Californians with Medicare coverage would no longer be surprised by huge medical bills stemming from “observation care” in hospitals under legislation that state lawmakers approved overwhelmingly last week and sent to Gov. Jerry Brown to sign into law.

The sticker-shock can happen when people go to the hospital but health care providers are not sure what’s wrong. If the patient is not sick enough to be formally admitted, but still not healthy enough to go home, they can stay in the hospital for “observation care,” which Medicare considers an outpatient service. That can mean higher out-of-pocket expenses for the patient.

Hospitals can bill observation patients for a larger share of the cost of any treatment and tests than admitted patients. Any routine medications they usually take at home may not be covered at all in the hospital. In some parts of the country, Medicare observation patients have been charged exorbitant prices for prescription drugs, including $18 for one baby aspirin.

And because observation patients have not spent the required minimum of three straight days as an admitted patient, Medicare will not cover their follow-up nursing home expenses after discharge. Observation care doesn’t count.

But patients may not even know they have been placed on observation care status when they’re lying in a hospital bed.

Read more: Protecting California’s Seniors From Surprise Hospital, Nursing Home Bills

Seventy-two percent of California’s previously uninsured gained coverage since the Affordable Care Act went into effect.

The majority of the recently insured say their experience with their current Covered California plan has been positive.

Nearly half of the remaining uninsured are unaware of the financial help available only through Covered California.

The survey found that recently insured consumers are getting access to quality care:

  • Seventy-seven percent say their health needs are being met, which is up from 49 percent in the first survey conducted before the launch of the Affordable Care Act and Covered California’s first open-enrollment period.
  • Seventy-six percent are satisfied with their choice of primary care doctors.
  • Seventy percent say their experience with their current Covered California health care plan has been positive.
Read more: New Survey Shows the Affordable Care Act Has Dramatically Reduced California’s Uninsured Rate

To enroll in coverage outside of Covered California’s open-enrollment period, consumers must experience a "qualifying life event." Many different types of qualifying life events are described in the chart below. If consumers experience a qualifying life event, they will be allowed to enroll in a Covered California health insurance plan outside of the normal open enrollment period. Most special enrollment periods last 60 days from the date of the qualifying life event.

In most cases, consumers must report changes and select a plan within 60 days of the qualifying life event to purchase a Covered California health insurance plan outside of open enrollment. Medi-Cal is available all year, and no qualifying life event or special enrollment period is required to enroll in Medi-Cal.

Read more: Qualifying Life Events for Special Enrollment

June is National Employee Wellbeing Month – an opportunity for companies nationwide to implement, evaluate and refine their employee wellness programs. An estimated 70% of employers already offer wellness programs, and 8% more plan to do so during the next year, according to the Society for Human Resource Management.

Employers are investing in wellness programs because these initiatives can support their employees’ desire to improve their health and create a happier, healthier workforce while reducing costs for employees and the company.

Some of these wellness programs give employees wearable devices at no additional charge, helping provide a more accurate and comprehensive summary of the user’s daily activity, sleep patterns and other health markers. Fitness trackers – usually small devices worn around the wrist or clipped onto clothing – give users a snapshot of actual physical activity.

Employers nationwide are expected to incorporate more than 13 million fitness tracking devices into their wellness programs by 2018, according to technology consultancy Endeavors Partners. That’s important, considering a study published in Science & Medicine showed people tend to overestimate how much exercise they get each week by more than 50 minutes, and they underestimate sedentary time by more than two hours. People who use wearable devices are better able to monitor and hold themselves accountable for their physical activity.

Read more: 5 Tips to Build a More Engaging Employee Wellness Program

A steady stream of clients filed into A+ Insurance on Friday with a mission to accomplish: sign up for a health plan by Sunday or pay a penalty. A big one.

That’s the provision under the Affordable Care Act that brought Caley Carr, a professional tap dancer and teacher, to the Valley Village business.

“The tax penalty is a little bit like the fire that got me moving,” said Carr, 29, as he sat with an agent to discuss his plan options. “I don’t want to pay a penalty again.”

People who receive health coverage from an employer, Medicare or another government program don’t have to worry, but those such as Carr, who are self-employed and who have gone without health insurance, have until Sunday. Those who qualified and went without health insurance in 2015 may have to pay a penalty at tax time, which can go up to $325 per adult and $162.50 per child or 2 percent of the total household taxable income, whichever is higher. That rate will rise to $695 per single filer and 2.5 percent come next tax season. The penalty may go as high as $10,000 for a family of four.

 

Read more: Naama featured in Daily News - Covered California warns uninsured to enroll by Sunday, or face...

Most ObamaCare customers will find they have to pay more for coverage in 2016 than they did this year, as they begin to select health insurance plans this weekend.

Premiums, as well as penalties for not buying insurance, are going up next year as the administration lowers expectations for overall enrollment.

The "silver plan," the second-cheapest available on the federal exchange, will cost on average 7.5 percent more next year, the Department of Health and Human Services announced.

By: Rich Edson
http://www.foxnews.com/politics/2015/10/27/obamacare-premiums-penalties-rising-as-open-enrollment-begins/

Congressman Tony Cardenas representing 29th District of California meeting With Naama O. Pozniak , NAHU current President: Don Goldman and Chad Schneider, chief sales officer of Code SixFour.

As an agent and broker in my community I look forward to help and support the future of the Healthcare industry.

To make the healthcare insurance market more efficient and more responsive to the constant changing environment, I believe some changes need to be made to ensure access, choice and affordability.

As part of being a NAHU member we all got together to make sure that the following top federal priorities policy be more responsive to American employers and individual health consumers:

  • To increase choice of Health Plans, we should make sure that consumers will always have the ability and to access licensed benefit professionals.
  • Employer Reporting H.R. 2712 and S.1996 to address new challenges related to counting employees and complying with employer reporting requirements.
  • Small Business Tax Credit : H.R. 762 and S.379 to increase the effectiveness and structure of the small business tax credits.
  • To address affordability ~ Repeal Cadillac/Excise Tax : H.R. 879, H.R. 2050, S.2045, and S.2075, to permanently repeal the "Cadillac Tax."

 

 

Congresswoman Mimi Walters representing the 45th District of California with Naama O. Pozniak

 

 

Kevin Counihan, CEO of Healthcare.gov in conversation with Brokers and Insurance agents.

Kevin explored the complications, improvements and future upcoming renewals. Regulating the enrollment process and pre-planning renewals, stability and functionality will be few of the key elements for the upcoming 2017 4th Open Enrollment.

 

 

Are you ready for the Open Enrollment season? Covered California's Renewal period started as of October 12, 2015 and Open Enrollment begins in 12 days!

Introducing Two New 2016 Covered California Health Plans

Oscar Health is a new health plan now available through CoveredCA: www.rightplan.com this year and the private market, serving Los Angeles and Orange Counties.

UnitedHealthcare is another new offering on CoveredCA www.rightplan.com for 2016. You can choose between the Core PPO and Core Essential EPO plans, giving you access to UnitedHealthcare’s entire Core and Core Essential network, including physicians and facilities in California, Arizona and Nevada.

UnitedHealthcare plans are available in these areas:

Northern California (Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba)
Santa Cruz, Monterey, San Benito
Fresno, Kings, Madera
San Luis Obispo, Ventura, Santa BarbaraMono, Inyo, Imperial

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