Feller/Anthem are more confusing on the best plan of action. Or rate changes after 6 months from now.
Any Advice or people to call?
Debra
Hi Debra…
Thanks SO much for visiting The Insurance Mom!
Of course the insurance company is going to recommend you stay on an expensive plan! All of the insurance companies are in profit making mode. Due to the Affordable Care Act, there are going to be so many changes coming this year that the companies are doing whatever they can to rake in the dough (IMHO, naturally).
That doesn’t necessarily mean that’s a good thing for you and your cash flow, though. Because there are no new people enrolling in these older plans, the risk pool shrinks. As the risk pool shrinks, the rates go up… way up. More and more of The Insurance Mom’s clients are moving away from the grandfathered plans for newer, less expensive plans. After all, if you can’t afford the monthly premium then, chances are, you won’t keep the policy which, in turn, puts you at greater financial risk. An affordable health insurance plan is always the way to go!
The newer plans include benefits that the older plans don’t, such as full preventive care and generic birth control, both paid 100% by the insurance company (but be sure to see an in-network provider for the check-up!).
Also, I think the rates for the grandfathered plans are going to skyrocket as we get closer to the launch of the ACA 1/1/14 (perhaps more than the newer plans). By the way, the Affordable Care Act is going to be anything BUT affordable! Watch out, it’s going to get messy and pricey!
Yes, I do know who you should call. The Insurance Mom, of course!
I’m “grandfathered” with Anthem. I’ve talked 3 times to them and they suggest I stay in my plan. Which is expensive monthly and has a $8,000+ deductable.
To change over they just informed me that “all” coverages will again be raised in 6 mo from today 1-7-13, with no telling the % rate known. I nor does anyone else seem to know what these rate changes will be if we stay Grandfathered or move, much less after the Health CAre Refoem takes place. Is it best to leave the “grandfathered” or stay.
I do not feel Blue Cross is actually telling me enough to make a prudent decision. All web sites on Feller/Anthem are more confusing on the best plan of action. Or rate changes after 6 months from now.
Any Advice or people to call?
Debra
Hi Debra…
Thanks SO much for visiting The Insurance Mom!
Of course the insurance company is going to recommend you stay on an expensive plan! All of the insurance companies are in profit making mode. Due to the Affordable Care Act, there are going to be so many changes coming this year that the companies are doing whatever they can to rake in the dough (IMHO, naturally).
That doesn’t necessarily mean that’s a good thing for you and your cash flow, though. Because there are no new people enrolling in these older plans, the risk pool shrinks. As the risk pool shrinks, the rates go up… way up. More and more of The Insurance Mom’s clients are moving away from the grandfathered plans for newer, less expensive plans. After all, if you can’t afford the monthly premium then, chances are, you won’t keep the policy which, in turn, puts you at greater financial risk. An affordable health insurance plan is always the way to go!
The newer plans include benefits that the older plans don’t, such as full preventive care and generic birth control, both paid 100% by the insurance company (but be sure to see an in-network provider for the check-up!).
Also, I think the rates for the grandfathered plans are going to skyrocket as we get closer to the launch of the ACA 1/1/14 (perhaps more than the newer plans). By the way, the Affordable Care Act is going to be anything BUT affordable! Watch out, it’s going to get messy and pricey!
Yes, I do know who you should call. The Insurance Mom, of course!
Hi Mom,
My wife and I are 57 and have a grandfathered California Blue Cross plan that will see a 24.2% increase starting 2/1/13. B/X says we can switch to a Serencsa settlement non-grandfathered plan that is good until the end of the year. It would reduce our monthly premiums a lot ($200 mo.) but the B/X rep warned that our premiums could double or triple once the settlement is over. We are self-employed and gross $65K a year. After business expenses we are dirt poor. The Blue Cross rep implied that if our gross income was under $60K there may be a low income discounts but we don’t qualify. However, under the Affordable Care Act on 1/1/14 it appears there may be subsidies or credits that could help people like us. We are going to switch our grandfathered plan to a Senencsa settlement plan. We know we can save a couple thousand dollars this year by doing so. The Blue Cross rep recommended that we hold on to our grandfathered plan to see what the rates will be towards the end of the year but I don’t see the benefit of doing so. Any comments on our logic would be appreciated.
Mark
Hi Mark…
I’ve always said it is most important to focus on your monthly budget. If you can’t afford to pay for a plan then chances are you won’t keep it for very long. You want a plan that’s going to fit into your monthly budget easily and have a good balance with the total financial exposure including the deductible and co-pay maximum. I don’t know many people who are staying in the old grandfathered plans. Too expensive! And they don’t have to conform with the federal mandates regarding preventive care. So go with a plan that’s easy to afford. Medical expenses can always be paid off over time if and when you have them.
Hi Mom,
My wife and I are 57 and have a grandfathered California Blue Cross plan that will see a 24.2% increase starting 2/1/13. B/X says we can switch to a Serencsa settlement non-grandfathered plan that is good until the end of the year. It would reduce our monthly premiums a lot ($200 mo.) but the B/X rep warned that our premiums could double or triple once the settlement is over. We are self-employed and gross $65K a year. After business expenses we are dirt poor. The Blue Cross rep implied that if our gross income was under $60K there may be a low income discounts but we don’t qualify. However, under the Affordable Care Act on 1/1/14 it appears there may be subsidies or credits that could help people like us. We are going to switch our grandfathered plan to a Senencsa settlement plan. We know we can save a couple thousand dollars this year by doing so. The Blue Cross rep recommended that we hold on to our grandfathered plan to see what the rates will be towards the end of the year but I don’t see the benefit of doing so. Any comments on our logic would be appreciated.
Mark
Hi Mark…
I’ve always said it is most important to focus on your monthly budget. If you can’t afford to pay for a plan then chances are you won’t keep it for very long. You want a plan that’s going to fit into your monthly budget easily and have a good balance with the total financial exposure including the deductible and co-pay maximum. I don’t know many people who are staying in the old grandfathered plans. Too expensive! And they don’t have to conform with the federal mandates regarding preventive care. So go with a plan that’s easy to afford. Medical expenses can always be paid off over time if and when you have them.
Hi,
I’m part of the open enrollment by Blue Cross because of the Feller/Freed settlement. I have a PPO 8850 deductible plan. If I change my plan by February 1 there is no medical underwriting. I can save a little money now but have herd in 2014 there won’t be plans that have deductibles higher than 2500. If that is the case the premium on any new plan is going to go way up. Have you herd anything about this? Should I change plans now to take advantage of no medical exam or stay with my current closed plan?
Thank you
Hi Jeff…
Thanks SO much for finding The Insurance Mom!
I always recommend that you have a plan of insurance that easily fits into your monthly budget. If you can’t pay the monthly premium chances are you won’t keep the coverage. So go with a plan that’s easiest to pay for. Medical expenses — if you have them — can always be paid off over time.
Due to the Affordable Care Act (ACA), the landscape of health insurance will be a moving target for a while. As the regulations get written and released by HHS, and as the insurance companies design their products to conform to the new guidelines and mandates, benefits and prices will change dramatically. We’ll know more by mid-year, I’m sure.
Yes, deductibles will be lower and chances are prices will be higher for most age groups.
Once we have definitive information from HHS (at least information that doesn’t keep changing!) and from the insurance companies, The Insurance Mom will let everyone know. So stay tuned here!
Hi,
I’m part of the open enrollment by Blue Cross because of the Feller/Freed settlement. I have a PPO 8850 deductible plan. If I change my plan by February 1 there is no medical underwriting. I can save a little money now but have herd in 2014 there won’t be plans that have deductibles higher than 2500. If that is the case the premium on any new plan is going to go way up. Have you herd anything about this? Should I change plans now to take advantage of no medical exam or stay with my current closed plan?
Thank you
Hi Jeff…
Thanks SO much for finding The Insurance Mom!
I always recommend that you have a plan of insurance that easily fits into your monthly budget. If you can’t pay the monthly premium chances are you won’t keep the coverage. So go with a plan that’s easiest to pay for. Medical expenses — if you have them — can always be paid off over time.
Due to the Affordable Care Act (ACA), the landscape of health insurance will be a moving target for a while. As the regulations get written and released by HHS, and as the insurance companies design their products to conform to the new guidelines and mandates, benefits and prices will change dramatically. We’ll know more by mid-year, I’m sure.
Yes, deductibles will be lower and chances are prices will be higher for most age groups.
Once we have definitive information from HHS (at least information that doesn’t keep changing!) and from the insurance companies, The Insurance Mom will let everyone know. So stay tuned here!
Hi Alison:
Thank you for this conversation – very helpful. My husband and I are planning to get pregnant this year with our second child and so I called Anthem looking for a lower deductible and out-of-pocket expense since I knew I’d be accruing tens of thousands on prenatal costs so would easily meet a deductible. Currently I’m in a grandfathered plan that already offers 100% preventative care. The deductible is $5000 with no other out-of-poccket expense and the premium is $328. The only other Anthem plan that would save me money annually is a non-grandfathered plan that costs $287 a month with a $5000 deductible – a $41 monthly savings in premium and a $900 annual savings in deductible/out of pocket expense. By the way, we have no trouble currently paying our premium. After adding up the savings on deductible, monthly premium and other minor benefits, we’d save about $1500 on this new plan for this year if I get pregnant. However, the Anthem health advisors are recommending that I do *not* switch for this fairly minor savings because if I leave my grandfathered plan, I can never go back and the new non-grandfathered plan could change a lot come 2014 and the premiums could go way up and I could ultimately pay more. They recommend that I stick with what I know and then see what happens in October when the news rules/plans emerge. By that time though, I (hopefully) would have already been several months pregnant and this whole issue would be moot. So I sort of need to decide now. Thanks so much for any advice.
Hi Lily,
Thanks so much for visiting The Insurance Mom!
The best way to compare plans is to calculate all of the known maximum costs in each plan and see where you come out ahead. So… take the monthly premium and multiply by 12 (to get the annualized cost), add the deductible and maximum co-pays (the out-of-pocket maximum). Compare the totals.
You’ll get to decide where you want to spend your money — either in lower premiums and slightly higher medical expenses, or higher premiums and slightly lower medical expenses. The choice is yours. Personally, I think most of The Insurance Mom’s lovely clients want to keep their monthly overhead as low as possible, so I always recommend a plan with a higher deductible.
As far as keeping a grandfathered plan (one which was purchased prior to the Affordable Care Act of 3/23/10), it makes sense to me that the insurance companies are recommending that you keep it… they make a lot more money! But, these days, I don’t see the sense of keeping a more expensive plan. Assuming that the rest of the ACA is launched 10/1/13, for enrollments starting on 1/1/14, all plans on the market are going to change, every single one. Premiums are likely to change in a BIG way too! If you want to save money now, then change your plan now and be a good money manager now.
There’s just no telling how things will evolve over the next nine months!
Hi Alison:
Thank you for this conversation – very helpful. My husband and I are planning to get pregnant this year with our second child and so I called Anthem looking for a lower deductible and out-of-pocket expense since I knew I’d be accruing tens of thousands on prenatal costs so would easily meet a deductible. Currently I’m in a grandfathered plan that already offers 100% preventative care. The deductible is $5000 with no other out-of-poccket expense and the premium is $328. The only other Anthem plan that would save me money annually is a non-grandfathered plan that costs $287 a month with a $5000 deductible – a $41 monthly savings in premium and a $900 annual savings in deductible/out of pocket expense. By the way, we have no trouble currently paying our premium. After adding up the savings on deductible, monthly premium and other minor benefits, we’d save about $1500 on this new plan for this year if I get pregnant. However, the Anthem health advisors are recommending that I do *not* switch for this fairly minor savings because if I leave my grandfathered plan, I can never go back and the new non-grandfathered plan could change a lot come 2014 and the premiums could go way up and I could ultimately pay more. They recommend that I stick with what I know and then see what happens in October when the news rules/plans emerge. By that time though, I (hopefully) would have already been several months pregnant and this whole issue would be moot. So I sort of need to decide now. Thanks so much for any advice.
Hi Lily,
Thanks so much for visiting The Insurance Mom!
The best way to compare plans is to calculate all of the known maximum costs in each plan and see where you come out ahead. So… take the monthly premium and multiply by 12 (to get the annualized cost), add the deductible and maximum co-pays (the out-of-pocket maximum). Compare the totals.
