faqs

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Who pays a broker’s fee?

A broker is paid a commission by the insurance company that you choose. Their consultation is at no cost to you.

Why use a broker?

Brokers understand the different plan designs and options. They demystify the process. After consulting with you, they will recommend plans that will work best for you, your family and/or your staff.

I keep hearing about Metal tiers. What are they?

With the advent of the Affordable Care Act there are now 4 tiers of health plan options: Bronze, Silver, Gold and Platinum. Bronze plans approximate 60% of claims payments; Silver approximates 70% of claims payments; Gold approximates 80% of claims payments and Platinum approximates 90% of claims payments. Your monthly premium payment will be the lowest with a Bronze plan and highest with a Platinum plan.

I used to be able to change my individual plan whenever I wanted to. Why may I only change during open enrollment?

The Affordable Care Act removed the ability for insurance carriers to decline insurance due to preexisting health conditions. This opened the possibility for some people to take advantage-purchasing a high level plan when they needed intensive medical care and changing to a low level plan once their health issue was resolved. This would greatly impact the healthcare system. Some of this was alleviated with the open enrollment time. People may change their plans only one time a year at open enrollment.

When is open enrollment?

For 2016 individual plans open enrollment is 11/15/16 through 2/15/17.
Open enrollment for group plans is the month in which the health insurance first went into effect.

I am an owner of a small business. What are the advantages of going through the California SHOP exchange?

If you staff earns an average of $50,000 or less your business may be eligible for a tax credit of up to 50% of your premium on a for profit business and 35% of your premium for a non-profit.
Your staff has access to various carriers- Kaiser, Health Net, Blue Shield, and Anthem Blue Cross. You choose a metal tier (see #2 above) and your staff may choose any carrier plan offered within that level in the SHOP system.

How is that different from the private open market?

On the open market you, as the owner of a small business, will probably have to choose one carrier, e.g. Blue Shield. Your staff is required to be insured with that carrier even if they prefer another.

As a small business owner why would I choose the open market?

The open market has many more plans to choose from with a variety of plan designs.

I tried going through Covered California Exchange to insure my family but they did not allow me to choose a plan. It made us go to Medi-Cal. Why?

If you are within 133% of the poverty level of the United States you will be directed to Medi-Cal.

My doctor was in the network of the plan I signed up with. But now he is not. Is this the fault of the Affordable Care Act?

No. Doctors have always had the ability to go in and out of networks. The reason is often due to the contracts that the carriers offer.

I have a short term health plan. Is that ok?

Do you have a short term health insurance policy? Or are you considering a short term health insurance policy instead of a regular policy because the premium is low? If you replied yes to either of these questions please read this article, The Hidden Risks of Short-Term Health Plans . Short term policies do not fulfill the Affordable Care requirements: they still have preexisting condition clauses, lifetime maximums, do not offer preventative care or some of the essential health benefits. And, because they do not fulfill the requirements, you will receive the penalty of $695 or 2.5% of your 2016 income on your taxes next year. I recommend short term health insurance policies only in the following scenarios: you missed the open enrollment; you were laid off the last quarter of the year. The last is due to the loophole in the Affordable Care Act. If you do not have health insurance for 3 months of the year or less you do not receive the penalty.

As soon as I turned 64 I received so much information about Medicare, plans supplements, prescription plans-I was drowning in paper! I was so confused. I didn’t know an Advantage plan from one that did not have advantages. Michelle at Claims Plus Insurance Solutions was so patient. She asked about my medical needs and found me the perfect combination of benefits. I have called since then when I had a question. I spoke to Carol who responded to me in a day with the answer. I can’t say enough good things about the people at Claims Plus Insurance Solutions!

Kathey Tappen
I have worked with Maria for several years in various organizations and she is deeply knowledgeable, easy and a pleasure to work with, produces enormous amounts of confidence and satisfaction to both me and all our staff. I will recommend her to anyone looking for someone who really knows how to navigate complicated and even simple health benefits structures. Thank you Maria!

Chris Lymbertos (LinkedIn)
Maria helped me discover why I was paying so much money out of pocket and switched me to a health plan where I am paying less. I was hit with a couple of health conditions a couple of years back and needed good specialist recommendations. Maria went above and beyond to find the right doctors for my wife and me. I even referred my friend to Maria and she looked over his plan and told him to keep it because it was best for him. My wife and I are fortunate to have met her. Thanks Claims Plus Insurance!

Bryant Sharifi (5 Star Yelp Review)

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