Cover Oregon – Oregons Health Insurance Exchange

May 26, 2013 in Affordable Health Insurance, Dependants, Employee Benefits, Employer Sponsored Plans, Group Health Plans, Health Care Costs, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

You will likely be impacted by Obamacare, which forces most individuals, families and many groups to change their health insurance benefits soon. According to Obamacare, over 50% of health plans on the market today which consumers often choose, don’t provide enough benefits. As a result, many will be forced onto new plans that meet Obamacare requirements and their old plans will be terminated. Most existing plans on the market today will go away and most of you will be forced to choose a new plan for 2014. If you do not choose a new plan in Oregon, your insurance provider will automatically enroll you into their least expensive health reform compliant plan.

One of the largest changes to the industry will be the health insurance exchanges. Coverage Point agents are in the process of becoming certified in multiple states, which will allow our agents to offer plans on the health insurance exchanges. We anticipate being able to assist you apply for plans both on and off the exchanges. Here is what to expect. All detail are not yet available, but this is our general understanding as of now.

Health Insurance Exchanges & New Health Care Reform Compliant Plans

Enrollment begins October 1, 2013. With these changes, there are many who will benefit from the services offered by Coverage Point. We are here to guide you, and those you know, through this new insurance market. It is estimated that there are nearly 30,000,000 people in the US, who have no health insurance. By 2014, these uninsured individuals, will be required to obtain health insurance, or face a penalty when they file their tax return. For many who can’t afford health insurance, there will be subsidies to make it more affordable for them. Unless prohibited by law, at this time we will give you a $50 Gift Certificate or $50 Gift Visa from us when you refer someone to us and they are issued a new, individual, family or group, health insurance policy, or elect to make us their agent of record on an existing health policy. Please keep your eyes and ears open for anyone who may benefit from our assistance and services. Those who will most likely benefit from our services are:

  • Those who think they can’t afford insurance
  • Those who think their group options are too expensive
  • Those who think their group plan costs too much to add their spouse and/or children to their plan
  • Employers of all sizes
  • Individuals and families of all sizes
  • Those who currently don’t have health insurance
  • Individuals and businesses who think they will qualify for a subsidy, or have questions about them
  • Those who are required to purchase health insurance on their own
  • The self employed

Changes to take place on or before January 1, 2013. Oregon has come up with some of its own ideas while implementing some of Massachusetts current health exchange, Health Connector. Massachusetts implemented many of their own health care reform rules and mandates back in 2006.