You’ll get to decide where you want to spend your money — either in lower premiums and slightly higher medical expenses, or higher premiums and slightly lower medical expenses. The choice is yours. Personally, I think most of The Insurance Mom’s lovely clients want to keep their monthly overhead as low as possible, so I always recommend a plan with a higher deductible.
As far as keeping a grandfathered plan (one which was purchased prior to the Affordable Care Act of 3/23/10), it makes sense to me that the insurance companies are recommending that you keep it… they make a lot more money! But, these days, I don’t see the sense of keeping a more expensive plan. Assuming that the rest of the ACA is launched 10/1/13, for enrollments starting on 1/1/14, all plans on the market are going to change, every single one. Premiums are likely to change in a BIG way too! If you want to save money now, then change your plan now and be a good money manager now.
There’s just no telling how things will evolve over the next nine months!
Hello Insurance Mom,
Based on the messages above. It appears there is probably NO real benefit to staying in a GRANDFATHERED Plan…
My premiums for a 2500D are $790 as of end of 2012. Rates have increased dramatically with no reason on my end (good health). I am in IndividualBlueAccess which they do not sell anymore and do not include the new preventative services. All doc appts go towards my 2500D. So…before I make a change…are there any GOOD reasons to keep a GRANDFATHERED PLAN? What Benefits are there for GRANDFATHERED PLANS for a consumer? Premiums have risen yet coverage has not increased. WHY would anyone want to stay in a GRANDFATHERED PLAN? It does pay for all my medical expenses and perscriptions after I hit my 2500D. Should I keep or should I switch?
Hi Mary…
How clever of you to visit The Insurance Mom! Good job!
When the Affordable Care Act was passed on 3/23/10, I told everyone who would listen (did you hear me?) that the immediate effect would be skyrocketing premiums on all policies. IMHO, there is nothing affordable about the Affordable Care Act. All of the companies in the country went into overdrive profit making mode to prepare for the onslaught of 1/1/14 when the rest of the ACA launches.
As far as keeping a grandfathered plan (one which was purchased prior to the Affordable Care Act of 3/23/10), I agree that it no longer makes good financial sense. These days, I don’t see the sense of keeping a more expensive plan. Nor do I see the wisdom of staying in a grandfathered plan. Assuming that the rest of the ACA is launched 10/1/13, for enrollments starting on 1/1/14, all plans on the market are going to change, every single one. Premiums are likely to change in a BIG way too! If you want to save money now, then change your plan now and be a good money manager now.
Hello Insurance Mom,
Based on the messages above. It appears there is probably NO real benefit to staying in a GRANDFATHERED Plan…
My premiums for a 2500D are $790 as of end of 2012. Rates have increased dramatically with no reason on my end (good health). I am in IndividualBlueAccess which they do not sell anymore and do not include the new preventative services. All doc appts go towards my 2500D. So…before I make a change…are there any GOOD reasons to keep a GRANDFATHERED PLAN? What Benefits are there for GRANDFATHERED PLANS for a consumer? Premiums have risen yet coverage has not increased. WHY would anyone want to stay in a GRANDFATHERED PLAN? It does pay for all my medical expenses and perscriptions after I hit my 2500D. Should I keep or should I switch?
Hi Mary…
How clever of you to visit The Insurance Mom! Good job!
When the Affordable Care Act was passed on 3/23/10, I told everyone who would listen (did you hear me?) that the immediate effect would be skyrocketing premiums on all policies. IMHO, there is nothing affordable about the Affordable Care Act. All of the companies in the country went into overdrive profit making mode to prepare for the onslaught of 1/1/14 when the rest of the ACA launches.
As far as keeping a grandfathered plan (one which was purchased prior to the Affordable Care Act of 3/23/10), I agree that it no longer makes good financial sense. These days, I don’t see the sense of keeping a more expensive plan. Nor do I see the wisdom of staying in a grandfathered plan. Assuming that the rest of the ACA is launched 10/1/13, for enrollments starting on 1/1/14, all plans on the market are going to change, every single one. Premiums are likely to change in a BIG way too! If you want to save money now, then change your plan now and be a good money manager now.
Wish I would have found you … 2 years ago. Out of fear of making changes and not knowing the impact of change…I have lost a great deal of money. Oh well…live and learn.
I love your website (brand) perfect for this industry. (Friendly and Helpful). Nice Job! Nice Service…
Awwww… so lovely! The Insurance Mom is also well-versed in life insurance and long term care insurance too! Let me know your FAQs. And thanks so much for visiting.
Wish I would have found you … 2 years ago. Out of fear of making changes and not knowing the impact of change…I have lost a great deal of money. Oh well…live and learn.
I love your website (brand) perfect for this industry. (Friendly and Helpful). Nice Job! Nice Service…
Awwww… so lovely! The Insurance Mom is also well-versed in life insurance and long term care insurance too! Let me know your FAQs. And thanks so much for visiting.
No one has mentioned that one of the benefits from the Feller-Freed settlement is that there is a rate cap limiting the amount of future rate increases. With all the unknowns surrounding the current landscape or health insurance I’ve chosen to stay in my closed plan and do my budget around my premium. Just wanted to add to this conversation.
No one has mentioned that one of the benefits from the Feller-Freed settlement is that there is a rate cap limiting the amount of future rate increases. With all the unknowns surrounding the current landscape or health insurance I’ve chosen to stay in my closed plan and do my budget around my premium. Just wanted to add to this conversation.
Hello – I hope you can help. I live in St. Louis, MO and I was diagnosed with CIS ( a precursor to MS) in 2012. I am on meds that cost $60K annually. My Anthem BCBS PPO Insurance and the drug company’s assistance program cover all of it but $35 per month. Whew! I have an individual plan that has a $2500 per person deductible and after it is met, the plan pays 100% – with the exception of co-pays. However, I get free preventative health and generic birth control as well. Premiums for myself and my husband are $1800+ quarterly for health insurance. What can we expect as far as coverage and rate increases in 2014? I am very anxious – as my medications and MRIs every year are very costly, even with our insurance…and I don’t want to have to change my Neurologist because she may become out of network…I hope you can clear this up a bit…Thank you in advance.
-Confused & Scared
Thanks so much for visiting The Insurance Mom!
The Affordable Care Act (some people call it ObamaCare) is here to stay. It is big, it is confusing and it is messy.
The Insurance Mom is in CA, so I can’t give you the specifics of what’s going to happen in MO. What I CAN tell you is that insurance benefits are going to change everywhere. Networks are shrinking. Drug plans are shrinking.
Since MO has elected not to run its own exchange, residents in your state will be using a federally run exchange system as one path to purchase health insurance. If your income is low enough, you may be eligible for a federal subsidy to help you pay for your health insurance. If you don’t qualify for a subsidy, then you’ll buy health insurance on the open market. The plans must be exactly the same as the ones being sold on the exchange, and at the same price.
Find out if Anthem BC/BS in MO will be automatically transferring you to one of the new ACA-compliant plans for 1/1/14. If you don’t like the plan you’re transferred to then you’ll be able to enroll in any other plan on the market in MO.
The open enrollment period starts 10/1/13 and will continue until 3/31/14. Additionally, there will be an annual open enrollment period every year from 10/1 to 12/7. So if you don’t like the plan you’re in you’ll be able to change it.
Talk to your doctors. Find out in what other networks they might be participating. Start planning now, don’t wait until the last minute. This will all sort itself out, but it’s going to take some time.
I highly recommend that you find a licensed, professional, educated, informed broker in your neck of the woods. We are all here to help you! Visit to find a broker in your city.
Hello – I hope you can help. I live in St. Louis, MO and I was diagnosed with CIS ( a precursor to MS) in 2012. I am on meds that cost $60K annually. My Anthem BCBS PPO Insurance and the drug company’s assistance program cover all of it but $35 per month. Whew! I have an individual plan that has a $2500 per person deductible and after it is met, the plan pays 100% – with the exception of co-pays. However, I get free preventative health and generic birth control as well. Premiums for myself and my husband are $1800+ quarterly for health insurance. What can we expect as far as coverage and rate increases in 2014? I am very anxious – as my medications and MRIs every year are very costly, even with our insurance…and I don’t want to have to change my Neurologist because she may become out of network…I hope you can clear this up a bit…Thank you in advance.
-Confused & Scared
Thanks so much for visiting The Insurance Mom!
The Affordable Care Act (some people call it ObamaCare) is here to stay. It is big, it is confusing and it is messy.
The Insurance Mom is in CA, so I can’t give you the specifics of what’s going to happen in MO. What I CAN tell you is that insurance benefits are going to change everywhere. Networks are shrinking. Drug plans are shrinking.
Since MO has elected not to run its own exchange, residents in your state will be using a federally run exchange system as one path to purchase health insurance. If your income is low enough, you may be eligible for a federal subsidy to help you pay for your health insurance. If you don’t qualify for a subsidy, then you’ll buy health insurance on the open market. The plans must be exactly the same as the ones being sold on the exchange, and at the same price.
Find out if Anthem BC/BS in MO will be automatically transferring you to one of the new ACA-compliant plans for 1/1/14. If you don’t like the plan you’re transferred to then you’ll be able to enroll in any other plan on the market in MO.
The open enrollment period starts 10/1/13 and will continue until 3/31/14. Additionally, there will be an annual open enrollment period every year from 10/1 to 12/7. So if you don’t like the plan you’re in you’ll be able to change it.
Talk to your doctors. Find out in what other networks they might be participating. Start planning now, don’t wait until the last minute. This will all sort itself out, but it’s going to take some time.
I highly recommend that you find a licensed, professional, educated, informed broker in your neck of the woods. We are all here to help you! Visit to find a broker in your city.
My daughter is in her early 30’s and is in school FT and I pay her Anthem BC individual plan policy, which is $500.00 per month. We are in Calif., so she was able to get the plan even with her pre-existing condition, as Calif started that provision sooner than other states. She also gets oral contraceptives for free. Should she switch plans now with Anthem or another company? She is unemployed and is a FT student but will likely be employed in 2-3 years and will likely have an employer paid health plan, as she will be working in a medical laboratory. Thanks for your help.
So good to see you here!
From the sound of things, I would guess that your adult daughter is insured through CA’s Major Risk plan, or even a HIPAA plan. For people with pre-existing conditions, California didn’t start any provision sooner than any other state … but we’ve always had a high risk pool specifically for the uninsurable.
Any minute now, all of the rules are going to change. The Affordable Care Act (ObamaCare) will make health insurance accessible to everyone, regardless of medical histories. As of 10/1/13, plans will be available for enrollment with coverage starting 1/1/14.
Please take a quick look at the easy-to-read one-page piece I put on the home page about the ACA… yes, really, one page!
Perhaps your daughter would like to talk to me personally about her options. She’s welcome to to give me a call on 323-654-2207.
My daughter is in her early 30’s and is in school FT and I pay her Anthem BC individual plan policy, which is $500.00 per month. We are in Calif., so she was able to get the plan even with her pre-existing condition, as Calif started that provision sooner than other states. She also gets oral contraceptives for free. Should she switch plans now with Anthem or another company? She is unemployed and is a FT student but will likely be employed in 2-3 years and will likely have an employer paid health plan, as she will be working in a medical laboratory. Thanks for your help.
So good to see you here!
From the sound of things, I would guess that your adult daughter is insured through CA’s Major Risk plan, or even a HIPAA plan. For people with pre-existing conditions, California didn’t start any provision sooner than any other state … but we’ve always had a high risk pool specifically for the uninsurable.
Any minute now, all of the rules are going to change. The Affordable Care Act (ObamaCare) will make health insurance accessible to everyone, regardless of medical histories. As of 10/1/13, plans will be available for enrollment with coverage starting 1/1/14.
Please take a quick look at the easy-to-read one-page piece I put on the home page about the ACA… yes, really, one page!
Perhaps your daughter would like to talk to me personally about her options. She’s welcome to to give me a call on 323-654-2207.
A friend was insured with what she referred to as ‘Catastrophic Coverage’ – an individual plan with Anthem Blue Cross for a healthy young person. They just cancelled her plan and told her ObamaCare made them do it. Do you have any insights in to what is happening here?
Hello Valerie, and thanks for visiting!
In CA, Anthem BC is not cancelling individual policies. For 1/1/14, Anthem BC is automatically transferring all current subscribers into one of the new plans that will conform to the guidelines of the Affordable Care Act (the ACA, aka ObamaCare).
Because Anthem BC is selling plans in Covered California (the CA exchange), they must, by law, make all of their off-exchange plans exactly the same, and for the same price. So, to comply with the ACA, all subscribers must be on one of these new plans, starting 1/1/14.
