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 Covered California has just released their 2019 individual market rates increase for the 2019 individual health insurance marketplace. The weighted average rate change will be 8.7 percent.  For a wide part of Los Angeles (Region 16) will follow the 8.6 percent weighted average increase, however, Region 15, which is located in the Northeast of Los Angeles will have a 10 percent increase.  Santa Barbara & Ventura region will see an 8.7 percent increase; Orange County, San Diego & Riverside regions: 9 percent and San Francisco: 9.4 percent weighted average rate change. This compares to a weighted average premium increase of 12.5% for 2018 and 13.5% increase in 2017 statewide.

Without the federal decision to eliminate the individual mandate penalty in 2019, Covered California states that Californians would be seeing a rate change closer to  5% percent. The insurance companies foresee a higher cost due to the elimination of the mandate penalty, especially as young healthy individuals will be less likely to participate in the Affordable Care Act health insurers’ risk pools, creating risk pools with a higher concentration of sick individuals and thus higher overall medical costs per capita. They are estimating that 262,000 consumers will leave the individual insurance market. Therefore they are calculating between 2.5 to 6 percentage points more to their rates.

88 percent of Covered California’s policyholder are receiving subsidies.  For them, the good news is that the subsidies are rising alongside the rate increases, which means that in effect they will feel the rate increase less. The Federal government is estimated to pay an additional $250 million in federal premium tax credits in 2019 than for 2018. Bronze level plans are rising with 10.2 percent which is higher than the Silver on Exchange plans with 5.2 percent. In 2019, Californians who shop the market and opt to switch to a health plan with a smaller network will offset the rate increases while changing to the lowest-priced plan in their metal tier or downgrade to a lower metal tier. Furthermore, all 11 insurers currently participating in the California individual marketplace will continue participating in the state in 2019.

Middle-class Californians, who earn more than the 400 percent Federal Poverty Level, and are not eligible to receive subsidies will “bear the full brunt of the increase “accordingly to Peter Lee. It remains to be seen if outside of Covered California the health insurance carriers will start to offer variations of health plans which might have adjustments to the metal tier plans or possibly improved HSA health plans. As an alternative, healthy Californians might look for short-term insurance or a variety of worldwide insurance carriers as they do not have to face the penalty of not having a health plan with the 10 essential benefits. To offset the health insurance increases, Californians should also reflect how important their hospitals and doctors of choice are. Choosing smaller networks with fewer hospital and doctor choices will allow lower health insurance premiums.

In its sixth year, Covered California remains “alive and strong”, currently serving more than 3.5 million Californians for health insurance and  5 million Californians for Medi-Cal, the state’s version of the federal Medicaid welfare program. Unlike several states across the United States, we as Californians are fortunate enough to have more than one insurer participating in the individual market. As a state, we also have a lower risk score versus the average state nationwide and we have not seen the off-exchange disenrollment as prevalent as other states, helping stabilize our premiums. It is still obvious that premiums continue to rise above inflation which has impacted everyone’s available income. The Affordable Care Act ensures that we keep comprehensive coverage, no one can be excluded or charged more for a pre-existing condition, and that we have the tools to provide great healthcare to both the rich and the poor.

At Solid Health Insurance Services, we will always strive to keep our clients informed about the healthcare trends and changes to the state and federal legislation around the Affordable Care Act. Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com.

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Are you a small business owner looking to offer group benefits? You must first ask yourself, are you really a small business? What even is a small group in regards to group health insurance? A small group employer in the eyes of the CA Department of Insurance is: “defined as employing at least 1, but no more than 100, full-time (including full-time equivalent) employees 50% of its working days during the preceding calendar quarter or preceding calendar year and employing at least 1 employee on the first day of the plan year.”

So, how do you even calculate full-time and full-time equivalents? First, count the number of employees who work 30 or more hours per week per month. Next, add up the number of hours worked by part-time employees for the month and divide by 120 (e.g. 3 employees each working 20 hours per week x 4 weeks = 240 hours, divide by 120 = 2 FTE employees).