  • Similar to group insurance now, there will be open enrollment periods for individual health plans. Like group, there will only be certain times of the year, or certain life instances that you will be eligible to apply for, or switch plans. These enrollment periods will apply to plans both in and outside of the exchange.
  • You must enroll into a health plan or there will be a penalty when you file your taxes. There will be a special “Catastrophic” plan available only for those who are considered as exempt from the penalty, or under the age of 30. The following will expected to be exempt from the penalty:
    o Certain religious groups
    o Certain Native American Indian Tribes
    o Undocumented immigrants
    o Prisoners
    o Those whose premium after federal subsidies and employer contributions exceed 8% of family income
    o Those whose income is so low they are not required to file a tax return
  • New required benefits
    o A health plans max out of pocket cannot exceed around $6,000 per person and $12,000 per family. Small group deductibles cannot exceed $2,000 per person and $4,000 per family
    o Plans must cover clinical trials
    o Plans must cover essential benefits. Lifetime and annual limits for essential benefits will be eliminated. Essential benefits are:
     Outpatient services
     Emergency
     Hospitalization
     Maternity & Newborn Care
     Mental Health & Substance Abuse
     Prescription Drugs
     Rehabilitative and habilitative services and devices
     Laboratory Services
     Preventive, wellness and chronic disease management services
  • Cover Oregon, Oregon’s health exchange is available to every individual and small group beginning October 1, 2013. Health exchange plan effective dates will begin January 1, 2014.
    o Insurance companies will no longer be allowed to deny someone for a preexisting condition. Rates are based on where you live, age and tobacco use. New premium ratios based on age for the January 1, 2014 rate adjustment, will result in a higher rate for children, and less significant for those nearing age 65.
    o Tax subsidy will be available to individuals and families who make up to 400% of poverty level. That means a family of 4 can make around $92,000 a year and still be eligible for a subsidy. A single person can make around $45,000 a year and still be eligible for a subsidy. The amount of the subsidy will be based on family income. The lower the family income, the higher the subsidy. Subsidies will only be available through the exchange. Here is an individual and family health insurance Subsidy Calculator.
    o Employers with 50 employees or fewer will have access to the exchange beginning 2014. Employers with up to 25 employees and an average wage less than $50,000, can receive a tax credit up to 50% the premium paid by the employer. These subsidies will be only available to plans purchased through the exchange. Here is the small group employer Subsidy Calculator.
    o The application process will be much simpler than it has been. Questions pertaining to health history will no longer be asked on the application. If you choose, the exchanges will give you the option to apply on your own and it will also allow you to choose us as your agent, or another agent. You will be able to give credit to the agent who assisted you, if you choose to apply on your own. The advice of an experienced agent is important to seek, prior to applying for any of these new plans that you are most likely unfamiliar with. There are important changes, details, knowledge and feedback about the exchanges, each plan and each company, which us agents have the knowledge or experience to guide you. Input that you will not get from an exchange or a brochure. Our agents are also brokers…we are not loyal to any one plan, one company, or the exchanges. Our assistance is still at no addition cost to you, like it always has been.
  • There will be 5 plan designs. Each insurance company will have comparable plans for each category below. Plans in the same category can somewhat differ from each other. There will be standardized Bronze, Silver and Gold plans, which will have identical benefits, no matter the insurer who offers them. Insurers are required to offer at least the standardized Bronze and Silver plan. Insurer who participate within the exchange are also required to offer a Gold option, though they are not required to offer the standardized Gold Plan. The most noticeable differences in the standardize plans are expected to be the premium you pay, provider networks and customer service received from the company.
    o Platinum – Covers on average 90%
    o Gold – Coverage on average 80%.
    o Silver – Covers on average 70%
    o Bronze – Covers on average 60%
    o Catastrophic – Covers on average 60%. This plan is for those who will be classified as exempt. Those who will be eligible for this plan are those who are under the age of 30, or those mentioned above.
  •  Employers with more than 50 employees will be required to offer insurance to their employees or face a penalty.

The 5 Most Outrageous Health Care Claims of the Week

May 9, 2013 in Uncategorized

The 5 Most Outrageous Health Care Claims of the Week

Posted by Kate Pickert Saturday, January 22, 2011 at 11:19 am

“Depending on which side you’re listening to during this phase of the health care debate, the Affordable Care Act (ACA) is either a deficit-slashing, job-creating wonder or a deficit busting, job-killing disaster. It’s easy to get confused, especially when lawmakers are throwing around numbers that don’t exactly depict reality. The biggest offenders this week were Republicans, mostly because they were doing most of the talking building up to their symbolic repeal of the ACA. Here’s a look behind this week’s claims….”

LifeWise Health Plan of Oregon SPECIAL Producer Bulletin – Products and Rates Filed for 2014

May 8, 2013 in Affordable Health Insurance, Grandfathered Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Agent, Health Insurance Exchange, Health Insurance Quotes, Health Insurance Reform, Individual Health Insurance

LifeWise Health Plan of Oregon SPECIAL Producer Bulletin – Products and Rates Filed for 2014 (05-08-13)

Affordable Access to an Attorney!