Anthem BC subscribers in CA will have 3 choices (and should have received their first mailing by now):
1. Accept the automatic transfer to a new ACA-compliant plan, as is, by 12/15/13
2. Request a transfer to a different Anthem BC plan that complies with the ACA
3. Apply to any other company for an ACA-compliant plan (but Anthem BC won’t tell you this part!)
I hope this clarifies things for you and your friend! You’re welcome to call me directly on 323-654-2207, or shoot me an e-mail to Alison@TheInsuranceMom.com.
A friend was insured with what she referred to as ‘Catastrophic Coverage’ – an individual plan with Anthem Blue Cross for a healthy young person. They just cancelled her plan and told her ObamaCare made them do it. Do you have any insights in to what is happening here?
Hello Valerie, and thanks for visiting!
In CA, Anthem BC is not cancelling individual policies. For 1/1/14, Anthem BC is automatically transferring all current subscribers into one of the new plans that will conform to the guidelines of the Affordable Care Act (the ACA, aka ObamaCare).
Because Anthem BC is selling plans in Covered California (the CA exchange), they must, by law, make all of their off-exchange plans exactly the same, and for the same price. So, to comply with the ACA, all subscribers must be on one of these new plans, starting 1/1/14.
Anthem BC subscribers in CA will have 3 choices (and should have received their first mailing by now):
1. Accept the automatic transfer to a new ACA-compliant plan, as is, by 12/15/13
2. Request a transfer to a different Anthem BC plan that complies with the ACA
3. Apply to any other company for an ACA-compliant plan (but Anthem BC won’t tell you this part!)
I hope this clarifies things for you and your friend! You’re welcome to call me directly on 323-654-2207, or shoot me an e-mail to Alison@TheInsuranceMom.com.
Hello,
Well back in March I emailed you about my grandfathered plan. I attempted to change several times over this past year and Anthem always put “fear” “doubt” into the conversation about changing my plan. “You should hold onto it until we know what the government is going to do”. “Grandfathered” like it was a benefit…but it was not a benefit at all. Between paying high premiums and 2,500 deductible I spent almost 10K a year. The last time I spoke to them they told me my rate was going to most likely go down. I just got a letter and it went up to 935.00 $200 increase. I am livid. So, now that I have vented…what do you recommend. I am 56 female in good health with just allergies and meds to control allergies…flonaise, singular and an inhaler that I purchase a couple times a year. What company should I go with or stay with Anthem. I feel like they took advantage of me. Mary
Hi Mary…
Yes, the whacky world of health insurance is getting whackier! As of this writing (10/11/13), it’s still difficult to know how to advise you. The CA Department of Insurance has not yet completed its review, rewrite, revamp and release of any plans that conform to the Affordable Care Act (ObamaCare). We’re still waiting.
Anything you’re seeing on the market — whether on Covered California (the CA exchange), or off — is not in its final form or at the final price.
Please do give me a call on 323-654-2207 to chat about your personal situation.
Hello,
Well back in March I emailed you about my grandfathered plan. I attempted to change several times over this past year and Anthem always put “fear” “doubt” into the conversation about changing my plan. “You should hold onto it until we know what the government is going to do”. “Grandfathered” like it was a benefit…but it was not a benefit at all. Between paying high premiums and 2,500 deductible I spent almost 10K a year. The last time I spoke to them they told me my rate was going to most likely go down. I just got a letter and it went up to 935.00 $200 increase. I am livid. So, now that I have vented…what do you recommend. I am 56 female in good health with just allergies and meds to control allergies…flonaise, singular and an inhaler that I purchase a couple times a year. What company should I go with or stay with Anthem. I feel like they took advantage of me. Mary
Hi Mary…
Yes, the whacky world of health insurance is getting whackier! As of this writing (10/11/13), it’s still difficult to know how to advise you. The CA Department of Insurance has not yet completed its review, rewrite, revamp and release of any plans that conform to the Affordable Care Act (ObamaCare). We’re still waiting.
Anything you’re seeing on the market — whether on Covered California (the CA exchange), or off — is not in its final form or at the final price.
Please do give me a call on 323-654-2207 to chat about your personal situation.
My ex-husband, who I’ve concerned about, makes about $60K a year now, but it’s a temp. job with no benefits and no assurance it will continue. He lives in San Diego, CA. It looks like he will have to pay $450 or so under Obamacare. Is that right? Or is he figuring it incorrectly? Thanks for any help or insight.
Hi Carol…
Thanks for visiting The Insurance Mom!
I wish I had a definitive answer for you. Sadly, as of this writing, the CA Department of Insurance has not finalized its review, rewrite or release of any plan from any company at any price, from any source, including Covered California (the CA exchange).
We’re waiting. And waiting.
Also, there will be no subsidy available for a single person making $60,000+ a year. Therefore, the new plans and prices will likely cost more for less benefits, have severely smaller provider networks and fewer prescription benefits.
But, hey, everyone can have one!
My ex-husband, who I’ve concerned about, makes about $60K a year now, but it’s a temp. job with no benefits and no assurance it will continue. He lives in San Diego, CA. It looks like he will have to pay $450 or so under Obamacare. Is that right? Or is he figuring it incorrectly? Thanks for any help or insight.
Hi Carol…
Thanks for visiting The Insurance Mom!
I wish I had a definitive answer for you. Sadly, as of this writing, the CA Department of Insurance has not finalized its review, rewrite or release of any plan from any company at any price, from any source, including Covered California (the CA exchange).
We’re waiting. And waiting.
Also, there will be no subsidy available for a single person making $60,000+ a year. Therefore, the new plans and prices will likely cost more for less benefits, have severely smaller provider networks and fewer prescription benefits.
But, hey, everyone can have one!
Mary
It seems your opinion on most “grandfathered” plans is to move and be ready for 2014. I disagree. I have been researching premium costs both on/off the HIX in VA and the rates are truly HIGH and unaffordable!!! I sure hope that Lily (pregnant mom) kept her grandfathered plan as the rates for Marketplace plans will outway most of the benefits/mandates. She is better off with her current plan and so are many others unless they qualify for a subsidy.
Hi Joanna…
Thanks for visiting the cutest website ever!
I can’t comment on “most” grandfathered plans… only those in CA. It’s almost impossible to compare insurance products and prices from one state to another.
However, I can agree with you on one point: There is nothing “affordable” about the Affordable Care Act. The prices are probably going to be more (since most people won’t qualify for a subsidy), the networks are going to be smaller and the drug benefits are going to be less.
Mary
It seems your opinion on most “grandfathered” plans is to move and be ready for 2014. I disagree. I have been researching premium costs both on/off the HIX in VA and the rates are truly HIGH and unaffordable!!! I sure hope that Lily (pregnant mom) kept her grandfathered plan as the rates for Marketplace plans will outway most of the benefits/mandates. She is better off with her current plan and so are many others unless they qualify for a subsidy.
Hi Joanna…
Thanks for visiting the cutest website ever!
I can’t comment on “most” grandfathered plans… only those in CA. It’s almost impossible to compare insurance products and prices from one state to another.
However, I can agree with you on one point: There is nothing “affordable” about the Affordable Care Act. The prices are probably going to be more (since most people won’t qualify for a subsidy), the networks are going to be smaller and the drug benefits are going to be less.
Quick question, does the anthem blue cross, cover or will have all the guidelines to meet the obama care? I need to get insured in my job, and they said if i my insurance does not meet the obama policies, then I will pay a fine, can you please help?
Hello Horacio…
Welcome to The Insurance Mom’s home.
If your employer is providing health insurance through Anthem Blue Cross, and if there are under 50 employees, then Anthem Blue Cross has informed us that their small group plans will comply with the guidelines of the Affordable Care Act (ObamaCare). During your employer’s open enrollment period in 2014, your employer will choose new plans from Anthem BC that comply with the ACA.
The ACA specifies that consumers will pay a fine only if you have NO insurance. It doesn’t matter what kind of insurance you have. It could be provided by your employer or you could buy insurance as an individual.
The fine in 2014 is minimal. The greater of $95 or 1% of your gross income (i.e., if you’re annual income is $40,000, the fine would be $400). The “fine” or “tax” (depending on your point of view!) will be reported when you file your 2014 tax return in 2015.
Your best ally is a licensed, professional, ethical, knowledgeable, educated, experienced agent/broker… like The Insurance Mom! For help finding an awesome agent/broker outside of CA go to http://www.NAHU.org.
Quick question, does the anthem blue cross, cover or will have all the guidelines to meet the obama care? I need to get insured in my job, and they said if i my insurance does not meet the obama policies, then I will pay a fine, can you please help?
Hello Horacio…
Welcome to The Insurance Mom’s home.
If your employer is providing health insurance through Anthem Blue Cross, and if there are under 50 employees, then Anthem Blue Cross has informed us that their small group plans will comply with the guidelines of the Affordable Care Act (ObamaCare). During your employer’s open enrollment period in 2014, your employer will choose new plans from Anthem BC that comply with the ACA.
The ACA specifies that consumers will pay a fine only if you have NO insurance. It doesn’t matter what kind of insurance you have. It could be provided by your employer or you could buy insurance as an individual.
The fine in 2014 is minimal. The greater of $95 or 1% of your gross income (i.e., if you’re annual income is $40,000, the fine would be $400). The “fine” or “tax” (depending on your point of view!) will be reported when you file your 2014 tax return in 2015.
Your best ally is a licensed, professional, ethical, knowledgeable, educated, experienced agent/broker… like The Insurance Mom! For help finding an awesome agent/broker outside of CA go to http://www.NAHU.org.
Hi Alison,
I’m 63 in good health except I have had two back operations in the past 18 months and have had my Blue Cross policy for over 30 years. I’m hoping I won’t need another operation, but with discs, ya never know!
I pay $260/month. Will my plan be going up when BC moves me and all current subscribers into a new plan? Any idea as to how much? I currently have a $5,000 deductible.
BTW, separately, I have a Delta Dental plan thru AARP at $64/month. Will that dental plan rate be going up or is dental insurance not affected by Obamacare?
Thanks!
DL
Hello Dave, and welcome!
If you are insured on an Anthem Blue Cross grandfathered plan — which means that you purchased it prior to 3/23/10 and have NOT upgraded it to any of the newer plans since 3/23/10 — then you will have the option of staying on this plan in 2014.
Or, you can transfer to any of Anthem BC’s new plans that comply with the Affordable Care Act (ObamaCare). Or you can apply for a totally different policy with a completely different company. The open enrollment period goes until 3/31/14. Basically, all plans are going to be mostly, sort of, the same… bronze, silver, gold or platinum.
I don’t know yet what the new rates are going to be for 1/1/14. But you can pretty much count on the new ACA-compliant plans being pricey with smaller, more restricted networks and fewer drug benefits. But, hey, everyone can get one! It may serve you better, for now, to stay with the plan you’ve got… especially if you like your in-network doctors.
I would highly suggest you reach out to your trusted insurance adviser for proper and complete guidance.
No, the ACA won’t affect your dental plan.
Hi Alison,
I’m 63 in good health except I have had two back operations in the past 18 months and have had my Blue Cross policy for over 30 years. I’m hoping I won’t need another operation, but with discs, ya never know!
I pay $260/month. Will my plan be going up when BC moves me and all current subscribers into a new plan? Any idea as to how much? I currently have a $5,000 deductible.
BTW, separately, I have a Delta Dental plan thru AARP at $64/month. Will that dental plan rate be going up or is dental insurance not affected by Obamacare?
Thanks!
DL
Hello Dave, and welcome!
If you are insured on an Anthem Blue Cross grandfathered plan — which means that you purchased it prior to 3/23/10 and have NOT upgraded it to any of the newer plans since 3/23/10 — then you will have the option of staying on this plan in 2014.
Or, you can transfer to any of Anthem BC’s new plans that comply with the Affordable Care Act (ObamaCare). Or you can apply for a totally different policy with a completely different company. The open enrollment period goes until 3/31/14. Basically, all plans are going to be mostly, sort of, the same… bronze, silver, gold or platinum.
I don’t know yet what the new rates are going to be for 1/1/14. But you can pretty much count on the new ACA-compliant plans being pricey with smaller, more restricted networks and fewer drug benefits. But, hey, everyone can get one! It may serve you better, for now, to stay with the plan you’ve got… especially if you like your in-network doctors.
I would highly suggest you reach out to your trusted insurance adviser for proper and complete guidance.
