Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
If the enhanced subsidy lapses, and Covered California must return to the pre-2021 subsidy curve, the consumer responsibility for health insurance increases. For the individual estimating $50,000, based on 2025 federal poverty level, they are still 343 percent FPL, but the consumer responsibility percentage increases from 7.08 percent to 9.78 percent*. (*Consumer Responsibility from IRS 2020 form 8962 instructions.)
The main takeaway is that the calculations for the ACA health insurance income estimates are separate from determining the tax on Social Security benefits. Specifically, all the Social Security income is included on the Covered California application as income, but only ½ is used for the combined income calculation of Social Security income taxes.
The underlying rational for the new rules is that CMS perceives consumers to be cheating the system. With no evidence presented, CMS believes that consumers are receiving subsidies and health insurance they are not entitled to. They accuse individuals, families, and agents of committing fraud. Again, they present no evidence to support their supposition. The focus of CMS is to save money and if people are denied health insurance and health care, that is simply collateral damage to achieving the goal of less federal expenditures. The new rules are meant to save money and help the health insurance companies.
The Covered California application has been updated to better recognize and process documents related to confirming the identity of the applicant. With just the information on the application (name, address, date of birth, and social security number) the system can now quickly verify the applicant. Covered California has done away with the identity proofing questions.
Once your application for health insurance is approved by Covered California, the clock starts ticking on the Reasonable Opportunity Period (ROP) of 95-days to submit any proof or verification requests from Covered California. If they do request verification for conditional elements such as income, immigration, or minimum essential coverage, they will send you a letter.
Covered California has estimated that 112,000 individuals will lose the health insurance subsidy under the proposed Republican budget reconciliation bill now under consideration in Congress. Language in the bill would prevent lawfully permanent residents in close to 40 categories from receiving the Advance Premium Tax Credit subsidy to lower health insurance premiums. Republican bill to […]
Except for a few qualifying life events, you have a 60-day special enrollment period window to enroll in health insurance from the date of the event. The qualifying life events listed below are of May 2025. Proposed rule changes by the Trump administration may mean some events are no longer eligible for the special enrollment period.
The management of websites, especially as large and complicated as Covered California, requires professionals that understand all the code, trackers, cookies, and tags. It is surprising that the Covered California IT team missed the tag that was gathering personal information and sending it to LinkedIn.
President Trump has instilled fear and caution in consumers applying for health insurance. Some consumers are skipping over optional questions that pertain to ethnicity and gender identity fearful their responses may be used against them in the future by the Trump administration. I agree with them.
Central to Altman’s response, and threads through eleven-page letter, is that Covered California’s success is a function of the flexibility the state had to implement innovative strategies to help consumers enroll in health insurance. The new CMS rules are based on a one-size-fits-all concept when each state’s population is different.