February 16, 2013 in Employee Benefits, Legal Protections, LegalShield


We would like to recommend and introduce to you and your family, a new product I offer, called LegalShield. LegalShield gives you, your spouse and dependents legal protection, by providing you access to an attorney for as little as $17 per month. LegalShield is a pre-paid legal service, which provides you and your family access to an attorney 24 hours a day. Not only does LegalSheild provide you protection from lawsuits (including trial defense) it also provides assistance from an AV rated (top rating a lawfirm can receive) lawfirm, for services to create or to update, your will, living trust and/or medical power of attorney, along with services for contract review, foreclosure, collections, identity theft, scams or fraud, landlord/tenant issues, realestate, traffic violations, and several other scenarios that you will likely encounter on a regular basis throughout life. For more details about this service, or to apply for this service, please click the “LegalShield” image above.

Waiving Healthcare Reform Goodbye- Part Deux

March 9, 2011 in Affordable Health Insurance, Dependants, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance

Waiving Healthcare Reform Goodbye- Part Deux

By Ashley Ahle
March 7, 2011

As reported on March 2nd, President Obama has chosen to allow certain states and companies to opt out of the Patient Protection and Affordable Care Act. So far the number of waiver’s granted by the Department of Health and Human Services has reached above 1,000. Though these waivers aren’t exactly the same as the Waiver for State Innovation, they do act in the same way, as a stop gap for companies and firms unable to meet the minimum annual coverage limit for 2011.

Companies eligible for these waivers receive a one year grace period for meeting the $750,000 coverage limit. Providing these waivers minimizes disruption in the health insurance market by allowing people to keep their coverage until realistic options become available. A spokesperson for HHS said that these waivers will ensure that American’s can continue to access needed services with little impact on premiums while the transition to a new marketplace in 2014 is under way.

So far, these waivers are covering about 2.6 million American’s- less than 2% of privately insured individuals. Waivers have been denied to companies, however, that cannot demonstrate that their compliance with the annual limit requirement would significantly increase their premiums or decrease coverage.

An important question being raised right now, is how will granting these waivers affect the credibility of health care reform all together? According to Kaiser Health News columnist John McDonough– a professor at Harvard School of Public Health, these waivers “offer a useful window into the health law’s evolving politics and future bargaining likely to take place.”

Lawmakers opposing health care overhaul are using these waivers as examples of flaws in the reform by saying they make for too many loopholes. While at the same time, they are demanding more “transparency” from HHS regarding why companies are being denied.

In response, HHS has said they have already provided the information requested, to the House Committee on Oversight and Government Reform. However in a letter sent in February the committee had clearly stated that they wanted a defined method of how the HHS was processing waivers, and where in the PPACA did it give HHS the legal right to grant these waivers.

Most companies being granted the one year waiver, are companies offering the lower cost “mini-med” plans. House members in opposition claim that this prevents the 2.6 million Americans covered by these plans from receiving the health insurance coverage that “President Obama believes every American deserves.”

There needs to be an adjustment period for everyone while this policy changing, far reaching health care overhaul takes place. If passed, one cannot expect changes to come immediately. Much like holding the Presidential elections in November but having a change of office in January, this law will need time to meld with the current market. And in time, if granted, these wrinkles may be ironed out in a way that suits us all.

Waiving Reform Goodbye? For Some States It May Be Possible

March 7, 2011 in Affordable Health Insurance, Dependants, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance

Waiving Reform Goodbye? For Some States It May Be Possible

By Ashley Ahle
March 7th, 2011

On the eve of February 28th, President Obama announced his support of the Waiver For State Innovation bill, authored by Sen. Ron Wyden and Sen. Scott Brown. This bill is one of the first bi-partisan acts supported by the President in regards to health care reform.

First proposed back in November of 2010, this bill was only 200 words long, allowing States the Opt out option in 2014 instead 2017. This will eliminate any costs accrued for states already planning to opt out in 2017, by allowing them to avoid costs associated with implementing the Affordable Care Act mandates, IE: individual mandate, employer mandate, health insurance exchanges and the federal design of health insurance coverage.

These costs would potentially be avoided because the federal subsidies allowed to the States could be used to implement health reform how they see fit. Now, the states planning to opt out will have to come up with an alternative reform that meets the following requirements:

1. The State waiver ensures that individuals receive coverage that is at least as comprehensive as under the Federal law.