Now that we have gone over calculating the number of full-time employees, we should go over employee participation rates. Each insurer has their own requirements for the percentage of employees that must participate and enroll in their group’s coverage. Most carriers have a minimum requirement of at least 60% participating in their group insurance. SHOP Covered CA, the small business arm of Covered CA, has a minimum participation rate of 70%. If you are interested in a given carrier, please do not hesitate to contact us so we can go over each carriers participation and documentation requirements. Carriers will exclude employees from the participation rate if they have valid waivers for not participating such as: on Medicare, Tricare, Medi-Cal, spousal coverage COBRA/CalCOBRA, MediExcel (cross-border plans). Some carriers are even accepting waivers for on- or off-exchange individual plans (Anthem & UnitedHealthcare through 12/15/2018) while Oscar is allowing on-exchange, subsidized employees to waive their group coverage.

Currently, some carriers are offering more relaxed participation rates for new business. Anthem is allowing groups from 7/1/2018-12/15/2018 to enroll only 65% if 1-4 employees enroll or 25% participation rate if 5 or more enroll. Through 9/30/2018, Blue Shield is allowing groups with 5 or more enrolled to have a 25% participation rate. Health Net: 66% for 1-5 enrolled, 50% for 6+ enrolled through 9/30/2018. Kaiser – no DE9C required for 6+ enrolled through 12/1/2018. This is great news for many small businesses, especially for those that have had trouble enrolling due to not enough employees being interested in a group plan.

Furthermore, you may ask yourself, “How much do I as the employer have to spend on my employees’ plans?” As an employer, most carriers require you to contribute at least 50% towards your employees’ health insurance premium. Many carriers will also allow you to contribute a flat dollar amount of $100. Please review your budget and think about how much you want to spend on your employees? Sometimes $100 is not enough to convince your employees to hop onto a group plan, especially with premiums steadily rising every year with wage growth not keeping up.

When deciding on a carrier, it is always important to understand the provider and drug formularies of each carrier. Ask your key employees if they have any preferred doctors, hospitals or brand-name prescriptions that they would like covered. You want to make sure that you are offering plans that cover at least some of the preferred doctors and hospital systems your employees hold dear to their health.

Once you have figured out your number of employees, the number that are expected to participate and which carrier(s) you are interested in, we can then proceed and submit your group’s application. We will need each employee’s application or valid waiver, the employer (master) application, as well as applicable payroll and business ownership documentation. Each carrier has their own documentation requirements so please do not hesitate to contact us to go over the requirements and get your application running smoothly.

At Solid Health Insurance Services, our services are completely free of charge and we will never ask you for any compensation. We want to help make your enrollment process as easy as possible and we will continue to service your group as your business and the insurance marketplace continue changing. Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com.

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Starting September 1st, 2018, small businesses will have easier access to association health insurance plans due to an executive order President Trump signed on October 12, 2017. The executive order intended to address the limited choice given to small businesses by allowing them to organize associations that offer their own insurance plans that may not have to abide by the Affordable Care Act.

Proponents of the association plans argue that these plans will offer more options and more affordable premiums to small businesses. Trump stated at the 75th anniversary of the National Federation of Independent Businesses, “You’re going to save massive amounts of money and have much better health care.” The lower premiums are mainly due to the fact that these plans do not have to abide by the Affordable Care Act, meaning that they may not have to cover the 10 essential health benefits required by the law. For example, these plans may not have to cover mental health, emergency services, maternity care, newborn care or even prescription drugs. The Labor Department stated that the association plans would not be able to deny or charge higher rates to individuals with pre-existing conditions; however, the plan administrators who decide on who is accepted into these health plans would be able to reject applicants at their own discretion, thus people with pre-existing conditions would likely be excluded to keep costs lower. Although President Trump stated people would be able to join association health plans across state lines, the Labor Department noted: “States have capacity to regulate in the state to the extent they previously had.” As licensed insurance agents regulated by the California Department of Insurance, we are interested to see how California and other state insurance regulatory bodies will respond.

