Kevin Knauss: Health, History, Travel, Insurance
When there is an error in a county Medi-Cal determination, it is nice if the beneficiary has an actual person to talk to. These people are known as case eligibility workers that work with most aspects of the eligibility determination process. Case eligibility workers seem to be going the way of most customer service departments for any business where access is governed by automated phone menus and chatbots.
Social Security recipients who have a Part D drug plan need to review their 2025 monthly premium rate. The changes to the Part D drug plans with a lower maximum out-of-pocket amount has forced many Part D plan sponsors to raise their monthly premiums. Rate increases of $30 to $50 per month is not uncommon.
We will see some health plans not be offered if there is a parallel marketplace with non-subsidized plans that have gaps and caps. Healthy people will migrate to the lower cost health plans leaving people who need health care services in the subsidized plans. This will cause the death spiral of the health plan as claims expenses increase with shrinking premium dollars.
The impacts of so many Medicare plans not paying an agent commission will suppress the number agents who are willing to assist enrollments for no compensation. In other words, some Medicare beneficiaries may have a tough time finding local agent help to evaluate their Medicare plan options.
However, individuals and families who had a qualifying event for a special enrollment period, and applied in October or November, are not in passive renewal status. You will need to push through the application for the next year. Select Apply Now from your home page to start the process.
The summary of benefits of the health plans indicates 100 days of skilled nursing facility residency per member per benefit period. The benefit period begins when you enter the facility and ends when you leave or 60 days after you are discharged. This is where the descriptions get a little hazy. One interpretation is that you can have multiple 100-day stays during the year as long as there is a 60-day span between admissions.
There are times when some regions get a huge windfall of subsidies. In Region 9, Valley Health Plan left the region. This dropped the expensive Blue Cross EPO into the SLCSP slot. This resulted in a 57 percent increase of the SLCSP rate in 2025 from Blue Shield HMO that was the SLCSP in 2024.
The Silver 73 has lower cost-sharing than a Silver 70 and is unchanged for 2025. There are no medical or pharmacy deductibles. The maximum out-of-pocket is $6,100. The most significant change is that it will be available to any Covered California enrollee with income over 250 percent of the federal poverty level.
For eligible households with income over 250 percent FPL, only the Silver 73 plan will be offered, which is a better value than a Silver 70. At least for 2025, there will be no Silver 70 for qualifying households. The Silver 70 will still be offered to consumers who opt not to be considered for the Advance Premium Tax Credit subsidies based on household income.
Other plans may have an out-of-network deductible of $500 to $750+. The out-of-network deductible must be satisfied before the plan begins to share in the cost of the health care services or out-of-network services.