2. State waiver ensures individuals get coverage as affordable as under federal law.

3. State waiver ensures that as many people are covered as under Federal law.

4. State waiver cannot increase Federal deficit.

These waivers, when granted, will be valid for 5 years with the option to renew after. If states are seen not fulfilling any of the aforementioned requirements, then Federal Overhaul and reform will take effect.

The main problem seen from moving this opt-out up is that without 3 years of complete overhaul experience under their belts, the states may set their figures for grants too high, since there wouldn’t have been enough time to actually see what their costs will be related to insuring their own citizens.

This bi-partisan bill may be just what Washington D.C. needs in order to break the gridlock surrounding the Affordable Care Act. This plan would lessen the government’s rule over health reform (wanted by Conservatives) and would ensure reform happens for everyone (wanted by Liberals).

As stated in previous posts, repeal of reform is extremely unlikely. Many Republicans are still unwilling to ‘reform health reform’ strictly because they are holding out for a full repeal, while their counterparts are making efforts to ensure a bi-partisan agreement can be made. The only thing to do now is wait and see what changes will come. And hope for the best.

Oregon May Have the Answer for Child Only Health Policies

March 3, 2011 in Affordable Health Insurance, Child(ren) Only Health Plans, Dependants, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Agent, Health Insurance Reform, Individual Health Insurance

Oregon May Have the Answer for Child Only Health Policies

By John Rueschenberg & Ashley Ahle of Coverage Point Insurance in Happy Valley, OR

The state of Oregon, a few months ago, restructured child only individual enrollments by switching to open enrollment periods, similar to that of a group open enrollment period. Child only applications are only accepted during the months of February and August of every year with effective dates of either March 1st or September 1st.

Congress Passed a law earlier this week allowing states to create similar laws that will close the loopholes in child only policies applications, which prevent insurance abuse of benefits. In order to keep insurance companies on board, regulation is needed to keep premiums from skyrocketing due people only obtaining coverage after they become sick and with no no consequences.

To simplify the process and reduce risk, annual enrollment periods across the industry, including enrollment for Medicare Advantage plans, should be changed to the month the eldest applicant was born. If this were to happen consumers, insurance companies, agents and the Federal Government would experience more ease when dealing with coverage.

Remembering the month you were born is far easier than researching the dates for the next enrollment period. Making this change would eliminate confusion that comes with purchasing an insurance policy. Enrollment periods that are lumped into a small time frame, like what currently happens for Medicare, group coverage and now child only policies in Oregon, increases the chances for error and reduces the quality of service, by creating an increased workload for the government, insurance companies and agents involved with enrollment.

Not only would changing the open enrollment period to the month of birth lessen the workload, it would also reduce the amount of SPAM email consumers receive year round. Instead of soliciting year round, agents and companies would only focus on the weeks leading up to the insureds birthday, making it easier for all parties involved.

Under health care reform, insurance companies are prohibited from denying any child with pre-existing conditions. Due to this change, many companies have either adopted the open enrollment periods or have stopped offering child only policies all together. Although companies are allowed to offer them outside enrollment periods, they are still prohibited from denying any child thus allowing people the opportunity to only gain coverage when an illness occurs, therefore driving up costs for everyone.

Not only would the birth month enrollment periods ease workloads across the industry, many more consumers would find it easier to obtain coverage and in turn, more people would be covered. Which is the goal of health care overhaul all together.

What Exactly are Reform Lawsuits Arguing?

February 24, 2011 in Affordable Health Insurance, College Students, Dependants, Employer Sponsored Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance, Specialists

What Exactly are Reform Lawsuits Arguing?

By Ashley Ahle
February 24th, 2011

Lawsuits being filed against the Obama administration’s Patient Protection and Affordable Care Act (PPACA), have amounted to the unconstitutionality of the individual mandate, and whether the federal government has the legal power to enforce such a provision. Currently out of five lawsuits that have made it to the courts, two of them have passed while still three have been ruled constitutional.

