Individual & Family Solutions

The Health Care Exchange ...2018 Open Enrollment November 1, 2017 - January 31, 2018 (CA)  (updated 9/6/2017)

Federal 2018 Open Enrollment other states November 1, 2017 - December 15, 2017 

Open Enrollment for new ACA (Affordable Care Act) plans continues in California and with other state Health Care Exchanges.  The Affordable Care Act brought about changes to the health insurance plans in both the individual and group markets. We will see some plan changes for 2018 in all markets in addition to rising premiums. Anthem in California with discontinue their individual health plans except for 3 Northern California counties.  This Anthem announchement does not effect those with grandfathered plans, group health insurance or Medicare Advantage plans. Everyone who signs up during open enrollment will be given a January 1st effective date.  Please contact our office before November 1st to discuss your options for change and set an appointment. Those enrolled via CoveredCA are encouraged to make their plan changes before December 15th or will be passively enrolled in a low cost plan.  Also look for our next newsletter.  

Each year you should review the Essential Benefits of your plan, pediatric dental and vision benefits if you have children under 19 on your plan,  and adjustments to deductibles and out of pocket maximums.  Pre-existing conditions are not part of underwriting, and premium subsidies continue for 2018.  Individuals can enroll in state Medi-Caid programs anytime of the year.  Plans are available ON and OFF the Exchange.  If you do not need assistance paying for health insurance premiums our suggestions is enroll OFF Exchange which does not require income or employment verification.

Grandfathered plans (plans in place prior to 3-22-2010) will continue indefinitely for most insurance companies.  All non-grandfathered plans have been discontinued and members were mapped to a comparable plan by the end of 2015.  Premiums will increase each year for most plans and most insurance carriers.

Short Term Health plans do not meet the guidelines of the ACA and do not have all Essential Benefits. The number of providers of these plans has decreased the past 2 years. You may enroll in a short term health plan for up to 90 days without penalty in California.

Some states have developed their own self managed Exchanges and some states will utilize the Federal Health Care Exchange for the first few years.

Those who lose their coverage or have a qualifying event can change coverage within 30-60 days of the event. Examples: marriage (30 days), birth or adoption of a child (30 days), lost of group coverage, moving from another state have a 60 day enrollment window.  Supporting documents for any event are required by the insurance companies.    

2015 Penalties:  The annual fee for not having insurance in 2015 is $325 per adult and $162.50 per child (up to $975 for a family), or 2% of your household income above the tax return filing threshold for your filing status – whichever is greater. 

2016 Penalties:  The annual fee for not having insurance in 2016 is $695 per person, $347.50 per child under 18, or 2.5% of your household income above the tax return filing threshold for your filing status – whichever is greater. If you are uninsured for more than 3 months despite having access to affordable coverage, you will be required to pay whichever amount is higher. (source:

2017 Penalties:  The annual fee for not having insurance in 2017 is $695 per person, $347.50 per child under 18, up to $2085 per family, or 2.5% of your household income minus the federal tax return filing threshold for your filing status. If you are uninsured for more than 3 months despite having access to affordable coverage, you will be required to pay whichever amount is higher (refer to exceptions such as hardship, unaffordable coverage options, incarceration, no tax filing, not lawfully present, religious conscience, health care sharing ministry, and American Indian tribes).  (sources: and  Previous OEP was Nov 1, 2016 - January 31, 2017.

2017 Comments to ACA / Obamacare Changes:

For 2017 we saw rate increases in the individual market from 15-30% and the deductibles and out of pocket maximum values increase between $50 and $1000 (+/-).   I have been reading and searching out new articles as we see them in the headlines about Trump and other legislators comments and actions regarding repeal.... replace...changes to the Affordable Care Act/Obamacare. As of major changes will happen for perhaps 3-12 months. Perhaps there will be a slowing down of some updates to the ACA that were planned for 2017, 2018 and 2019. Those changes may be minor as not requiring by law that everyone have coverage or be penalized.  Some of the senators have written their own bills for repeals / or change that may change the amount of subsidy given to a person (say 55+) versus those younger (30 and less); give the states more power to deregulate health insurance, and change the amounts of deductibles that seem to be increasing.  It would be fair to all if positive constructive and financial changes were across the board for the consumer, the insurance company, the doctors, the agent, and pharmaceutical companies.
As I read today (January 21, 2017), the President cannot craft or pass legislation but can make suggestions for others to write their bills.  But he does have the right to veto.   

Make the Right Decision Today:

The value of having reliable health coverage shouldn’t be underestimated. There are multiple health insurance carriers that can be trusted, and provided affordable, flexible and dependable coverage.

You can’t afford to be without health coverage.
Health coverage helps protect you and your family physically and financially.

Because life is unpredictable.
Even if you are healthy now and exercise regularly, you could be caught off guard by an unexpected illness or injury.

Because medical care is expensive.

Cost of a typical Hospital stay (about 4 days and 2 follow-up visits):

$4,000 - Physician charges
$24,600- Hospital charges
$400 - Follow- up care
$29,000 Total

Services covered under most plans:

Doctor’s Visits
Physical Therapy
Preventative Care
Occupational Therapy
Emergency Room
Home Health Care
Skilled Nursing Facility
Well Child Care
Respiratory Therapy
Family Planning
Diabetes Care
Mental Health Services
Chemical Dependency Services
Durable Medical Equipment
Out-Patient Services
Out-of-State Services

Contact us today for a free, no obligation, discussion regarding your needs. Contact Us >>