No, the ACA won’t affect your dental plan.
I am self-employed and have been paying Anthem about $125 per month for a high-deductible plan covering me and my 8 year old son. I got notice that my plan was not grandfathered, the cheapest plan available to me (through ehealthinsurance) is also an Anthem plan, high-deductible, for $375 per month. I make more than the minimum for ACA subsidy. Reading news reports on ACA, never seen anyone report a 300% increase. Anthem clearly considers my plan non-Grandfathered, but all I can remember changing since 2010 was the premium inching up. Can I appeal Anthem’s decision to not Grandfather my plan? Any other options Insurance Mom?
Hello Mark…
The grandfathering guidelines are part of the Affordable Care Act and are being enforced by the CA Department of Insurance. Either the plan was purchased prior to 3/23/10 and is, therefore, grandfathered. Or it was purchased after 3/23/10 and is non-grandfathered.
There’s just no way around it.
There will be other options. But not yet. The CA Department of Insurance has NOT yet completed its review, rewrite, revamping, repricing of ANY plan from any company at any price.
However, for new plans that comply with the ACA, you can pretty much count on the prices being higher and the networks being smaller. In my opinion, unless someone qualifies for a subsidy (due to low-ish income), there is nothing affordable about the Affordable Care Act.
I am self-employed and have been paying Anthem about $125 per month for a high-deductible plan covering me and my 8 year old son. I got notice that my plan was not grandfathered, the cheapest plan available to me (through ehealthinsurance) is also an Anthem plan, high-deductible, for $375 per month. I make more than the minimum for ACA subsidy. Reading news reports on ACA, never seen anyone report a 300% increase. Anthem clearly considers my plan non-Grandfathered, but all I can remember changing since 2010 was the premium inching up. Can I appeal Anthem’s decision to not Grandfather my plan? Any other options Insurance Mom?
Hello Mark…
The grandfathering guidelines are part of the Affordable Care Act and are being enforced by the CA Department of Insurance. Either the plan was purchased prior to 3/23/10 and is, therefore, grandfathered. Or it was purchased after 3/23/10 and is non-grandfathered.
There’s just no way around it.
There will be other options. But not yet. The CA Department of Insurance has NOT yet completed its review, rewrite, revamping, repricing of ANY plan from any company at any price.
However, for new plans that comply with the ACA, you can pretty much count on the prices being higher and the networks being smaller. In my opinion, unless someone qualifies for a subsidy (due to low-ish income), there is nothing affordable about the Affordable Care Act.
okay, moma,, another question lol! first thank you for replying I was surprised, okay my employer said that the insurance here where I work does not meet the obama standards, that I will pay a fee, so I assume and was told to get insurance that meets the obama care, the thing is everything is too expensive. I am 25 years old, single, and have a bad knee injury, I am scared to go to the hospital without insurance because I may need surgery, so I am in desperate need of getting insurance, but everyone is so expensvie, I may just apply for medical, and I do not even know how to start with that, I tried to go to your page for the broker, but it would not take met here,
I LIKE surprises, don’t you?!
You will only pay a fine if you are UNinsured in 2014. The ObamaCare guidelines don’t differentiate between individual coverage or employer coverage. As long as you HAVE health insurance you’ll be okay.
Yes, coverage is expensive. And it’s going to get worse.
IF your income is low enough then you MIGHT be eligible for a federal subsidy to help you pay the premiums, depending on how much your employer is contributing to the cost of the group plan. To find out more about Medi-Cal eligibility and how to apply go to .
okay, moma,, another question lol! first thank you for replying I was surprised, okay my employer said that the insurance here where I work does not meet the obama standards, that I will pay a fee, so I assume and was told to get insurance that meets the obama care, the thing is everything is too expensive. I am 25 years old, single, and have a bad knee injury, I am scared to go to the hospital without insurance because I may need surgery, so I am in desperate need of getting insurance, but everyone is so expensvie, I may just apply for medical, and I do not even know how to start with that, I tried to go to your page for the broker, but it would not take met here,
I LIKE surprises, don’t you?!
You will only pay a fine if you are UNinsured in 2014. The ObamaCare guidelines don’t differentiate between individual coverage or employer coverage. As long as you HAVE health insurance you’ll be okay.
Yes, coverage is expensive. And it’s going to get worse.
IF your income is low enough then you MIGHT be eligible for a federal subsidy to help you pay the premiums, depending on how much your employer is contributing to the cost of the group plan. To find out more about Medi-Cal eligibility and how to apply go to .
Hi! I just received a letter from Anthem Blue Cross about my small group plan through my employer in CA. The letter stated something like ‘Because of the requirements of the new laws, we can no longer offer your current Anthem Small group policy. You will receive more information in the future.’ What does this mean? What can we expect? My employer provides this benefit at 100%. I also have a 25 year old son, living at home, earning minimum wage. He is not covered by my insurance. Could you shed some light on these two issues for me, please.
Hello Gwen…
All plans — group or individual — are being replaced (not cancelled like the media is saying! Except for Aetna and UHC which are leaving the CA individual market) by new plans that comply with the regulations of the Affordable Care Act. You won’t be uninsured. You’ll have different insurance.
That bit about “you’ll receive more information … ” simply means that the insurance companies don’t yet have the final green light from the CA Department of Insurance (the CA regulatory body in Sacramento). None of the new products have been released yet in their final form. We’re waiting. And waiting.
You can expect four different levels of benefits — bronze, silver, gold and platinum. There will be various levels of coverage in each metal tier. The costs will increase as you move up through the levels of coverage in each tier.
And then your employer will decide which plans to offer — some or all. When your employer’s group plan renews in 2014, the new plan designs will replace the old ones. (by the way… I think your employer is extraordinarily generous!)
As to your 25 year old son, the Affordable Care Act says he can stay on your policy until age 26. Or, tell him to put on his big-boy pants and call The Insurance Mom for info about getting his very own grown up insurance!
Hi! I just received a letter from Anthem Blue Cross about my small group plan through my employer in CA. The letter stated something like ‘Because of the requirements of the new laws, we can no longer offer your current Anthem Small group policy. You will receive more information in the future.’ What does this mean? What can we expect? My employer provides this benefit at 100%. I also have a 25 year old son, living at home, earning minimum wage. He is not covered by my insurance. Could you shed some light on these two issues for me, please.
Hello Gwen…
All plans — group or individual — are being replaced (not cancelled like the media is saying! Except for Aetna and UHC which are leaving the CA individual market) by new plans that comply with the regulations of the Affordable Care Act. You won’t be uninsured. You’ll have different insurance.
That bit about “you’ll receive more information … ” simply means that the insurance companies don’t yet have the final green light from the CA Department of Insurance (the CA regulatory body in Sacramento). None of the new products have been released yet in their final form. We’re waiting. And waiting.
You can expect four different levels of benefits — bronze, silver, gold and platinum. There will be various levels of coverage in each metal tier. The costs will increase as you move up through the levels of coverage in each tier.
And then your employer will decide which plans to offer — some or all. When your employer’s group plan renews in 2014, the new plan designs will replace the old ones. (by the way… I think your employer is extraordinarily generous!)
As to your 25 year old son, the Affordable Care Act says he can stay on your policy until age 26. Or, tell him to put on his big-boy pants and call The Insurance Mom for info about getting his very own grown up insurance!
Thank you for the information and clarification! I ‘assumed’ and you know what they say about that…that group/employer coverage would remain as-is! So this makes sense now. Yes, my employer is extraordinarily generous (she pays100% of our family premium) and just a great person all around!! I’m blessed!! Can my employer choose to not provide coverage for my son? He came off of the insurance over a year ago because he had a life-changing event take place and now he’s starting over. Thanks again!! Was happy to find your blog!!
Hello again!
If your employer decides not to pay for dependent coverage, that doesn’t mean it’s not being provided. It just means that your employer isn’t paying for it any more. If that happens, then she must treat all employees equally, no discrimination allowed (!).
The CA insurance companies don’t have contracts for “employee only” coverage. They all give the employee the option to include dependents. But it’s up to the employer to decide who’s contributing to the cost of the dependent coverage.
I hope that helps!
Thank you for the information and clarification! I ‘assumed’ and you know what they say about that…that group/employer coverage would remain as-is! So this makes sense now. Yes, my employer is extraordinarily generous (she pays100% of our family premium) and just a great person all around!! I’m blessed!! Can my employer choose to not provide coverage for my son? He came off of the insurance over a year ago because he had a life-changing event take place and now he’s starting over. Thanks again!! Was happy to find your blog!!
Hello again!
If your employer decides not to pay for dependent coverage, that doesn’t mean it’s not being provided. It just means that your employer isn’t paying for it any more. If that happens, then she must treat all employees equally, no discrimination allowed (!).
The CA insurance companies don’t have contracts for “employee only” coverage. They all give the employee the option to include dependents. But it’s up to the employer to decide who’s contributing to the cost of the dependent coverage.
I hope that helps!
That does help!! Thank you for your time!! If he doesn’t end up on my coverage at work, I’ll have him call you!!
That does help!! Thank you for your time!! If he doesn’t end up on my coverage at work, I’ll have him call you!!
Hi Alison,
Thanks for the response.
Our close friend, 70, around the corner from us like me has a grandfathered plan with BC of CA but she’s received the notice/packet fr BC saying her rate is doubling in a month. I haven’t received anything. If mine doubles, I’ll be forced out. If forced out, should I sign up for a low-priced plan with another company? Or should I stay with BC?
Thanks!
Hello again Dave…
I’m curious how your 70 year old friend is still on an individual health insurance plan. Are you sure it’s not a Medicare plan?
By now you should have received mail directly from Anthem BC telling you that subscribers on the old grandfathered plans have the option of staying on those plans next year. You can call the customer service number on your Anthem BC ID card and they’ll be able to tell you the new rate for 2014.
Then you can decide to either: 1) stay on the grandfathered plan; 2) switch to a new Anthem BC plan that conforms to the mandates of the Affordable Care Act (ObamaCare); or, 3) enroll in any other plan from any other company.
If your income is low-ish and you qualify for a subsidy (help from the feds to pay the premium), then you’ll have to enroll in a plan through Covered California (the CA exchange). If you don’t qualify for a subsidy then there is nothing affordable about the Affordable Care Act!
Hi Alison,
Thanks for the response.
Our close friend, 70, around the corner from us like me has a grandfathered plan with BC of CA but she’s received the notice/packet fr BC saying her rate is doubling in a month. I haven’t received anything. If mine doubles, I’ll be forced out. If forced out, should I sign up for a low-priced plan with another company? Or should I stay with BC?
Thanks!
Hello again Dave…
I’m curious how your 70 year old friend is still on an individual health insurance plan. Are you sure it’s not a Medicare plan?
By now you should have received mail directly from Anthem BC telling you that subscribers on the old grandfathered plans have the option of staying on those plans next year. You can call the customer service number on your Anthem BC ID card and they’ll be able to tell you the new rate for 2014.
Then you can decide to either: 1) stay on the grandfathered plan; 2) switch to a new Anthem BC plan that conforms to the mandates of the Affordable Care Act (ObamaCare); or, 3) enroll in any other plan from any other company.
If your income is low-ish and you qualify for a subsidy (help from the feds to pay the premium), then you’ll have to enroll in a plan through Covered California (the CA exchange). If you don’t qualify for a subsidy then there is nothing affordable about the Affordable Care Act!
Hi. Please notify me of follow-up comments by email. Thanks
Hi. Please notify me of follow-up comments by email. Thanks
Hello insurance mom…
I’m trying to decide whether to bail from my individual policy to the exchange (in California) or not.
In our zipcode, only Anthem has an available plan, and I haven’t found any source for the provider network. Do you know of any link or other source for what that might be?
Helloooo!
There is no magic happening with Covered California (the CA exchange). There are no “better” plans there than on the open market. In fact, the Affordable Care Act (ObamaCare) specifically says that the plans ON and OFF the exchange must be identical.
So why shop on an exchange? ONLY if you qualify for a subsidy, which means you have a low-ish income. There is NO other reason to shop on an exchange, NONE; it is simply an enrollment mechanism to an insurance company IF you are subsidy-eligible.
Yes, in Los Angeles County, Anthem Blue Cross will be offering a smaller network called an EPO – Exclusive Provider Organization. The EPO has benefits IN network ONLY; but the network for 2014 will be about 60% of the current PPO. There are NO benefits out of the network EVER. Many major hospitals are NOT in the EPO network, including Cedars-Sinai Hospital.
