A health plan without your preferred doctors is not health insurance. Similarly, dental or vision benefits without it being accepted by your preferred dentist or optometrist is just a selling gimmick. Consequently, before favoring a Medicare Advantage plan because of the dental or vision benefits embedded in the plan, it is important to learn about the network of providers and if your preferred doctor is in the network.
Tom received unemployment insurance in 2021. Because of the unemployment insurance, Tom’s household income is 133 percent of the federal poverty level, regardless of his income. That 133 percent of the federal poverty level translates into $0 annual contribution for the second lowest cost Silver plan. Since the second lowest cost Silver plan premiums equaled $15,000 for the year that amount becomes the maximum subsidy allowed. Tom is eligible for an additional $2,318.40 ($15,000 – $12,681.40) in Premium Tax Credit because of the unemployment insurance benefit.
When you remove a family member from the health plan only, not the tax household, and everything else stays the same, the subsidy will decrease. The income is the same. The household size is the same. The full rate of the health insurance has been reduced. As the health insurance cost is reduced, the subsidy is reduced as less subsidy is needed to keep the household’s health insurance premium at the consumer responsibility level.
It is doubtful that in California individuals who remain unvaccinated would be slapped with a surcharge to cover the risk of future medical claims associated with treating a Covid-19 infection. That is not the way California approaches health insurance rates. However, the health plans can increase rates in regions that have demonstrated elevated health care costs and reasonably predict the higher cost trend to continue because of unvaccinated adults.
At $40,000 the 2020 Kia Niro PHEV EX Premium compact SUV was the most expensive car I ever considered buying. After one year, the Niro has met my standards for a semi-premium vehicle. First, it is comfortable for my 6 foot and 1 inch height. I can drive for hours and never get a back or leg ache. One reason for the limited stress on my frame is the adaptive cruise control on the highway. I set the speed and car lengths between me and the car in front of me and the car does the rest. All I have to do is pay attention to the road and my surroundings. The adaptive cruise controls the car and saves gas because the vehicle stays at a relatively constant speed.
There are a couple different ways to structure Medicare coverage. In the absence of any extra help from Medicaid or Social Security for Part D prescription drug coverage, the average Medicare beneficiary will realize the $170.10 for Part B and approximately $35 (national average) for a Part D plan. If the beneficiary adds a Medicare Supplement to cover most of the deductibles, copayments, and coinsurance of Original Medicare, there could be an additional cost of approximately $150 (Plan G in California.) That brings the monthly insurance costs up to $355.
If you consider certified agents are an extension of the Covered California customer service staff, the different agent compensation models are like paying a different hourly wage based on the health plan enrollment. The varying compensation amounts introduces a certain level of bias. If you are paid $15 an hour for enrollments in health plan X and only $8 per hour for enrollments in health plan Y, which health plan would you favor?
The BlueCard program allows members to receive some health care services outside of California. This is an important feature for individuals who routinely spend weeks or months outside of California on business. With the exception of emergency services, if an individual needed small health care service in another state, they were almost forced to buy two health plans; one for California and one for the other state.
If you indicate that your income in 2022 will begin on January 1, 2022, and you are applying in December, Covered California will determine you have NO income for December and are therefore eligible for Medi-Cal.
Most consumers would be surprised to learn that their health plans are being rated on how well their doctors treat them. Consumers don’t want their health plan involved in their health care decisions or interactions with their doctors. Consequently, some health plans are paying for the sins of some providers by being labeled with a low star rating.