Opponents of the executive order argue that healthy individuals will be attracted to these plans and cause higher premiums for people that stay with the more regulated ACA-compliant health insurance plans. Simply put, there will likely be a higher concentration of sick individuals on the ACA-compliant plans, causing even higher premiums for the individual marketplace in 2019. The plans will most likely offer less comprehensive care and may force many people to still stick to an ACA-compliant health insurance plan. Chris Hansen, president of the American Cancer Society, stated individuals with serious illnesses such as cancer would face “ever-increasing premiums for comprehensive coverage.” Furthermore, Nancy LeaMond, AARP’s executive vice president, stated: “AARP has long raised concerns with the lack of protections and benefits to consumers under AHPs, specifically since AHPs increase the fragmentation of risk pools, which drive up the cost for older Americans.”

At Solid Health Insurance Services, we strive to keep our individual and small business clients informed about changes to the health insurance industry. We want to inform our clients about their options but we also are pressing caution when considering an association plan. In years prior, the Labor Department has identified “unscrupulous promoters who sell the promise of inexpensive health benefit insurance, but default on their obligations.” With an independent eye, we will always strive to meet our fiduciary duties to serve the interests of our clients.

Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com.

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Under President Trump’s administration, we have seen several significant challenges to the Affordable Care Act. In 2017, we saw Trumpcare or the American Health Care Act (AHCA) pass the House yet failed to pass the Senate. However, Trump successfully passed a federal tax bill which removed the tax penalty for not having health insurance which will likely affect the enrollment numbers of healthy individuals in 2019, the year the mandate is removed.

Protesters speak out against the Affordable Care Act in front of the Supreme Court during a previous legal challenge. Photo: Brooks Kraft LLC/Corbis via Getty Image

Now in June 2018, the guaranteed issue provision of the Affordable Care Act is in jeopardy. The guaranteed issue provision of the Affordable Care Act requires the insurers to accept applicants regardless of their age, gender, or most importantly, of their pre-existing conditions. These factors would otherwise allow insurers to charge some people more than others due to their medical history. With the tax penalty removed, a new lawsuit filed in June by 20 state attorneys asserts that the guaranteed issue provision and other key provisions of the healthcare bill should also be removed due to their inherent link to the tax penalty.

If their case wins, we shall see the guaranteed issue provisions, protections for those with pre-existing conditions, and the current price ratings based on age and region removed. Technically, the ACA individual mandate is still in force although the tax penalty has now been set to zero. Since Trump’s tax bill did not effectively remove the mandate, the lawsuit led by Ken Paxton would be seen by many experts as lacking support. On the other hand, we will likely see a reduction in healthy individuals enrolling into the individual market due to the removal of the tax penalty, thus increasing premiums for everybody else as the sick and disabled take a bigger share of the enrollees. However, we are seeing some pushback at the state level with some states such as New Jersey and Massachusets implementing their own tax penalty for not having health insurance. We are surprised to see California and other states have not yet followed this path to stabilize the ACA.

In all, Obamacare is still upheld at every opportunity by the Supreme Court and we have also seen 70 repeal attempts by the House fail. On the other hand, the Affordable Care Act has failed to address the steadily rising medical costs and thus health insurance premiums. In one of our previous articles, we went over the big hospital systems being major contributors to medical inflation, especially with the acquisition of smaller hospitals and then immediately jacking up the prices of their services. We have seen drug costs rising to over 18% of the total medical costs yet there is little power and authority given to the insurers to control drug prices. The Trump administration’s new Secretary of Health and Human Services, Alex Azar, wants to give private insurers more power to negotiate drug prices, especially for Medicare prescription drug plans. Healthcare costs are estimated to be roughly 1/6th of the U.S.’s GDP (CMS national health expenditure data) which is, to the say the least, substantial. If the U.S. insurers can be granted more authority over the prices they pay (and thus the consumers), we may be able to see at least a slowdown in health insurance premium hikes.

At Solid Health Insurance Services, we will always strive to keep our clients informed about the healthcare trends and changes to the state and federal legislation around the Affordable Care Act. Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com.

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Are you going to or have you recently graduated? If so, congratulations on your success and best of wishes on your career! With graduation season in full-swing, many grads are applying for jobs, preparing resumes, transitioning into careers, going on vacation or even moving back home to the family. One important yet oftentimes overlooked aspect of “adulting” is your insurance.