At the moment Anthem BC has no on-line technology — from any source — available to search the EPO network. You’ll have to ask your fave docs if they’re in the new 2014 Anthem BC Pathway EPO Network. But don’t be surprised if your doctor’s office doesn’t know. Even if you call Anthem BC directly, they probably won’t know either.
There are a couple of other companies in CA that are not selling on Covered CA and that are worth considering. You’re welcome to e-mail me directly for more info.
Hello insurance mom…
I’m trying to decide whether to bail from my individual policy to the exchange (in California) or not.
In our zipcode, only Anthem has an available plan, and I haven’t found any source for the provider network. Do you know of any link or other source for what that might be?
Helloooo!
There is no magic happening with Covered California (the CA exchange). There are no “better” plans there than on the open market. In fact, the Affordable Care Act (ObamaCare) specifically says that the plans ON and OFF the exchange must be identical.
So why shop on an exchange? ONLY if you qualify for a subsidy, which means you have a low-ish income. There is NO other reason to shop on an exchange, NONE; it is simply an enrollment mechanism to an insurance company IF you are subsidy-eligible.
Yes, in Los Angeles County, Anthem Blue Cross will be offering a smaller network called an EPO – Exclusive Provider Organization. The EPO has benefits IN network ONLY; but the network for 2014 will be about 60% of the current PPO. There are NO benefits out of the network EVER. Many major hospitals are NOT in the EPO network, including Cedars-Sinai Hospital.
At the moment Anthem BC has no on-line technology — from any source — available to search the EPO network. You’ll have to ask your fave docs if they’re in the new 2014 Anthem BC Pathway EPO Network. But don’t be surprised if your doctor’s office doesn’t know. Even if you call Anthem BC directly, they probably won’t know either.
There are a couple of other companies in CA that are not selling on Covered CA and that are worth considering. You’re welcome to e-mail me directly for more info.
I’m considering the exchange for a couple of reasons.
. My grandfathered plan is a high deductible plan and is not dissimilar to the silver exchange plan. In some ways, I believe that the silver plan has more benefits.
. I’m considering retiring in 2014 and can basically make my income be anything I like by balancing investments between tax and non-tax deferred vehicles. If my income is too low for the year (and they would shove me into MediCAL) I would just transfer money between account and incur the tax.
My area is Sierra Foothills, so there’s not much in the way of choice here.
I’m considering the exchange for a couple of reasons.
. My grandfathered plan is a high deductible plan and is not dissimilar to the silver exchange plan. In some ways, I believe that the silver plan has more benefits.
. I’m considering retiring in 2014 and can basically make my income be anything I like by balancing investments between tax and non-tax deferred vehicles. If my income is too low for the year (and they would shove me into MediCAL) I would just transfer money between account and incur the tax.
My area is Sierra Foothills, so there’s not much in the way of choice here.
Hello insurance mom,
I was recently changed an extra $100 dollars on my insurance with anthem blue Cross. It’s usually $131.00/mth and increased to $237. I called my insurance company and they said it had something to do with Obamacare, but she wasn’t sure what was going on. When I looked online I saw that people were required to pay pediatric insurance under obamacare even if you don’t have kids. Is there any way to decline this extra charge. I don’t have kids either, so I shouldn’t have to pay for pediatric dental from obamacare. Now I can’t afford to pay for my own dental coverage.
Hi… and thanks SO much for finding The Insurance Mom!
There are thousands of new regulations included in the Affordable Care Act — aka ObamaCare. And one of those happens to be the inclusion of pediatric dental benefits in EVERY plan, whether you like it or not. We’re all paying for kids up to age 19 whose parents want their kids to have clean teeth. No, you can’t decline it. Yes, you have to pay for it.
Overall, however, I’ve never recommended dental insurance as a good use of your money. Generally speaking, if you do the math, paying for a dental plan every month so you can get your semi-annual “free” cleaning, means that the cleanings aren’t “free” — they’re costing you the annual premium you’re paying. Right?
And in the worst case scenario if you have any major dental work done, a PPO dental plan will pay out approximately $1000 – $1500 a year in total benefits. You’re paying a good portion of that in premiums. Is it worth spending around $500-ish a year to get $1000 – $1500 back?
I’m just sayin’ !!
Hello insurance mom,
I was recently changed an extra $100 dollars on my insurance with anthem blue Cross. It’s usually $131.00/mth and increased to $237. I called my insurance company and they said it had something to do with Obamacare, but she wasn’t sure what was going on. When I looked online I saw that people were required to pay pediatric insurance under obamacare even if you don’t have kids. Is there any way to decline this extra charge. I don’t have kids either, so I shouldn’t have to pay for pediatric dental from obamacare. Now I can’t afford to pay for my own dental coverage.
Hi… and thanks SO much for finding The Insurance Mom!
There are thousands of new regulations included in the Affordable Care Act — aka ObamaCare. And one of those happens to be the inclusion of pediatric dental benefits in EVERY plan, whether you like it or not. We’re all paying for kids up to age 19 whose parents want their kids to have clean teeth. No, you can’t decline it. Yes, you have to pay for it.
Overall, however, I’ve never recommended dental insurance as a good use of your money. Generally speaking, if you do the math, paying for a dental plan every month so you can get your semi-annual “free” cleaning, means that the cleanings aren’t “free” — they’re costing you the annual premium you’re paying. Right?
And in the worst case scenario if you have any major dental work done, a PPO dental plan will pay out approximately $1000 – $1500 a year in total benefits. You’re paying a good portion of that in premiums. Is it worth spending around $500-ish a year to get $1000 – $1500 back?
I’m just sayin’ !!
I have Anthem Blue Cross in CA and we were on a non grandfathered plan. Well we got pregnant in October…then our plan switched over automatically to a higher deductible plan after Jan 1st :/ I’m wondering if prenatal visits will now be considered “preventative care” under the Affordable Care Act and will be covered before we meet our deductible??? (wishful thinking)
Hi… and congratulations!
Under the guidelines of the Affordable Care Act (ObamaCare) when you see an in-network provider all prenatal and postnatal care must be paid for by the insurance company. The delivery and hospital charges will be applied to a deductible (if you have one) and processed just like any other illness or injury.
The problem, however, is NOT the plan design. It is the network. The new 2014 Anthem BC network is NOT the same PPO network to which you’ve been accustomed. So be careful! Make sure your fave docs are IN the new 2014 narrowed network from Anthem BC.
I have Anthem Blue Cross in CA and we were on a non grandfathered plan. Well we got pregnant in October…then our plan switched over automatically to a higher deductible plan after Jan 1st :/ I’m wondering if prenatal visits will now be considered “preventative care” under the Affordable Care Act and will be covered before we meet our deductible??? (wishful thinking)
Hi… and congratulations!
Under the guidelines of the Affordable Care Act (ObamaCare) when you see an in-network provider all prenatal and postnatal care must be paid for by the insurance company. The delivery and hospital charges will be applied to a deductible (if you have one) and processed just like any other illness or injury.
The problem, however, is NOT the plan design. It is the network. The new 2014 Anthem BC network is NOT the same PPO network to which you’ve been accustomed. So be careful! Make sure your fave docs are IN the new 2014 narrowed network from Anthem BC.
I am currently with Anthem Blue Cross Calif and have a grandfathered policy. I’ve had it for many, many years.
We are currently thinking about moving house, possibly to a different region (you know how they divide a state into regions for rates). I can’t find anywhere online if that will affect my grandfathered status. I really don’t want to call them and ask Anthem–because I don’t want to be “accidentally” cancelled or receive a huge rate increase.
Can you help sleuth this out?
Thank You
Hi… Thanks SO much for finding The Insurance Mom! Cute, right?
From what we know so far, if you have a grandfathered plan, you can keep it — at least for 2014. Relocating in CA shouldn’t affect the grandfathered status. But… then again… we ARE dealing with the crazy known as the Affordable Care Act (ObamaCare), with the added crazy of the insurance industry.
I can only tell you what I know to be true today!
I am currently with Anthem Blue Cross Calif and have a grandfathered policy. I’ve had it for many, many years.
We are currently thinking about moving house, possibly to a different region (you know how they divide a state into regions for rates). I can’t find anywhere online if that will affect my grandfathered status. I really don’t want to call them and ask Anthem–because I don’t want to be “accidentally” cancelled or receive a huge rate increase.
Can you help sleuth this out?
Thank You
Hi… Thanks SO much for finding The Insurance Mom! Cute, right?
From what we know so far, if you have a grandfathered plan, you can keep it — at least for 2014. Relocating in CA shouldn’t affect the grandfathered status. But… then again… we ARE dealing with the crazy known as the Affordable Care Act (ObamaCare), with the added crazy of the insurance industry.
I can only tell you what I know to be true today!
Hi. I have an Anthem Blue Cross grandfathered plan. I was paying $268 for a plan with a $3500 deductible. I just got a notice that my plan rate is being increased to $333(24.3% more). There is a Covered California plan for $268 with a $2000 deductible. Should I switch?
Hi Paul, and welcome to the home of The Insurance Mom!
To switch, or not to switch, that is the BIG question. And it is the most challenging to answer. For me it’s not just a question of cost, but a question of the networks.
The ONLY reason to shop through Covered CA (the CA exchange) is IF you qualify for a subsidy IF your income is on the low-ish side. If you do NOT qualify for a subsidy, then stay far, far away from Covered CA.
The exact same plans & prices are available on the open market. In fact, there are even some *other* choices if you shop on the open market.
But keep in mind that *only* by staying on your grandfathered plan, will you continue to have access to the full Anthem BC PPO network. That means access to Cedars Sinai Hospital and many of its doctors (if you’re in the LA area) as well as coverage for non-emergencies when you’re traveling to any other state.
IF you change to a new 2014 ACA-compatible plan, you will NOT have the same PPO network. Anthem BC only has the EPO — Exclusive Provider Organization — in LA County. Some other areas of CA have the PPO network, but it is much smaller, skinner, more restrictive than it was previous to the ACA.
If you choose any *other* company (either on or off the exchange) you will only have access to smaller, skinner, more restrictive networks.
So… do you want to just save money? Or do you also want to have continued access to your fave docs? Often, in this new world order, you can’t have both. Before you make *any* changes, be sure that your docs are in the network you’re contemplating.
Hi. I have an Anthem Blue Cross grandfathered plan. I was paying $268 for a plan with a $3500 deductible. I just got a notice that my plan rate is being increased to $333(24.3% more). There is a Covered California plan for $268 with a $2000 deductible. Should I switch?
Hi Paul, and welcome to the home of The Insurance Mom!
To switch, or not to switch, that is the BIG question. And it is the most challenging to answer. For me it’s not just a question of cost, but a question of the networks.
The ONLY reason to shop through Covered CA (the CA exchange) is IF you qualify for a subsidy IF your income is on the low-ish side. If you do NOT qualify for a subsidy, then stay far, far away from Covered CA.
The exact same plans & prices are available on the open market. In fact, there are even some *other* choices if you shop on the open market.
But keep in mind that *only* by staying on your grandfathered plan, will you continue to have access to the full Anthem BC PPO network. That means access to Cedars Sinai Hospital and many of its doctors (if you’re in the LA area) as well as coverage for non-emergencies when you’re traveling to any other state.
IF you change to a new 2014 ACA-compatible plan, you will NOT have the same PPO network. Anthem BC only has the EPO — Exclusive Provider Organization — in LA County. Some other areas of CA have the PPO network, but it is much smaller, skinner, more restrictive than it was previous to the ACA.
If you choose any *other* company (either on or off the exchange) you will only have access to smaller, skinner, more restrictive networks.
So… do you want to just save money? Or do you also want to have continued access to your fave docs? Often, in this new world order, you can’t have both. Before you make *any* changes, be sure that your docs are in the network you’re contemplating.
In December 2012 I purchased health care through an agent from Anthem Blue Cross, a PPO with a 3300 deductible for $178 a month (it went up to $220 that June). When I called my agent to find out how the ACA would effect my non-grandfathered policy, I was told that the policy would basically stay the same but be updated to comply with the ACA. I received info from Anthem on new features such as pediatric dental, but never any prices or details on the policy, so finally I called my agent just before the first of the year and he checked the price for me, it was going up to $285. That did not include a separate $6/month they are now charging me for a separate pediatric dental policy (I don’t even have kids, thank you ACA). Last week I finally received my policy info, after paying two months of inflated premiums, only to find that I am now on an EPO with a $5600 deductible! This feels like such a massive bait and switch… do I have any recourse here?
