A glaring deficiency in the report is the failure to attribute any decline in enrollments, either on the federal level or at Covered California, to an improving economy. Unemployment is at record low percentages and more people are working for employers who offer group health plans. Covered California’s own small group plans have seen increased enrollment since its inception in 2014 and their budget report estimates continued enrollment growth.
I find it amusing that the strategy to kill off government funded and managed health insurance for people may be the very illustration and demonstration of how single payer can work. The added benefit is a nod to the fact that, if included, volunteer work or family care work is treated as equally valuable as a wage earning job for eligibility for Medicaid. This is an acknowledgement that people volunteering in our communities plays an important role in the maintenance of the community fabric.
If you own a small business or receive income for a service you provide, and most likely file a schedule C with your tax return, you should consider having your estimated taxable income reviewed by your tax planner. The IRS has noted that as they develop guidance for all of the changes to the tax regulations for 2018 they will be posting them on their website.
The real looming threat is the loss of health plans participating in the IFP market. In 2017 three carriers dominated the market with 72% of the enrollments: Anthem Blue Cross 19%, Blue Shield 25%, Kaiser 28%. With the loss of Blue Cross in the major metropolitan markets such as the Bay Area and Southern California, two carriers, Blue Shield and Kaiser, are likely to command over 60% of the market place in 2018. If one of those two carriers determines that offering IFP plans is just too risky in 2018, it could lead to other carriers such as Health Net, Molina, or Oscar also pulling out of the market.
There a lots of different dental plans off-exchange or outside of Covered California. The number of plans makes comparisons complicated and confusing. Delta Dental and Anthem Blue Cross offer dental plans through Covered California and a variety of different plans off-exchange. The single largest difference between the Covered California plans and the ones offered off-exchange is the 12 month waiting period for major dental work such as extractions, root canals, and crown. The six month waiting period usually applies to minor restorative work such as getting a cavity filled.
Both Health Net and Blue Shield have wasted thousands of hours of time for consumers, agents, and their customer service staff. Tempers have become short and patience has run thin. And as of December 21st, a month after some people have applied for health insurance, 10 days before the plans are to become effective, many families don’t know if they will have insurance on January 1, 2018.
The real story is that rates, especially for older people, have risen so much in the individual and family market that health insurance under the IRS definition of being unaffordable can happen at a very young age. Below are examples of the least expensive Bronze plan rates in Region 1 and Region 3. Within a thirty minute drive between Auburn (Region 3) and Grass Valley (Region 1) in Northern California the rates can be sharply higher.
Upon submitting your application for 2018, the Covered California system checks your eligibility for 2017. If the system finds you ineligible, which you mostly likely are because you are not applying for 2017 coverage, the system automatically generates a letter informing you that you are not eligible for 2017 coverage.
I don’t mind enrolling people into Medi-Cal. I’m a one-person operation and I enjoy chatting with people. But I have to draw the line with people who insist on me answering a million questions and then failing to give me the appropriate information to complete their Covered California Medi-Cal eligibility application. I also will not knowingly participate in any misrepresentation or fraud so a person can either be enrolled in Medi-Cal or be determined eligible for the tax credits through Covered California.
In the case of this specialty genetic laboratory test, the lab billed $8,000 for the test. The health plan determined that the Allowable Amount was $3,000 for the test. The health plan paid 50% of the allowable amount in the form of a check to the plan member. Oddly, the Evidence of Billing indicated that none of the $8,000 claim was covered, even though they sent a check to the plan member for 50% cost-sharing for the test. Regardless, the plan member is still responsible for full $8,000 to the lab for the test.