If you are on your school’s health insurance, you will certainly lose your coverage around your graduation. You must apply for a new health insurance plan within 60 days of losing your coverage during the Special Enrollment Period from February 1st-October 31st. Please note: loss of coverage due to non-payment is not a qualifying life event. During the Open Enrollment Period from November 1st-January 31st in California (November 1st-December 15th in most other states), you can apply for a health insurance plan without a qualifying life event for a January 1st effective date at the earliest.

As a recent graduate, you have several options for your health insurance. At Solid Health Insurance Services, we work with all the major health insurers and we can help you navigate through the carriers to find a plan that meets your budget and provider preferences. If you are still under 26, you may want to consider going back onto your parent’s health insurance, especially if you are unemployed and living with the family. On the other hand, your parent’s health insurance may not be sufficient if you live in a different region or it may be simply too expensive to be added to. We can always review your options for you and see if you qualify for premium tax credits. Furthermore, if you are continuing your education through grad school, your school will most likely offer health insurance for you. You can always review your options with us to see if we can find you a competitively priced plan that better meets your needs.

It is common for recent graduates to have tight budgets, especially with many graduates facing difficulty finding a good paying job after graduation. Depending on your income, you may qualify for premium tax credits/subsidies through Covered California to help lower your monthly premium. Premiums have steadily risen each year although subsidies have also increased to help lower-income individuals and families stay able to afford their health insurance. If you are unemployed and legally present in the United States, you may be eligible for Medi-Cal, the state welfare program (Medi-Caid is its federal program). As independent insurance agents, we can help you navigate through Covered CA or among the off-exchange carriers from the likes of Blue Shield, Oscar, Kaiser, Health Net, LA Care, Molina Care and more. Our services are completely free of charge, you pay the same rates with or without an insurance agent. However, by assigning us as your broker, we can call the insurers on your behalf, help you review the available plans, recommend you providers, help you dispute claims, etc. Finding the right carrier and plan depends on your budget, your provider preferences and your region as rates, provider networks, and carrier availability varies by region. If you are lucky enough to have an employer-sponsored health insurance plan out of school, take advantage of the benefits as the employer will most likely contribute at least 50% towards your monthly premium. We can also help small businesses with their group health, dental, vision and life insurance, all free of charge.

Students who are in the U.S. on a student visa should make sure to have an active visa to be able to apply for an Affordable Care Act-compliant health insurance plan. A visitors visa is not acceptable for ACA-compliant health insurance. If you need an immigration attorney, we have some great recommendations to help you with your immigration status. If you are a foreign citizen living in the United States and have missed the Open Enrollment Period or 60-day window at the Special Enrollment Period, we can help you enroll in global health insurance or even traveler’s insurance depending on your length of stay and residency.

Our mission at Solid Health Insurance Services is to find for you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com

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As a restaurant owner or manager, you know first-hand how tough it is to keep costs down while simultaneously retaining your top talent. The restaurant industry is a historically competitive industry with a high turnover with many restaurants “bellying up” within 2 years. With that in mind, it is important to stay ahead of the competition and focus on what matters most, your restaurant and just as importantly, your staff.

One of the most important investments you can make in your restaurant is in you and your employees. Investing in your staff by offering group benefits is a great way to retain key employees and to attract the top talent. I am sure your managers, chefs, sous chefs, line cooks, prep cooks, waiters, and dishwashers share a strong camaraderie from working from the early mornings to late nights as a team to serve your clients’ constant needs. Consider investing in their health and financial well-being by offering affordable health, dental, vision, life and disability insurance and workers’ compensation.

Even with health insurance premiums increasing each year, there are some tools available to small business owners to help lower the costs of such benefits. For one, there are premium tax credits available to employers with fewer than 25 employees making on average less than $50,000 annually (not counting the owner). SHOP Covered California, California’s exchange for small businesses, can offer you at tax credits of at least 50% of the premium for your employees and even more depending on the average employee’s income and employer contribution. The federal tax credits offered through Covered CA can be for up to two consecutive years. You can also write off the health insurance premium from your business’s expenses to help lower your taxable income.

Covered CA is certainly not the only option. California Choice is another means of offering multiple carriers such as Anthem, UnitedHealthCare, Kaiser, Sutter Health (Bay area), Health Net, SHARP (San Diego area). If your restaurant is part of the National Restaurant Association, we can help you get a discounted rate through their partnership with UnitedHealthCare. We can also help you enroll in a specific carrier of your choice without the use of an exchange such as Covered CA or California Choice. Go to our recent blog post to get more information on how to control costs while offering a great benefits package.