Hi Robert…
Thanks for finding The Insurance Mom and the cutest website ever!
You have my condolences for your sense of entrapment (manipulation? frustration?) as a result of the Affordable Care Act. It is more than a nightmare. You say that you wanted to keep that non-grandfathered plan (purchased after the ACA was enacted on 3/23/10)? You’re out of luck… the ACA doesn’t allow it. Oh, and those pediatric dental premiums that you’re paying for… again, you’re out of luck, they are a mandatory provision of the ACA.
You wanted choice? Control? A larger network? Lower premiums? Hmmmm… not so much.
Yes, you have some recourse. You don’t have to accept Anthem BC’s automatic transfer to the new ACA-compliant plan. You can choose any other plan offered by Anthem BC. The open enrollment period ends 3/31/14. Between now and then you can enroll in any plan with any company. But beware… most networks have been reduced, shrunken and made anorexic as a direct result of the ACA.
You’re invited to reach out to me directly; I’d be happy to show you some alternatives.
In December 2012 I purchased health care through an agent from Anthem Blue Cross, a PPO with a 3300 deductible for $178 a month (it went up to $220 that June). When I called my agent to find out how the ACA would effect my non-grandfathered policy, I was told that the policy would basically stay the same but be updated to comply with the ACA. I received info from Anthem on new features such as pediatric dental, but never any prices or details on the policy, so finally I called my agent just before the first of the year and he checked the price for me, it was going up to $285. That did not include a separate $6/month they are now charging me for a separate pediatric dental policy (I don’t even have kids, thank you ACA). Last week I finally received my policy info, after paying two months of inflated premiums, only to find that I am now on an EPO with a $5600 deductible! This feels like such a massive bait and switch… do I have any recourse here?
Hi Robert…
Thanks for finding The Insurance Mom and the cutest website ever!
You have my condolences for your sense of entrapment (manipulation? frustration?) as a result of the Affordable Care Act. It is more than a nightmare. You say that you wanted to keep that non-grandfathered plan (purchased after the ACA was enacted on 3/23/10)? You’re out of luck… the ACA doesn’t allow it. Oh, and those pediatric dental premiums that you’re paying for… again, you’re out of luck, they are a mandatory provision of the ACA.
You wanted choice? Control? A larger network? Lower premiums? Hmmmm… not so much.
Yes, you have some recourse. You don’t have to accept Anthem BC’s automatic transfer to the new ACA-compliant plan. You can choose any other plan offered by Anthem BC. The open enrollment period ends 3/31/14. Between now and then you can enroll in any plan with any company. But beware… most networks have been reduced, shrunken and made anorexic as a direct result of the ACA.
You’re invited to reach out to me directly; I’d be happy to show you some alternatives.
I am searching for a cedar, ucla,huntington memorial, city of hope oncological surgeon and having trouble finding one that will take my platinum level Anthem PPO as in-network. They accept the epo, not the ppo. Can I switch? nicole
Hi Nicole, and welcome to the cutest website ever!
Under the guidelines of the Affordable Care Act (ObamaCare), the open enrollment period ends on 3/31/14. Until then you can enroll in any plan you like.
After 3/31/14, the next open enrollment period (or so they say!) will be in November & December, during which time you can change again if you want to.
I hope that helps!
I am searching for a cedar, ucla,huntington memorial, city of hope oncological surgeon and having trouble finding one that will take my platinum level Anthem PPO as in-network. They accept the epo, not the ppo. Can I switch? nicole
Hi Nicole, and welcome to the cutest website ever!
Under the guidelines of the Affordable Care Act (ObamaCare), the open enrollment period ends on 3/31/14. Until then you can enroll in any plan you like.
After 3/31/14, the next open enrollment period (or so they say!) will be in November & December, during which time you can change again if you want to.
I hope that helps!
Hi. I purchased Anthem PPO individual plan in 2012. Since then I have been battling breast cancer and in the middle of a treatments and surgeries with good prognosis of winning this battle. However, my battle continues with the ACA and the Obamacare. I found out that my PPO plan now is an EPO plan and the surgery planned in mid March has been canceled because the surgeon is out of the network. Mia it a good idea to switch plan since open enrollment is until 3/31/14 and I still have few weeks to enroll?
Hello… We’re so happy that you visited The Insurance Mom!
If it were me, I’d want to be in a network that gives me the broadest choices and the most control. In my opinion, that is not an EPO — exclusive provider organization. The EPO is the only network offered by Anthem BC in many counties.
You’re welcome to be in touch and I’d by happy to show you another terrific option.
Hi. I purchased Anthem PPO individual plan in 2012. Since then I have been battling breast cancer and in the middle of a treatments and surgeries with good prognosis of winning this battle. However, my battle continues with the ACA and the Obamacare. I found out that my PPO plan now is an EPO plan and the surgery planned in mid March has been canceled because the surgeon is out of the network. Mia it a good idea to switch plan since open enrollment is until 3/31/14 and I still have few weeks to enroll?
Hello… We’re so happy that you visited The Insurance Mom!
If it were me, I’d want to be in a network that gives me the broadest choices and the most control. In my opinion, that is not an EPO — exclusive provider organization. The EPO is the only network offered by Anthem BC in many counties.
You’re welcome to be in touch and I’d by happy to show you another terrific option.
My family of four have a grandfathered PPO with Anthem Blue of Calif. Can I remove and possible add back later my daughter from the plan without affecting my grandfathered status? Because of the latest Anthem rate hike we are looking to reduce our PPO costs. Our daughter is required to buy her University Calif insurance because our PPO deductible is too high to qualify for an exception. I called and sent messages to Blue Cross without any real answers. Thank you
Hi… Thanks for finding The Insurance Mom!
You can remove a family member from a grandfathered plan. But you can’t put them back on!
In my opinion, there is only one up-side to staying on a grandfathered plan. You will still have access to the largest PPO network. But you will see higher rate increases as time goes on. As the risk pool decreases (because fewer people are on the plan and no new people can enroll) the rates go up. It’s the nature of insurance… any type of insurance.
Hi Insurance Mom,
Anthem BC wrote me a month ago that my new rate as of April 1st will be $49 higher or 18% more. However, now they’re saying in the bill I received from them that the premium is the same as it’s been. What gives?
DL
Hi Dave, this is The Insurance Mom calling…
…without seeing the invoice I can’t begin to fathom why the premium notice from Anthem BC is different from the notification you previously received. But let’s face it. You’re dealing with an insurance company; they make mistakes.
Do you want to notify Anthem BC that they didn’t charge you enough?
Hi Insurance Mom,
I suppose not. $50/month is a lot of dough here!
Dave
My family of four have a grandfathered PPO with Anthem Blue of Calif. Can I remove and possible add back later my daughter from the plan without affecting my grandfathered status? Because of the latest Anthem rate hike we are looking to reduce our PPO costs. Our daughter is required to buy her University Calif insurance because our PPO deductible is too high to qualify for an exception. I called and sent messages to Blue Cross without any real answers. Thank you
Hi… Thanks for finding The Insurance Mom!
You can remove a family member from a grandfathered plan. But you can’t put them back on!
In my opinion, there is only one up-side to staying on a grandfathered plan. You will still have access to the largest PPO network. But you will see higher rate increases as time goes on. As the risk pool decreases (because fewer people are on the plan and no new people can enroll) the rates go up. It’s the nature of insurance… any type of insurance.
Hi Insurance Mom,
Anthem BC wrote me a month ago that my new rate as of April 1st will be $49 higher or 18% more. However, now they’re saying in the bill I received from them that the premium is the same as it’s been. What gives?
DL
Hi Dave, this is The Insurance Mom calling…
…without seeing the invoice I can’t begin to fathom why the premium notice from Anthem BC is different from the notification you previously received. But let’s face it. You’re dealing with an insurance company; they make mistakes.
Do you want to notify Anthem BC that they didn’t charge you enough?
Hi Insurance Mom,
I suppose not. $50/month is a lot of dough here!
Dave
Hi,
I purchased a Blue Shield PPO Silver Plan (Enhanced PPO 150) through the exchange. I used that insurance at USC with no problem, until today when my USC Physical Therapist called me to say that they are no longer in network because my plan “Converted” from Blue Shield PPO to Obamacare. I’m really not sure what this means. I thought I had purchased Blue Shield PPO? I pay through their website. If you could explain to me what this means, I’d really appreciate it!
Hello… We’re happy to see you at the home of The Insurance Mom!
ALL plans on the market today must comply with the mandates of the Affordable Care Act, aka Obamacare. It doesn’t matter where you buy a plan — either through an exchange (in CA that’s Covered California), or on the open market.
The new Blue Shield network for ACA-compliant plans was reduced by 70%. Providers are dropping like flies. It’s possible that when you enrolled in the Blue Shield PPO plan your provider was “in-network” but has since disenrolled.
Your plan didn’t “convert” to anything. If you purchased a plan for coverage starting 1/1/14 or later, it has always been an “Obamacare” plan.
The in/out of network problem is THE biggest challenge of the Affordable Care Act. And, sometimes, there is just no easy solution.
Hi,
I purchased a Blue Shield PPO Silver Plan (Enhanced PPO 150) through the exchange. I used that insurance at USC with no problem, until today when my USC Physical Therapist called me to say that they are no longer in network because my plan “Converted” from Blue Shield PPO to Obamacare. I’m really not sure what this means. I thought I had purchased Blue Shield PPO? I pay through their website. If you could explain to me what this means, I’d really appreciate it!
Hello… We’re happy to see you at the home of The Insurance Mom!
ALL plans on the market today must comply with the mandates of the Affordable Care Act, aka Obamacare. It doesn’t matter where you buy a plan — either through an exchange (in CA that’s Covered California), or on the open market.
The new Blue Shield network for ACA-compliant plans was reduced by 70%. Providers are dropping like flies. It’s possible that when you enrolled in the Blue Shield PPO plan your provider was “in-network” but has since disenrolled.
Your plan didn’t “convert” to anything. If you purchased a plan for coverage starting 1/1/14 or later, it has always been an “Obamacare” plan.
The in/out of network problem is THE biggest challenge of the Affordable Care Act. And, sometimes, there is just no easy solution.
I have a PPO with Anthem. Recently Anthem sent me a letter asking me if I would like to join their “enhanced personal health care” program. What are they asking me to join? I can’t see anything different or better than my current coverage other than the word “enhanced.”
Welcome… come on in!
Marketing. It’s all about the marketing. Nothing more. Something “enhanced” sounds more appealing than “now we’re charging you a higher premium every month and not giving you anything in return.”
I’m just sayin.’
I have a PPO with Anthem. Recently Anthem sent me a letter asking me if I would like to join their “enhanced personal health care” program. What are they asking me to join? I can’t see anything different or better than my current coverage other than the word “enhanced.”
Welcome… come on in!
Marketing. It’s all about the marketing. Nothing more. Something “enhanced” sounds more appealing than “now we’re charging you a higher premium every month and not giving you anything in return.”
I’m just sayin.’
Hello! I am on a grandfathered Anthem Blue Cross individual PPO plan with a $1500 deductible. It’s a great plan but my premium went up to $300 per month. I’d like to just raise my deductible but I’ve been told that will push me out of the gf plan. I am a healthy woman who has one doctor that i’ve been with for 15 years. Other than that I haven’t really used the insurance for anything major. I want to save money every month but I’m afraid if I switch to the new policies to save $50 per month, that premium will eventually go up anyway and I won’t have the access to my current PPO network. But if my current plan keeps rising by 23% I won’t be able to afford it soon. What do you think is the best form of action here? Thank you!
Oh, isn’t health insurance fun? (not!)
Premiums are higher on the lower deductible plans. You pay more per month in exchange for taking less personal responsibility for medical expenses IF they happen (i.e., a lower deductible).
The ONLY way to pay less is to have a higher deductible. If you don’t have a lot of medical needs, you may want to consider a plan with a higher deductible. YOU choose how you want to spend your money: Lower monthly cost/higher medical costs IF they happen. Or higher monthly cost/lower medical costs IF they happen.
If you stay with Anthem BC, and are in LA County, the PPO network is no longer offered on any of the new plans which comply with the Affordable Care Act (ObamaCare “reform”). Also, if you move from a non-grandfathered plan (your old PPO one), to a new ACA-compliant plan, you can’t go back.
Premiums will always be on the rise. It’s the nature of the beast. However, I’ve always said that you should have a plan that’s easiest to pay for… medical expenses may never happen. But if they do then you can always pay them off over time or negotiate with your doctor.
