Let's look at some of the changes occurring in 2016 for Blue Shield in Covered California.
There will be the usual rate and benefit adjustments but also some bigger items to consider.
Blue Shield has consistently performed well in Covered Ca with approximately 1/3rd of the enrollment across the State.
This is a strong showing and reflects Blue Shield's strategy of fully embracing the new market place.
Let's dive right in and look at their options and changes for 2016
This is a big one.
For 2014 and 2015, certain counties (in fact, almost half the State) had an EPO option but no PPO option from Blue Shield.
First, some background on the EPO versus PPO networks. (a full discussion on California networks can be found here)
The EPO and PPO both share the same doctors and provider lists but with an EPO, there is no benefit out of network (other than a true emergency).
A PPO offers some benefit out-of-network.
This is a big deal with all the network changes since 2014!
The PPO expansion also opens up access to the Blue Card network which allows people to use BCBS providers in other States.
This is vital to people that live next to State borders and for people that travel throughout the U.S.
These are the two structural changes specific to just Blue Shield.
Let's look at the annual changes due to Open Enrollment.
2016 Blue Shield of California Covered California Rates
There are two impacts on the rates:
The first will occur each year since rates are tied to the age of the person.
Rate increases no longer occur during your birth month but at Open Enrollment time (typically Nov 1st - Feb 1st)
This means that the 2016 rate will hold through the remainder of the year which adds some stability and predictability.
The second reflects actual health care costs from the prior year.
This number will change according to zip code, age, and plan.
Keep in mind that the tax credit may also change at renewal based on a few factors.
This is a good time to re-estimate your Modified Adjusted Gross Income for 2016. (yes, 2016 so tax filing in April of 2017)
This part is tricky and we've seen plenty of self-enrollees with incorrect information.
In some cases, the tax credit may actually go up faster than the premium increase.
This is good news!
Most Californians will see negligible or small increases in their net premium for 2016 Blue Shield plans.
Blue Shield will continue to offer options at the 4 basic plan levels in addition to an HSA equivalent Bronze plan and a Minimum Coverage (or catastrophic) plans for individuals under age 30.
Keep in mind that preventative benefits are covered on all Blue Shield Covered Ca plans.
Here are the basic tiers for Blue Shield:
We're happy to walk through the plans with you to find the BEST value.
IMPORTANT UPDATE: Blue Shield has opted for an embedded deductible for HSA plans.
This is huge if you're looking at an HSA plan.
The old way basically made a person pay up to the family deductible in case of big bills. The Embedded deductible means that a person will get help when he hits his/her single deductible; up to two people in a family.
This is much better if you want an HSA plan
There are small changes to the core plans from 2015
This is true for all the Covered Ca plans since they are standardized by the ACA law.
This means a Silver plan will have the same core benefits as a Silver plan from another carrier.
Deductibles are increasing slightly and some copays are changing (but very small).
The core benefits in terms of what is covered will not change.
Doctor networks are always changing.
This is good news for State!
2016 is no exception so it's important to re-check your providers to make sure they are continuing to participate.
We don't see wholesale changes in the network like we did in 2014 but there will be additions and subtractions in the network.
We're happy to check your doctor and/or hospital for you during Open Enrollment for 2016 providers.
There are multiple networks out there now so it's more important than ever to make sure your doctor participates in the "Covered Ca Blue Shield" network.
Many doctors will say, "Yes, we take Blue Shield PPO" but they mean the employer based network or the old Grandfathered PPO.
In order to get a tax credit we need to enroll through Covered Ca.
Here's what to have ready:
We'll help you narrow down the Blue Shield plans to the best value.
All told, this is the average time needed for Covered Ca enrollment with us:
We'll make sure you get the most tax credit available to you.
Blue Shield is a strong carrier on the market in 2016 and we can help you explore their options at no cost to you.
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We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.
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