At Solid Health Insurance Services, we work with local restaurants and tailor benefits packages around each restaurant’s unique medical and budgetary needs. We work with all of the major insurers including Kaiser, Blue Shield, Anthem, Oscar, Health Net, UnitedHealthCare, and more. Let us find a plan that meets your budget and medical needs completely free of charge. We walk with our clients through the entire process, from the prep work to expediting your plans to ensure everything is just right for you and your employees. We are here to service your needs and the tip isn’t even part of your tab. You pay the same premiums working with a broker or going directly to a carrier. As independent insurance agents, we will always be dependable through the constant changes to the insurers and the laws around insurance and we will always make sure to keep you up to date with an independent eye always looking out for your needs.

Our mission at Solid Health Insurance Services is to find you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com

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As many of you may know, your health insurance plan under the Affordable Care Act covers one free annual wellness checkup; but, did you also know that your health insurance plan also covers preventative screenings, immunizations and other services free of charge? What services are free comes down to if the service is preventative or not and depends on your age. For example, colonoscopies are usually covered once you turn 50 as preventative yet would normally be billed as a diagnostic for a younger individual.

For adults, screenings for blood pressure, diabetes, colorectal cancer, breast cancer, cervical cancer, prostate cancer, sexually transmitted infections, HIV, osteoporosis and more are fully covered by your health insurance plan as long as they are billed as preventative and not diagnostic. It is extremely important to first speak with your doctor and use appropriate language when requesting a preventative service. Services may be billed as non-preventative and your out-of-pocket costs can get into the thousands of dollars depending on the service if you are not careful.

Free preventative immunizations for adults – Hepatitis A & B, Human Papillomavirus (HPV), Measles, Mumps & Rubella (MMP), Pneumonia, Tetanus, Varicella (chicken pox), Influenza (flu) and Zoster (shingles).

Free counseling for adults – Domestic Violence, Family Planning & Breast-feeding Support

Free preventative screenings for children: Diabetes, Weight, Height & BMI, Vision and hearing tests, Pelvic exam, Pap and HPV tests, sexually transmitted infections (STIs) for adolescents

Free preventative immunizations for children – Hepatitis A & B, Tetanus, Influenza, Haemophilus Influenza Type B (HiB), Inactivated Poliovirus Vaccine (IPV), Measles, Mumps & Rubella (MMP), Pneumonia, Varicella (chicken pox), Rotavirus, Meningococcal & Human Pappilomavirus (HPV)

You should always make sure to get your one free annual wellness checkup each year to check up on your vitals. The key to a healthy life is good nutrition and exercise as well as preventative care to address issues before they become major.

When you schedule your yearly check-up, make sure to indicate to the doctor that you would like to have a preventive care visit. The coding and paying system for preventive care and diagnostic care is different. We at Solid Health Insurance Services hear sometimes complaints from policyholders that they had to pay for their preventive services. However often the fact is that during the preventive exam the policyholders mentioned to the doctor that something beyond the preventive exam bothers them, and then suddenly the preventive visit is coded as a diagnostic visit, which then will require co-payments or payments against the deductible. So it is the best procedure to talk to the doctor clearly on how he or she will bill the visit if you ask a question or medical issue in the preventive visit so that you will not be surprised by any possible charges.

Our mission at Solid Health Insurance Services  is to find you affordable health insurance, life insurance, long-term care insurance and travel insurance which fits your medical needs and budget for your individual, family and business needs. Please contact us at 310-909-6135 or at info@solidhealthinsurance.com

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With prescription drugs approaching 20% of total medical costs, patients, insurance companies, and government bodies are finally putting pressure on the pharmaceutical industry. Maybe hiring former pharmaceutical executive Alex Azar as Secretary of Health & Human Services  will put more pressure for reform. Alex Azar made a strong statement on May 14th, 2018 giving consumers hope:

“For too long, there’s been a lot of talk on drug prices, and no action. Drug companies have insisted we can have new cures or affordable prices, but not both. I’ve been a drug company executive—I know the tired talking points: the idea that if one penny disappears from pharma profit margins, American innovation will grind to a halt. I’m not interested in hearing those talking points anymore, and neither is the President.”