Tuesday night, United States District Judge Gladys Kessler ruled in favor of health reform, stating that it does not violate the individual’s religious freedoms. She also stated that Congress is well within their means to penalize people who forgo insurance. under the Commerce Clause in the constitution.

A ruling in favor of a 26 state lawsuit against reform in Florida was upheld by Judge Roger Vinson. He dismissed the law in it’s entirety stating that picking apart the law and taking out the mandate would render it “toothless” anyway. The administration is asking Vinson to further clarify his ruling and will more than likely seek a stay of judgment, further delaying the case’s move to the Supreme Court.

When fighting the reform, the state’s main fear is that it would give the government too much power by allowing it to penalize individuals without, and force people to purchase health insurance. In defense, the government claims that everyone will buy health care at some point whether it’s with insurance or in an emergency. Without the mandate, premiums would skyrocket and no one would benefit.

Parts of the constitution that are being used in these cases are Commerce Clause, Supremacy Clause (states that federal power is supreme over state power), and the 10th amendment which leaves to the state “all powers not explicitly granted to the federal government go to the state.”

While it remains to be heard in the Supreme Court, it is also unclear if the PPACA can stand without the individual mandate. There may be too many other parts of the bill connected with the mandate that would have to be repealed or changed as well.

Don’t let any of this confuse you as these cases have yet to make it to the supreme court. As of now there has been no final decision about repeal and the cases are still being heard around the country.

Changes and Rescission of “Conscience Clause”

February 21, 2011 in Doctors, Health Care, Health Care Costs, Health Care Reform, Health Insurance Reform, Individual Health Insurance, Primary Care Physician, Specialists

Changes and Rescission of “Conscience Clause”

By Ashley Ahle
February 21, 2011

In 2008, former President Bush put into act during his final days the 2008 Final Rule. This law aimed to further protect health-care employees, including Doctors, who chose not to perform certain medical procedures or assist with them due to religious or moral convictions. In January of 2009, President Obama sought to rescind this rule and further clarify the need to protect workers in these situations. What some opponents don’t realize is that for the past 30 or so years, the “Conscience Clause” has already been in effect.

Bush’s final rule, however, was never permanently enacted because it used “too broad of language” for the workers in the health care industry. Here is a little background into why this is a current issue with health care reform.

The “Conscience Clause,” originally known as the “Church Amendments,” were enacted in the 1970’s to clarify that federally funded health care facilities wouldn’t require their employees to perform medical procedures, like abortion or sterilization, if it went against their moral or religious beliefs. It also protected those people from being fired or wrongfully terminated because of those actions. On the very basic level this was essential in retaining the credibility of the Medical Field.

This original law went to include, beyond abortions and sterilizations, biomedical research, behavioral study programs and health study programs. Essentially, any person or entity receiving federal funding (grants, loans etc.) had the ability to opt out of providing certain medical services without recourse, if it went against their beleifs.

Under the new Affordable Care Act, no health plan offered in the health exchanges is allowed to discriminate against any provider or facility because of their unwillingness to provide, pay for, cover or refer for abortions. Obama moved to rescind part or all of the 2008 Final Rule because it’s power was thought to be too broad and unclearly written.

In order for protection of these individual’s beliefs, and for the 2008 Final Rule to work, there had to be some form of enforcement in place. These regulations included clear education of the “Conscience Clauses” to the public, working with state and local governments receiving federal funding to make sure they comply, and if compliance is deemed unsuccessful, non-discriminatory laws would be enforced by Department mechanisms to ensure Federal money is not going to supporting discrimination.

Obama’s original proposal to rescind or replace the ’08 Rule received over 300,000 public comments both for and against the changes. Many comments supporting Obama stated that the main fear with Bush’s rule is that patients would lose their right to receive services and that this blanket law would allow Doctors to easily refuse any kind of care.

