For the family of a small business owner, the reduction of the MAGI because of the 20% deduction could drop any dependents under 18 years old into Medi-Cal. A family of four earning $70,000 makes all the household members eligible the tax credit subsidy through Covered California. If the family reduces their income by the 20% deduction, the new income is $56,000. That is below 266% of the federal poverty level for a family of four and all dependents 18 and younger are then deemed eligible for Medi-Cal.
Anthem Blue Cross started out as carrier with the largest enrollments in 2014 and 2015. They dropped to 26% market share in 2016. They dropped again 2017 down to 19%. Part of the drop, from my perspective, was related to the cost of the health plan versus their EPO network. People didn’t see the value of the smaller network and no out of network coverage relative to other alternatives. Then in 2018 Blue Cross pulled out of most of California. They offered plans only in region 1 (Northern California), region 7 (Santa Clara County) and region 10 (Central Valley counties). This dropped their market share down to 5%.
The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.
In another situation I, as the agent on behalf of a client, had made a routine address change. Everything was going smoothly until we went to update the plan selection. That’s when we got the error message. Nothing I could do (logging out of the system and logging back in) changed the error code. We could not select the plan for the new region the clients were moving to.
The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
Covered California takes a dig at the federal government correctly pointing out that rate increases, because of the removal of the individual mandate, means the subsidy amounts for consumers in Covered California will increase, “…the federal government will end up paying an estimated $250 million more in higher tax credits.” The loss of consumers will also impact Covered California. They estimate that enrollment in Covered California could decrease by as much as 162,000 individuals. Covered California is funded by a health plan fee for every member who enrolls through Covered California.
Over the last couple of years Covered California has been redesigning different parts of their online application to be less confusing to consumers. They have also enhanced sections such as the income portion to help guide consumers in selecting the correct entries. The document upload section is one of the last sections to get a face lift.
When I looked at the submitted application – there it was – I had to have selected the permanently moved to California QLE which is below loss of coverage. The permanent move to California QLE triggers the standard effective date of the 1st of the following month, in this case August 1st. So the family really did not have insurance for July!
So why is this significant? Because Kaiser was sending statements to the Covered California household for past due balances greater than one month. They were also sending termination notices even though they had already sent Covered California cancellation of the plan and Covered California terminated the enrollment. But Covered California will not investigate the erroneous terminations. They just tell the agents and consumers they have to deal with the health plan. In this case, the family has sent voluminous amounts of documents to Kaiser showing they made their premium payments.
Covered California consumers are penalized for having the good fortune of their household income’s increase. To add another layer of insult, if the consumer makes over 400% of the federal poverty level, they have to repay all the monthly tax credit subsidies they received during the year and pay for an artificially inflated Silver plan rate. Ouch!