Alex Azar, Secretary of Health & Human Services

For Secretary Azar, high drug prices come down to multiple factors and “attempting to squeeze one end of the balloon won’t lead to lasting change”. These factors include high list prices, overspending by government programs, high out-of-pocket costs and the reliance on foreign governments on US pharmaceutical research and development.

To combat the high drug prices, Secretary Azar lists four strategies: “improved competition, lowering out-of-pocket costs, enhanced negotiation, and incentives for lower list prices”. He elaborates by focusing on Medicare Part D where negotiating powers on drug prices are minimal. Medicare Part D is a prescription drug plan and offered privately by insurers to complement Medicare Part A (hospitals, surgery, lab tests, hospice care) & Part B (doctor visits, outpatient care, preventative services). Each insurer’s Part D plan has its own unique drug formulary or lists of drugs it covers and each drug is ranked under a tier system from 1-4 (generic to specialty). Each plan has its own list of covered drugs and some drugs may be Tier 3 on one plan yet a Tier 2 on another plan so you should always do a drug formulary search before deciding on a prescription drug plan.

Currently, Medicare Part D plans have discounts on prescriptions of 0-6% compared to the typical 20-30% discount found in private health insurance plans. Secretary Azar wants to give Medicare Part D insurers the same negotiating powers as the health insurers to lower drug costs. Azar wants to also go after the “protected classes” of drugs which constitute $30 billion in annual costs for Part D plans or roughly 10% of the entire nation’s drug costs. These drugs are protected from price negotiation and are covered by all the prescription drug Part D plans due to their major importance in treating serious conditions. The protected classes are:

  1. Immunosuppressants
  2. Antidepressants
  3. Antipsychotics
  4. Anticonvulsants
  5. Antiretrovirals
  6. Antineoplastics

Health Secretary Axar suggests that these protected classes of drugs are better negotiated under private insurers compared to Medicare and he suggests we need to provide Part D plans better negotiating tools to help lower these costs. Some of these drugs under the “protected classes” cost as much as $700 a month with a Part D prescription drug plan yet the average Social Security monthly check comes out to just $1,400. This is completely unsustainable for many Medicare members who rely on these protected drugs for their daily living and those who rely on Social Security as their main source of income are especially affected.

It is not only Medicare Part D that needs price negotiation, we can see this in Medicare Part B as well which has no negotiation powers and covers doctor visits and outpatient care. Secretary Azar states, “Right now in Part B, essentially as soon as a drug is approved by the FDA, it’s covered. Medicare gets a bill for the drug, composed of the standard price plus a 6 percent markup.” Azar goes on to suggest that it may be better to merge Medicare Part B with Part D to combat this issue since Part D at least has some price negotiating powers. The main message here is that we need more competition and transparency around drug pricing.

One of the best tool for consumers to see what a prescription drug costs, which store offers the lowest price and if there is a possible discount available is Good RX. Knowing the upfront cost of a medication might also start the conversation with your doctor about suitable lower priced alternative medications.

At Solid Health Insurance Services, we are always happy to help our clients find the right insurance for their prescriptions as well as medical and financial needs. Let us help you with your prescriptions to find the best plans for your unique needs. Please do not hesitate to contact us at 310-909-6135 or email us at info@solidhealthinsurance.com and we would be happy to tailor your plans to your needs.

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With healthcare costs steadily increasing, it is important for us all to find ways to cut down on healthcare costs. Medical inflation has increased at 3 times the rate of overall inflation since 1960 (roughly 6% a year). Between 2011-2016, health insurance premiums for the average California family increased by $5,208 or 36% while wages had only increased $3,307 or 8%. With healthcare costs and thus health insurance premiums impacting our wages, here is a list of 5 simple tips to save money on your health insurance and medical costs.