Rescinding this rule allows patients the right to make unbiased informed decisions about their choices of treatment. If the ’08 rule stays the way it is, one runs the risk of letting informed decision making fall by the way side.

Everyone deserves the right to their beliefs and it goes both ways. Homosexual couples should be allowed to receive fertility treatments, and women who need life saving abortions should be able to receive them. Doctors and health care providers deserve their right to deny treatment, but they shouldn’t walk away form these patients either. Their duty as a Doctor, and one of their first oaths upon entering into their chosen field, is to ‘Do No Harm.’ Do No Harm. That’s what we all strive for.

Effect of Repealing the Individual Mandate

February 17, 2011 in Affordable Health Insurance, Employer Sponsored Plans, Grandfathered Health Plans, Group Health Plans, Health Care, Health Care Costs, Health Care Reform, Health Insurance Exchange, Health Insurance Reform, Individual Health Insurance, Specialists

Effect of Repealing the Individual Mandate

By Ashley Ahle
February 17th, 2011

Deeming the individual mandate of the Patient Protection and Affordable Care Act unconstitutional has caused many people to question the need for it. As I have said in past posts, an individual mandate is necessary for the PPACA to be successful. Without it or something similar, the Health Care Reform would fail. That said, how can the individual mandate be altered to fit the needs of those fighting for repeal? And by piecing apart the PPACA, what will the costs be to the government and will a repeal actually solve anything?

According to the Congressional Budget Office, they estimate that a repeal of the mandate would bring in roughly $202 billion dollars between 2014 and 2019, while at the same time increasing the number of uninsured by 16 million people. It would also reduce the number of people on Medicaid and the Children’s Health Insurance Program by 6-7 million people; individual coverage by 5 million and employee sponsored coverage by 4-5 million people. The question is, then, is saving that $202 billion dollars more beneficial to the people of the country?

Alternatives to the mandate are out there, however people voting to repeal all of the Reform are unwilling to present these options due to the fear that they may actually strengthen the PPACA. Since the reform will fail without a mandate, there needs to be something in place that is strong enough to discourage people from buying coverage only when they are sick. Reform will prohibit risk adjustments from being made individually. Instead there will be a community rating; this is a way to calculate premiums by evaluating the risk factors of all persons in the market, instead of evaluating it individually like it is done now.

Under this community rating, it makes it so healthy and sick people pay virtually the same amount in premiums. If there were a repeal of the mandate, health costs would rise to such a crushing rate that we may face another government bailout like that of the auto industry. The aim in repealing the mandate is to lessen the government’s involvement and this would run the risk of increasing it.

Other options to the mandate that have been kicked around include the possibility of a small tax, limiting enrollment to once every two years, penalizing people who wait, and implementing a five year lock-out. The small tax would be set close to the amount proposed for the penalty. For people who go uninsured this would be a tax they would pay at the end of the year and for people who can prove credible coverage this would be a tax credit at the end of the year. The reason that Democratic politico’s didn’t propose this originally is because of the political fight over taxes that would ensue.

Limiting enrollment to once every two years would disable people who decide to go uninsured from buying coverage only when they are sick. It would act as a buffer, similar to the enrollment periods for Medicare. Penalizing people who wait for coverage is similar to the penalty on Medicare Prescription Drug Benefit. It would implement higher premiums for those who decided to wait. The five year lock out would prevent people who go without coverage, access to government subsidies and insurance protections for five years. Even if they wanted to buy coverage in the first place.

Here the problem lies with Congress. There has to be a middle ground at this point, that both Republicans and Democrats can meet. The way things are progressing, that ground may continue to elude all parties. Republican’s and Democrats fighting for a repeal will not vote for alternatives to the individual mandate because they don’t want reform at all, and those alternatives may actually strengthen the PPACA. If we all, in fact want the same thing, a system with lower costs and near universal care, there has to be compromise. Otherwise the amount of money wasted on arguing all facets of Reform will outweigh the benefits.

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