Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
If there is no existing enrollment of any family member into a Covered California health plan, the default plan selection in most cases will be the lowest cost Silver plan. For many people with low incomes, there may be no monthly premium for the lowest cost Silver plan. If you don’t like the plan selection, you can change it.
No one at Covered California calls the IRS for information and the IRS does not send Covered California any of your information. No one at Covered California will ever see your federal tax return unless you provide it to them.
The income columns that have been updated to reflect the higher federal poverty levels are 138%, 213%, 266%, and 322%. All those income columns, based on household size, correspond to Medi-Cal eligibility for adults, Medi-Cal for Pregnant Women, Medi-Cal for Children, and Medi-Cal Assess Program and CCHIP for children in counties in San Francisco, San Mateo, and Santa Clara counties. The other income columns that are not tied to Medi-Cal eligibility remain unchanged from the 2023 open enrollment period.
Lines 24 through 26 of Part II of form 8962 determine if the household is eligible for an additional Premium Tax Credit. In this situation, the final household MAGI was slightly lower than estimated income amount of the Covered California application. The result is that the household is eligible for an additional $23 in Premium Tax Credit. They were eligible for an annual subsidy of $16,832, but only received $16,809.
The Covered California plan covers no adult orthodontia unless medically necessary. The direct Delta Dental HMO plan does include adult orthodontia or braces. Neither plan covers dental implants. If you need a whiter smile, the direct Delta Dental HMO plan includes custom trays for the home bleaching process at a $125 fee.
Column A. Monthly enrollment premiums is the full premium rate for the health insurance that the family members were enrolled in for the month. The important role this dollar amount plays is limiting your health insurance Premium Tax Credit subsidy. You can only receive a subsidy equal to the cost of the health insurance. If you are eligible for a subsidy of $2,500 per month, but enroll in a health plan that only costs $2,000 per month, your subsidy will be limited to $2,000.
Because Medi-Cal workers don’t understand or comprehend some of these sources of income, they terminate the Covered California enrollments of adults and children. This creates chaos for these families. An unknown, uninvited, and unauthorized individual accesses a Covered California application and makes an uneducated determination of the household’s income. Then this same elusive individual terminates coverage for individuals and families, some of them undergoing health care treatment with specific providers not in any Medi-Cal HMO network.
The subsidy benefit for families burdened with crippling employer group health insurance premiums can be enormous. Unfortunately, acquiring the necessary employer information and calculating the affordability percentage can be daunting for some families. However, Covered California has created some worksheets and tools to help in the process.
In this particular case, the user ID of System-CW-San Diego alerted us that a case worker at San Diego County Medi-Cal had reviewed the application. I cannot say that the case worker changed the tax filing status. There are instances when the Medi-Cal system does not properly mesh with the Covered California CalHEERS software. There are times when conditional information is just erased or changed because of an incompatibility with the data fields.
Effective January 1, 2023, a new California law expands the definition of “dependent” for the purposes of enrollment in a Qualified Health Plan (QHP), to include a parent or stepparent of a qualified consumer. Rules for this benefit include that a dependent parent or stepparent must:
