The Western Center On Law & Poverty has put together a comprehensive guide to the Medicaid program in California known as Medi-Cal. Published in March 2016, there are bound to be changes to many of Medi-Cal’s programs, conditions, and eligibility in 2017. Titled Getting and Keeping Health Coverage for Low-Income Californians: A Guide for Advocates is 375 pages long and covers many topics from eligibility, citizenship, enrollment, re-determination, and the variety of programs Medi-Cal offers such as Children’s Health Insurance Program, Medi-Cal Access Program (MCAP) for pregnant women.
Like a mugger coming out of the shadows, San Diego County Medi-Cal worker(s) mugged a family enrolled in Covered California and stole their health insurance for 2107. The attack was unprovoked as the couple had not been in Medi-Cal and don’t have any children in Medi-Cal. However, Covered California reported the family to San Diego County because the family fit the profile of a household who they think aren’t smart enough to estimate their own income for 2017.
Consumers should be cautious when a health insurance agent wants to bundle a bunch of other products such as life and accident insurance with the Covered California health plan. These agents and marketing organizations are more interested in selling higher commission products such as life, accident, cancer, stroke, heart attack, and dental plans than they are health insurance. They may try to convince a consumer to drop the health plan to a Bronze level so they can sell questionable indemnity plan products as extra protection for the higher deductible.
As a Certified Insurance Agent for Covered California I am scrupulous when it comes to reading each question on the application for health insurance exactly as written, except when the Covered California application asks for the sex of the applicant. Instead, I ask for the person’s or dependent’s gender. Covered California should stop asking about a person’s sex and allow them to specify a gender.
California individual and family plan health insurance carriers have been combating fraudulent enrollment for open and special enrollment periods. Many of the health insurance companies have placed additional requirements on applicants to verify California residency. Unfortunately, enrollments through Covered California, which have virtually no verification of special enrollment eligibility, continue to be a source of high-cost claims from fraudulent enrollments.
Some Covered California consumers are receiving confusing letters stating they are either not eligible for health insurance or will be awarded no monthly tax credits for 2017. These letters are arriving after consumers have already successfully renewed their coverage or just enrolled for 2017 health insurance. The letters seem to be automatically generated in error as the consumer’s account still show enrollment with tax credits.
For most Covered California consumers there will be only one PPO health plan to select. Blue Shield is the only health insurance company participating in Covered California that will offer a PPO health plan in the major metropolitan regions of California. While the PPO plan design signals to consumers that they have some freedom to use out-of-network providers, the Blue Shield benefits may be very restrictive.
With the constant erosion of the commission structures to agents for enrolling consumers into health plans in California, many agents have expressed their desire to stop assisting individuals and families with enrollment into Covered California health insurance. There has been renewed talk of allowing agents to charge a consultation fee to make up for the dwindling commissions they earn from the health plans and insurance companies. However, if agents want to make a decent return for enrolling consumers into health plans they need to provide the service so many of them advertise. We need to move from order-takers to consumer advocates, and we need fair compensation for our services.
The open enrollment and renewal period for Covered California is fraught with peril if you need to make changes to your household such as a change to income. If you make adjustments for 2017 before you renew your coverage, the system thinks you are making changes for 2016. This could have the impact of placing household members into Medi-Cal.
Anthem Blue Cross is terminating many of their 2016 PPO and Tiered PPO plans across different regions of California. They are being replaced with an EPO version in 2017. Covered California has misleading information placed on the consumer’s accounts that the new EPO is the same as the old PPO plans.