Monday, November 18, 2013

ObamaCare 101

What is happening and how it affects you!

As you have heard, the implementation of ObamaCare (hereinafter called ACA) has the government and insurance companies in a state of chaos.

Following is a summary of what we know so far.

If you have a plan in place you do not have to do anything. You will be rolled over into an ACA compliant, or grandfathered plan automatically on January 1, 2014.

Our health insurance clients fall into five categories;

    1. New individual policies
    2. Grandfathered individual policies
    3. Uninsured
    4. Group policies
    5. Medicare supplements & drug plans

NEW INDIVIDUAL POLICIES are those policies that were written after the ACA was enacted on March 23, 2010.

If you do not proactively change your policy, you will be rolled over into the ACA plan most similar to your current plan on January 1, 2014. Most people will be put in the basic Bronze Plan. The Bronze Plan will have a $5,000 deductible, 30% copay, and a $6,350 out-of-pocket maximum.

Most new individual plans in Alameda and Marin Counties that are insured with Blue Shield will be cancelled. Blue Shield could not get enough doctors and hospitals to join their network in these counties. You will have to switch to Blue Cross, or HealthNet. Contact us for an application and details. We have the rates, applications and the coverages for these plans and can help you change companies.

GRANDFATHERED INDIVIDUAL POLICIES are those written prior to March 23, 2010.

Your network of providers and coverage should stay the same and Blue Shield will keep Marin and Alameda county residents with grandfathered plans. We do not yet have the rates, coverages, or change request forms for the grandfathered plans. You should receive a letter with this information soon. I got my renewal yesterday from Blue Shield with a 9.7% increase. If you have a grandfathered plan, keep it because you will have better prices and providers.

Some grandfathered plans are being cancelled because the company decides that it cannot meet ACA requirements profitably. If this happens, you will get a cancellation letter and will need to pick a new ACA plan. Call us for an application and guidance.

UNINSURED INDIVIDUALS are those broken into two categories:

1. Those that qualify for a subsidy: If you earn less than $43,000 single, or $93,000 for a family, you may seek a subsidy. We cannot help you with these types of subsidized policies and suggest that you contact Covered California at 1-800-300-1506 for assistance, or visit their website at

2. Those that do not qualify for a subsidy: We can help you with the same plans available to NEW INDIVIDUAL POLICYHOLDERS. Call us for an application, rates, and coverage options.

GROUP POLICIES will be rolled over to an ACA compliant plan on January 1, 2014:

Group policies should have the same provider that you have now. The rates will go up at renewal and are rumored to be going up 50%. We have already contacted all of our group clients to lock in the current rates for as long as possible. MEDICARE SUPPLEMENTS AND DRUG PLANS are not affected by ObamaCare.

The following is a summary of the different elements of the ACA plans.

COVERAGE - Coverages and optional deductibles do vary. Call us for explanations.

PRICES - All rates among companies are about the same.

PROVIDER NETWORKS - The main difference between companies will be their provider networks. Because doctors and hospitals will get reduced reimbursement schedules, companies are having a hard time signing up providers.

COMMISSIONS - Our commissions have been cut by 80%, so Allied Brokers is weighing our ability to continue offering health insurance assistance and advice profitably. For the present time we will actively service all present clients with their health insurance needs.


• ObamaCare does not affect Medicare rates, coverages, or providers yet!

Subsidies are available through Covered California to individuals earning less than $43,000 per year, or $94,000 of earnings for a family of four.

• If you are in a high risk or COBRA plan you can buy a new ACA plan that will be less because there is no extra charge for pre-existing conditions. Call us for an application to switch to an ACA plan.

• If you are over 50 you may save some money with an ACA plan in that it now illegal to charge more than three times more for a 64 year old than a 21 year old.

This whole mess is a work in progress and we should have more clarity in 2014. Sandy White has retired for medical reasons, so I will be your new contact person going forward. Everyone has been very kind with their concern and admiration for Sandy. I have some big shoes to fill and will do my best to help you.


Chris A. Grammar
Insurance by Allied Brokers

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