The open enrollment period will start again 11/15/14 at which time you can make whatever changes you like for new coverage to start 1/1/15.
Hello! I am on a grandfathered Anthem Blue Cross individual PPO plan with a $1500 deductible. It’s a great plan but my premium went up to $300 per month. I’d like to just raise my deductible but I’ve been told that will push me out of the gf plan. I am a healthy woman who has one doctor that i’ve been with for 15 years. Other than that I haven’t really used the insurance for anything major. I want to save money every month but I’m afraid if I switch to the new policies to save $50 per month, that premium will eventually go up anyway and I won’t have the access to my current PPO network. But if my current plan keeps rising by 23% I won’t be able to afford it soon. What do you think is the best form of action here? Thank you!
Oh, isn’t health insurance fun? (not!)
Premiums are higher on the lower deductible plans. You pay more per month in exchange for taking less personal responsibility for medical expenses IF they happen (i.e., a lower deductible).
The ONLY way to pay less is to have a higher deductible. If you don’t have a lot of medical needs, you may want to consider a plan with a higher deductible. YOU choose how you want to spend your money: Lower monthly cost/higher medical costs IF they happen. Or higher monthly cost/lower medical costs IF they happen.
If you stay with Anthem BC, and are in LA County, the PPO network is no longer offered on any of the new plans which comply with the Affordable Care Act (ObamaCare “reform”). Also, if you move from a non-grandfathered plan (your old PPO one), to a new ACA-compliant plan, you can’t go back.
Premiums will always be on the rise. It’s the nature of the beast. However, I’ve always said that you should have a plan that’s easiest to pay for… medical expenses may never happen. But if they do then you can always pay them off over time or negotiate with your doctor.
The open enrollment period will start again 11/15/14 at which time you can make whatever changes you like for new coverage to start 1/1/15.
Anthem Blue Cross canceled my individual PPO plan at the end of last year and automatically converted me over to their Pathways PPO plan. I didn’t realize at the time that that little “Pathways” at the bottom of my card was so important. I had checked my clinic’s website and saw that, yes, they still took Anthem BC PPO, so saw no reason to not accept Anthem’s switch. Now, last week, I got a call from my cardiologist’s office just before a visit that they do not accept Pathways PPO. I’m now in a pickle. It seems almost no one in my area accepts Pathways. And I’m outside the open enrollment period. What can I do?
Hi Kingston…
On 1/1/14 Anthem BC transferred you to one of the new ACA-compliant plans. If you’re in Los Angeles County, the plan includes the Pathway EPO — Exclusive Provider Organization — and it’s the only network available from Anthem BC in LA County if you’re on an individual plan. In some other CA regions (the state was divided up into 19 of them), the Pathway PPO is available, but the networks are smaller, skinnier and more restrictive. In either case, EPO or PPO, these new networks are what I call “anorexic.”
Sadly, the Affordable Care Act (ObamaCare “reform”) doesn’t allow any changes off the open enrollment period, which ended 3/31/14. The next open enrollment period starts 11/15/14 for new coverage to start 1/1/15. There are some exceptions, however.
In addition to the exceptions listed here, there is one which is not too widely publicized. IF you have been in treatment within the last 60 days for a life threatening illness or condition with a doctor who dis-enrolls from your network, you might be able to fit into one of these “Life Qualifying Events.” Each insurance company seems to be interpreting the ACA guidelines differently (I guess it depends on their legal teams!).
If these exceptions don’t apply to you, then it breaks my heart to say that you’ll have to wait until November to make any changes in your health insurance.
Thanks for your response. In my case, I’m not sure that my doctor has “dis-enrolled”, since isn’t the Pathway PPO a whole new plan that started 1/1/14, in which case, my doctor never enrolled in that in the first place. Right?
In my case, I get no subsidies whatsoever under ACA. Does that make any difference in terms of my options? At this point, I’d much rather just sign up for Blue Shield PPO since I know that my doctor accepts that. And I’ve been hunting around and simply can’t find a credible cardiologist locally that accepts Pathway PPO. (I’m in Santa Clara county.)
Your original description of your situation is right on the money… you’re definitely in a pickle. And there’s no solution. At least not right now. You’re stuck in your plan until the Fall.
Whether or not you’re eligible for a subsidy (federal premium assistance due to low-ish income) is irrelevant to your situation. Even if you were eligible for a subsidy and were forced to go through Covered CA (the state exchange), you would still not be able to change plans or companies right now. We can begin to look at other options for you starting 11/15/14 for new coverage that will take effect 1/1/15.
Not the news you wanted to hear, I know.
Anthem Blue Cross canceled my individual PPO plan at the end of last year and automatically converted me over to their Pathways PPO plan. I didn’t realize at the time that that little “Pathways” at the bottom of my card was so important. I had checked my clinic’s website and saw that, yes, they still took Anthem BC PPO, so saw no reason to not accept Anthem’s switch. Now, last week, I got a call from my cardiologist’s office just before a visit that they do not accept Pathways PPO. I’m now in a pickle. It seems almost no one in my area accepts Pathways. And I’m outside the open enrollment period. What can I do?
Hi Kingston…
On 1/1/14 Anthem BC transferred you to one of the new ACA-compliant plans. If you’re in Los Angeles County, the plan includes the Pathway EPO — Exclusive Provider Organization — and it’s the only network available from Anthem BC in LA County if you’re on an individual plan. In some other CA regions (the state was divided up into 19 of them), the Pathway PPO is available, but the networks are smaller, skinnier and more restrictive. In either case, EPO or PPO, these new networks are what I call “anorexic.”
Sadly, the Affordable Care Act (ObamaCare “reform”) doesn’t allow any changes off the open enrollment period, which ended 3/31/14. The next open enrollment period starts 11/15/14 for new coverage to start 1/1/15. There are some exceptions, however.
In addition to the exceptions listed here, there is one which is not too widely publicized. IF you have been in treatment within the last 60 days for a life threatening illness or condition with a doctor who dis-enrolls from your network, you might be able to fit into one of these “Life Qualifying Events.” Each insurance company seems to be interpreting the ACA guidelines differently (I guess it depends on their legal teams!).
If these exceptions don’t apply to you, then it breaks my heart to say that you’ll have to wait until November to make any changes in your health insurance.
Thanks for your response. In my case, I’m not sure that my doctor has “dis-enrolled”, since isn’t the Pathway PPO a whole new plan that started 1/1/14, in which case, my doctor never enrolled in that in the first place. Right?
In my case, I get no subsidies whatsoever under ACA. Does that make any difference in terms of my options? At this point, I’d much rather just sign up for Blue Shield PPO since I know that my doctor accepts that. And I’ve been hunting around and simply can’t find a credible cardiologist locally that accepts Pathway PPO. (I’m in Santa Clara county.)
Your original description of your situation is right on the money… you’re definitely in a pickle. And there’s no solution. At least not right now. You’re stuck in your plan until the Fall.
Whether or not you’re eligible for a subsidy (federal premium assistance due to low-ish income) is irrelevant to your situation. Even if you were eligible for a subsidy and were forced to go through Covered CA (the state exchange), you would still not be able to change plans or companies right now. We can begin to look at other options for you starting 11/15/14 for new coverage that will take effect 1/1/15.
Not the news you wanted to hear, I know.
We’ve had Anthem for the family the last 3 years and hardly used it except for checkups and immunizations for our preschooler. Because it’s a high deductible plan we’ve never reached the deductible and always paid for doctors out of pocket. Until this year. My husband had something come up and has seen to the doctor enough times to, I thought, reach his deductible (each visit is $200 a pop, and the deductible is $1000). All the visits were to either our in-network primary care physician but not a single doctor bill has been credited towards the deductible. They all say “denied”. In fact, looking back the previous year, all those charges were denied too. I spent over hour on the phone with Anthem (mostly on hold). The customer service rep says she couldn’t figure out why the charges were denied by Anthem. She said she’d resubmit the claims and I should check back in a few days to see what happens. I recorded the call, just in case. Now, a few days have passed and the charges still have not been credited towards the deductible. I called, and the rep today said there is no record of the claims having been resubmitted. I’m wondering, how exactly do you reach your deductible when nothing actually is a “covered service”? Is Anthem a scam?
Oh dear. I’m so sorry you’re dealing with this insurance mess!
No… not a scam. Although it totally makes sense to me how you’d feel that way. There is a lot of misunderstanding about how doctors bill the insurance companies and charge you for their services.
Doctors charge you TWO separate fees. First, the office visit co-pay is what they charge you just for showing up for the appointment (the consultation). It’s a “co”-pay because it’s an expense you share with the insurance company… they pay the rest. BUT, this office visit fee has NOTHING to do with the medical services rendered to you and does NOT get applied to the deductible. Ever.
The second charge is for the medical services. These charges DO get applied to your deductible, based on the insurance company’s in-network negotiated (discounted) rate. When you look at the Explanations of Benefits (EOBs) from Anthem BC, be sure to read the footnotes. There’s valuable info there. Sometimes “denied” means “not for now because we’ve asked your doc for more info.”
If the insurance company has asked the doctor for more info and your doc hasn’t responded it can cause an awful delay. Ultimately, the claim will simply be closed if the info isn’t received.
Other than a phone convo you had with the Anthem BC rep, do you know for sure that your doctor’s billing service re-submitted the claims to Anthem BC AND used the correct billing codes? Why rely on them? Why not get a copy of all the bills and submit them yourself to Anthem BC so that you’re absolutely sure it’s done? Do you have a copy of everything that the billing service said they sent to Anthem BC?
While I have no problem holding Anthem BC — or any insurance carrier — responsible for the things they do wrong, usually the provider’s office has a big part to play in billing and claims errors.
Thank you so much for replying. What an incredible resource you are. Thank you. I think that must be it. We have no “co-pay”. The insurance is just supposed to pay 100% once we reach our deductible. I will follow up with the provider’s office. I do wish that Anthem would give out the info that you just did. Their customer service rep for example could help here. They could do a lot more walk their deductible customers through the process. I didn’t realize I was responsible for my doctor’s paperwork as well! I certainly will get it from now on.
Hello again. The info I gave you yesterday assumed a traditional PPO plan. From what you’re saying now, I imagine you have an HSA-compatible PPO plan. If that’s the case, then ALL of your expenses for the entire household — office visits, prescriptions and services — are applied to one common deductible. There are NO co-pays. In other words, you never share expenses with an insurance company. Either you’re paying 100% or they are, after you meet the deductible in a calendar year.
The in-network PPO discounts still apply. And if your doc is IN-network, they MUST take responsibility for filing claims correctly, no matter how many times it takes to get it right. They don’t have a choice, it is a contractual obligation between the providers and the insurance company. I suggested that you also file the claim so that you have some control over the process.
I recommend that you request a “claims summary” from Anthem BC for last year and year-to-date for 2014. That way you’ll see a list of claims received, processed and paid (or not).
More… If your doc is IN-network, they are NOT allowed to charge you more than the in-network negotiated rate (the discount). If you’re paying $200 per visit you may very well be over-paying. Personally, I never pay for stuff at the time of the visit. I always wait for the claim to be processed so I know what the negotiated rate is. That’s when I pay the doctor.
More… if your plan IS HSA compatible, have you opened and funded your Health Savings Account? If so, then your tax-free dollars can be used to pay these medical expenses.
We’ve had Anthem for the family the last 3 years and hardly used it except for checkups and immunizations for our preschooler. Because it’s a high deductible plan we’ve never reached the deductible and always paid for doctors out of pocket. Until this year. My husband had something come up and has seen to the doctor enough times to, I thought, reach his deductible (each visit is $200 a pop, and the deductible is $1000). All the visits were to either our in-network primary care physician but not a single doctor bill has been credited towards the deductible. They all say “denied”. In fact, looking back the previous year, all those charges were denied too. I spent over hour on the phone with Anthem (mostly on hold). The customer service rep says she couldn’t figure out why the charges were denied by Anthem. She said she’d resubmit the claims and I should check back in a few days to see what happens. I recorded the call, just in case. Now, a few days have passed and the charges still have not been credited towards the deductible. I called, and the rep today said there is no record of the claims having been resubmitted. I’m wondering, how exactly do you reach your deductible when nothing actually is a “covered service”? Is Anthem a scam?
Oh dear. I’m so sorry you’re dealing with this insurance mess!