Tip # 1 – Choose more affordable EPO or HMO plans for lower monthly premiums

One of the most common ways to save money on your health insurance premiums is by enrolling onto an HMO or EPO insurance carrier, limiting your provider network yet limiting your premium. Many Los Angeles individuals and families have either decided to lower their metal tier one or two levels for the same insurance type or have shifted from PPO plans to more affordable HMO or EPO plans from Kaiser, Oscar or Health Net to just maintain a similar premium from last year. We have seen a rise in Oscar membership, especially in the West LA area, as many Blue Shield PPO members look to more affordable carriers that cover hospitals such as UCLA, USC and Providence. At Solid Health Insurance Services, we will happily look for your providers to see which plans they are in-network at as well as to weigh the pros and cons of each plan type and metal tier for you.

Tip #2 – Search for a  primary care doctor which you feel comfortable with and trust

Finding a good primary doctor, which you feel comfortable with and you trust is very important for your overall health. In all health plans, you have the ability to switch primary doctors. It is important that you start a relationship with your primary doctor. So that when you do not feel good, you can trust in his ability to know if this is something he can solve or a specialist needs to be referred too.  Get your free annual wellness checkup once a year and keep your doctor in the know about your medical needs. Preventative services help to detect medical problems at an early stage, so that with early intervention chronical illness can be avoided. About 85 % of all doctor visits can be treated by primary doctors. Visiting a specialist is more expansive. In the Los Angeles region, a specialist visits cost approx. $700 versus $150 for a primary doctor, and often invasive testing such as MRI’s, endoscopies and colonoscopies are fast ordered, which increases the overall health cost.

Tip #3 – Utilize telemedicine services

With telemedicine services either free or at a low copay for most insurance carriers, you can save money by avoiding taking a trip to your primary doctor by calling a doctor on call, either over the phone or via video chat. This can save you from your regular doctor visit copay, usually between $30-75. Oscar offers free telemedicine services to their members as well as a concierge service consisting of 4 care guides who become familiar with your medical needs and provider preferences. Blue Shield offers their telemedicine services through Teladoc, usually at a $5 copay per call. In the Los Angeles and San Francisco region Heal offers doctor house calls which are in-network with Blue Shield, Health Net, Anthem, Aetna, UHC, and Cigna offered mostly for the same co-payment as a primary doctor rate. Should you have no insurance Heal’s doctor house call visits are offered at $ 99. If you have minor medical needs, you should give telemedicine a try and see if it works for you. Some members like it for its convenience and low or no cost while others may prefer going to their primary doctor face to face to address issues.

Tip #4 – Avoid out-of-network providers

One of the biggest reasons for why PPO plans cost more is due to the fact that these plans cover out-of-network providers. Out-of-network providers do not negotiate rates with insurance carriers and thus can charge significantly more than an in-network provider. On the other hand, the insurance carrier will pay not for the first  $ 5000 of services as they apply on all metal plans an out-of-network service deductible of $ 5000 or higher.  After you meet the deductible a  50% co-insurance for your out-of-network services will be applied. However, the insurance carrier will only pay the usual and customary rate in the region or the in-network rate, which leaves you with the obligation to pay the balance to the doctor. For example, an orthopedic doctor wants to charge $ 800  for a visit, but the insurance carrier pays normally $ 250 for the service. Then with a 50 % co-insurance, you would receive $ 125  from the insurance carrier but would be liable for $ 675, a steep bill to pay next to the regular monthly health. If you need to see service with an out-of-network doctor you a better off to negotiate a cash price.

Tip #5 – Prescriptions

With prescription drugs, you should pay attention to your drug deductible for your health insurance plan. For your plan to cover your prescriptions, you must first meet your drug deductible of anywhere between $0 to $500 per prescription.  For chronical illness, you are best off to review the actual cost of each medication. If the prescription costs are high then the upper metal plan like Platinum and Gold might more sense then buying a Silver or Bronze plan. As you might be liable to pay $ 250 or $ 500 per prescription if the drug is in Tier 4. A very good resource to review the actual cost of the prescription is GoodRX. Good RX gives you an overview of the prescription drug cost with different pharmacies and offers coupons and also generic alternatives, which you might discuss with your doctor.