No… not a scam. Although it totally makes sense to me how you’d feel that way. There is a lot of misunderstanding about how doctors bill the insurance companies and charge you for their services.
Doctors charge you TWO separate fees. First, the office visit co-pay is what they charge you just for showing up for the appointment (the consultation). It’s a “co”-pay because it’s an expense you share with the insurance company… they pay the rest. BUT, this office visit fee has NOTHING to do with the medical services rendered to you and does NOT get applied to the deductible. Ever.
The second charge is for the medical services. These charges DO get applied to your deductible, based on the insurance company’s in-network negotiated (discounted) rate. When you look at the Explanations of Benefits (EOBs) from Anthem BC, be sure to read the footnotes. There’s valuable info there. Sometimes “denied” means “not for now because we’ve asked your doc for more info.”
If the insurance company has asked the doctor for more info and your doc hasn’t responded it can cause an awful delay. Ultimately, the claim will simply be closed if the info isn’t received.
Other than a phone convo you had with the Anthem BC rep, do you know for sure that your doctor’s billing service re-submitted the claims to Anthem BC AND used the correct billing codes? Why rely on them? Why not get a copy of all the bills and submit them yourself to Anthem BC so that you’re absolutely sure it’s done? Do you have a copy of everything that the billing service said they sent to Anthem BC?
While I have no problem holding Anthem BC — or any insurance carrier — responsible for the things they do wrong, usually the provider’s office has a big part to play in billing and claims errors.
Thank you so much for replying. What an incredible resource you are. Thank you. I think that must be it. We have no “co-pay”. The insurance is just supposed to pay 100% once we reach our deductible. I will follow up with the provider’s office. I do wish that Anthem would give out the info that you just did. Their customer service rep for example could help here. They could do a lot more walk their deductible customers through the process. I didn’t realize I was responsible for my doctor’s paperwork as well! I certainly will get it from now on.
Hello again. The info I gave you yesterday assumed a traditional PPO plan. From what you’re saying now, I imagine you have an HSA-compatible PPO plan. If that’s the case, then ALL of your expenses for the entire household — office visits, prescriptions and services — are applied to one common deductible. There are NO co-pays. In other words, you never share expenses with an insurance company. Either you’re paying 100% or they are, after you meet the deductible in a calendar year.
The in-network PPO discounts still apply. And if your doc is IN-network, they MUST take responsibility for filing claims correctly, no matter how many times it takes to get it right. They don’t have a choice, it is a contractual obligation between the providers and the insurance company. I suggested that you also file the claim so that you have some control over the process.
I recommend that you request a “claims summary” from Anthem BC for last year and year-to-date for 2014. That way you’ll see a list of claims received, processed and paid (or not).
More… If your doc is IN-network, they are NOT allowed to charge you more than the in-network negotiated rate (the discount). If you’re paying $200 per visit you may very well be over-paying. Personally, I never pay for stuff at the time of the visit. I always wait for the claim to be processed so I know what the negotiated rate is. That’s when I pay the doctor.
More… if your plan IS HSA compatible, have you opened and funded your Health Savings Account? If so, then your tax-free dollars can be used to pay these medical expenses.
The rates for my grandfathered plan have gone sky high. I need to insure against major accidents which would wipe me out both physically and financially. Are there any catastrophic plans with large networks?
The rates for my grandfathered plan have gone sky high. I need to insure against major accidents which would wipe me out both physically and financially. Are there any catastrophic plans with large networks?
Mom, I’ve had my daughter enrolled in anthem bc 3500 ppo since 2009. She had a baby in January and added the baby that same month. Recently I have been helping her try to understand why she is paying in full for her baby’s immunizations, approx.$550 per immunization visit(3 so far).
I have called customer service 4 times to find out they have no idea what they are talking about. They, as I, assumed that immunizations would be covered. Finally I was directed to healthy vouchers and spoke to a lady who said that Grandfathered in policies do not pay for current immunizations. Say what??? The following immunizations are covered by BC: tetanus, tdap, mmr, polio, chicken pox, flu, hep c and b. My granddaughter’s statements show she received a RotateQ immun. for the rotavirus…not covered $121, a Pentacel immun. which covers dtap, ipv combo containing Hib tetanus, polio myelitis, and haemophilus influenza type E…not covered $169, and a Prevnar 13 immun. that protects against 13 strains of pnumoccocal bacteria …not covered $169. This is on top of the well exam charge and $292 per month insurance fee she pays for both of them. Basically, is there anything we can do to get BC to offset some of these immunizations? I would hope at least the Pentacel would be covered. HELP ME PLEASE!
Mom, I’ve had my daughter enrolled in anthem bc 3500 ppo since 2009. She had a baby in January and added the baby that same month. Recently I have been helping her try to understand why she is paying in full for her baby’s immunizations, approx.$550 per immunization visit(3 so far).
I have called customer service 4 times to find out they have no idea what they are talking about. They, as I, assumed that immunizations would be covered. Finally I was directed to healthy vouchers and spoke to a lady who said that Grandfathered in policies do not pay for current immunizations. Say what??? The following immunizations are covered by BC: tetanus, tdap, mmr, polio, chicken pox, flu, hep c and b. My granddaughter’s statements show she received a RotateQ immun. for the rotavirus…not covered $121, a Pentacel immun. which covers dtap, ipv combo containing Hib tetanus, polio myelitis, and haemophilus influenza type E…not covered $169, and a Prevnar 13 immun. that protects against 13 strains of pnumoccocal bacteria …not covered $169. This is on top of the well exam charge and $292 per month insurance fee she pays for both of them. Basically, is there anything we can do to get BC to offset some of these immunizations? I would hope at least the Pentacel would be covered. HELP ME PLEASE!
Help… i am a 7 year breast cancer survivor and have really had no claims in 6 years. Im 55 in good shape and I am getting insurance on my own. I have Anthem grandfathered and my bill is now going to 1180. a month. Insane. Im 250 deductable and 100 percent covered unless out of network. 30. office visit and 15 for meds. I am so afraid to get rid of this and I do not know why. Im just afraid some bad situation will come along and wipe out my bank account. when i look at in the network w a 6000. max I know that the max is not really the max if you get sick and are out of network. also what about if you get hurt in a foreign country. Thanks
Help… i am a 7 year breast cancer survivor and have really had no claims in 6 years. Im 55 in good shape and I am getting insurance on my own. I have Anthem grandfathered and my bill is now going to 1180. a month. Insane. Im 250 deductable and 100 percent covered unless out of network. 30. office visit and 15 for meds. I am so afraid to get rid of this and I do not know why. Im just afraid some bad situation will come along and wipe out my bank account. when i look at in the network w a 6000. max I know that the max is not really the max if you get sick and are out of network. also what about if you get hurt in a foreign country. Thanks
Hi. I’m on a PPO family plan with Anthem B/C and our premium is going up to over $2000/month for a family of 4. I just got divorced and my portion of the premium is about $700. I could save about $100/month switching over to their bronze 6250 (deductible) and save about $75/month on my branded prescriptions. However, my doctor is not in the new bronze ACA network. Is it worthwhile for me to leave my grandfathered policy but leave my ex and kids on it to save this money? I live in Sonoma County. Thanks so much!
Hi. I’m on a PPO family plan with Anthem B/C and our premium is going up to over $2000/month for a family of 4. I just got divorced and my portion of the premium is about $700. I could save about $100/month switching over to their bronze 6250 (deductible) and save about $75/month on my branded prescriptions. However, my doctor is not in the new bronze ACA network. Is it worthwhile for me to leave my grandfathered policy but leave my ex and kids on it to save this money? I live in Sonoma County. Thanks so much!
I have Kaiser through the Covered California plan. I have a 13 year old. I was under the impression that she, being under the age of 19, now had basic pediatric dental as part of her health plan, yet Kaiser does not have dentists. Other dentists will not accept my Kaiser insurance stating I need a dental plan. Cover CA says that my dental is included in my medical plan. I’m going in circles. Short of just paying directly for services, I am not sure what else to do and none of them (dentists, Kaiser or Cover CA) can provide me with instructions on how this works. Really frustrated.
I have Kaiser through the Covered California plan. I have a 13 year old. I was under the impression that she, being under the age of 19, now had basic pediatric dental as part of her health plan, yet Kaiser does not have dentists. Other dentists will not accept my Kaiser insurance stating I need a dental plan. Cover CA says that my dental is included in my medical plan. I’m going in circles. Short of just paying directly for services, I am not sure what else to do and none of them (dentists, Kaiser or Cover CA) can provide me with instructions on how this works. Really frustrated.
My primary care doctor doesn’t take my blue shield silver seven 3750 ppo why?because it’s a IFP?hes not on any blue shield network but the plan is good for me otherwise $7 for labs,drugs,co pays (except him)$35 specialist,should I keep this plan for 2017 and just pay cash?he charged me $65 last time and with$7 labs that’s $72,with some plans it’s $45 co pay and $45 for labs,I’d like to hear your thoughts I pay $980 a month with no help from the government,thank you,Kurt
My primary care doctor doesn’t take my blue shield silver seven 3750 ppo why?because it’s a IFP?hes not on any blue shield network but the plan is good for me otherwise $7 for labs,drugs,co pays (except him)$35 specialist,should I keep this plan for 2017 and just pay cash?he charged me $65 last time and with$7 labs that’s $72,with some plans it’s $45 co pay and $45 for labs,I’d like to hear your thoughts I pay $980 a month with no help from the government,thank you,Kurt
Hi
Hoping you can help me figure this out. My husband and I are both self employed/do not have option for healthcare through our jobs. Moved to California and ended up with the pathways plan for anthem blue cross. We pay an absurd 1000/month for our family of five. I cannot find any alternative for us other than California obamacare plans…even through anthem websites but the problem is that where we live, there is not a single pediatrician that takes these new California anthem plans, only non-pathway anthem plans. I ask them, how do I get that?! It feels as if it is a medical type plan because providers are limited yet our premium is triple what it was before. Help help help!
Hi
Hoping you can help me figure this out. My husband and I are both self employed/do not have option for healthcare through our jobs. Moved to California and ended up with the pathways plan for anthem blue cross. We pay an absurd 1000/month for our family of five. I cannot find any alternative for us other than California obamacare plans…even through anthem websites but the problem is that where we live, there is not a single pediatrician that takes these new California anthem plans, only non-pathway anthem plans. I ask them, how do I get that?! It feels as if it is a medical type plan because providers are limited yet our premium is triple what it was before. Help help help!
Sorry. I meant to say medi-cal or low income type plans…
Sorry. I meant to say medi-cal or low income type plans…
I have Anthem Blue Cross Covered California PPO. I’m type 1 diabetic and was just notified that the PPO plan will be changing to EPO, cutting of all out of network provider coverage. Very few providers now take Anthem Blue Cross CoveredCA. What would you suggest doing? Is there a better option?
I have Anthem Blue Cross Covered California PPO. I’m type 1 diabetic and was just notified that the PPO plan will be changing to EPO, cutting of all out of network provider coverage. Very few providers now take Anthem Blue Cross CoveredCA. What would you suggest doing? Is there a better option?
We are in Ventura County. My husband and I did the Covered California route in the beginning and found the policies we obtained were useless and taken nowhere. We then contacted Anthem Blue Cross direct and purchased a plan from them but are now finding that no one seems willing to accept our insurance because it states “pathway” at the bottom of the card. We had specific changed our plan in the last open enrollment and asked them to please place us in regular medical insurance because no one was taking our previous Pathway insurance and the people at Anthem assured us we had regular insurance. But sure enough our new cards ended up reading “Pathways” and no one wants to take the insurance. Our dermatologist even has a sign in their office that reads “We accept Anthem Blue Cross insurance BUT NOT PATHWAY”. So what in the universe is this pathway and how in the universe do we ensure we do not end up back in this program next time around?
We are in Ventura County. My husband and I did the Covered California route in the beginning and found the policies we obtained were useless and taken nowhere. We then contacted Anthem Blue Cross direct and purchased a plan from them but are now finding that no one seems willing to accept our insurance because it states “pathway” at the bottom of the card. We had specific changed our plan in the last open enrollment and asked them to please place us in regular medical insurance because no one was taking our previous Pathway insurance and the people at Anthem assured us we had regular insurance. But sure enough our new cards ended up reading “Pathways” and no one wants to take the insurance. Our dermatologist even has a sign in their office that reads “We accept Anthem Blue Cross insurance BUT NOT PATHWAY”. So what in the universe is this pathway and how in the universe do we ensure we do not end up back in this program next time around?