At Solid Health Insurance Services, we are always here to help our clients find the right plans for their budget and medical needs. Please do not hesitate to contact us with any questions you may have about the carriers and plans available in your area. As independent insurance agents, our services are free of charge as we are compensated by the insurance carriers directly for servicing our clients’ needs. Please call us at 310-909-6135, email us at info@solidhealthinsurance.com or visit our website at www.solidhealthinsurance.com

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As employees look to increase their wages while their employers are focused on minimizing costs, medical costs and with that, health insurance premiums, appear to be the elephant in the room. The California Health Care Foundation reported that between 2011 and 2016, the yearly cost of health insurance for a family rose by $5,208 or by 36% while wages have only risen by $3,037 or 8%. If healthcare costs stayed flat during this time, we would have seen wages increase by $8,245 for a family, substantially increasing the family’s spending power. What gives? California Attorney General Xavier Becerra’s lawsuit against Sutter Health suggests a big part of the problem is hospital networks with too much power inflating medical prices.

At the end of March, California Attorney General Xavier Becerra filed a lawsuit alleging that Sutter Health, the dominant hospital network in Northern California, “illegally inflated prices” from insurers, employers, and patients. Becerra argues that Sutter’s market power has driven in-patient costs in Northern California to be as much as 70% higher than in Southern California. He goes on to suggest that these higher costs have “injured the general economy of Northern California and thus of the state”. Many employers are looking to Sutter and other large hospital systems and wondering what they can do about this. At Solid Health Insurance Services, we understand the local provider networks and local plans and we can help your business find the right plans for your budget and medical needs.

Sutter Health is being accused of using its hospital-network dominance to inflate prices for insurers and thus patients and employers. The case was initially filed by a health plan associated with United Food and Commercial Workers union and may involve as many as 9,000 employers and unions who were contracted with Sutter Health since 2002, covering millions of employees. The plaintiffs argue that they may have overpaid as much as $700 million for services at Sutter. A USC study from 2016 by Glenn Melnick and Katya Fonkych documented that prices per hospital admission have risen by 76% for California from 2004 to 2013 while they rose by 113% at hospitals that were part of Sutter Health and Dignity Health systems. Their research suggests that hospital prices were “driven in part by increased market power by large, multi-hospital systems”. To add to the fire, in 2008 the FTC or Federal Trade Commission reexamined Sutter Health’s 1999 acquisition of Oakland’s Summit Medical Center, only 2.5 miles away from Alta Bates Medical Center in Berkeley, a Sutter Health affiliate. The FTC noticed that while Summit’s prices had been lower than Alta Bate’s, after the acquisition, its prices rose by as much as 72%, “among the largest of any comparable hospital in California.” “The merger of a higher priced hospital with a lower-priced hospital produced two higher-priced hospitals.” Unfortunately, this is not unique to Northern California, yet we see more competition and thus lower premiums in Southern California.

With medical costs out of control and health insurance premiums impacting our salaries and the bottom lines of businesses, how can we stop these hospital networks from becoming too powerful and inflating prices? Melnick believes that we cannot rely on the Federal Government to act and we must instead rely on our state legislature. For one, Melnick argues we should get rid of all-or-none contracting which Sutter and many other hospital networks consistently uses to force insurers to cover all or none of its providers and hospitals. Another potential solution would be to modify the current anti-trust regulations to keep markets competitive and pass the savings on to consumers. We must also prohibit hospital networks from adding other clauses to their insurance contracts that hinder members from using more affordable providers. Furthermore, we must discourage hospitals from contracting out-of-network providers using in-network facilities, especially in an emergency room setting. As Melnick puts it, “Without such actions, families will watch wage gains that are rightfully theirs disappear into the coffers of doctors and hospitals”.  

As independent insurance agents, we at Solid Health Insurance Services always want our clients to stay up-to-date about their healthcare. Employers are advised to reassess their offered plans to see if the health insurance plans are affordable and cover the preferred providers of the key employees. Employees must be vocal about which providers are vital to their health but also be conscious of the costs involved. We all have to deal with these large hospital networks. Do not hesitate to contact us at 310-909-6135 or email us at info@solidhealthinsurance.com to review your group benefits to find you the most affordable plans with the best provider networks. Our services are free of charge and we hope that we can help you with your budget and bring income back to your employees through the premium savings. To get a free group quote, please click here.

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