The cost of the individual mandate is nothing compared to the cost of a decent health insurance plan. People are not enrolling in health insurance because it is too damn expensive. I don’t know what percentage of the decline in new enrollments for Covered California is due to expensive health insurance and they don’t know either. Talk to any health insurance agent they will tell you they fielded many calls from consumers wanting a lower rate on health insurance. They were willing to take anything, even if crappiest of plans if they could just afford it. I don’t sell them, but I had to inform people of the health care sharing ministries. These health care sharing plans are not insurance, but they can seem like a health plan for half the cost of a Covered California plan. How many people enrolled in these health care sharing plans and by-passed Covered California and the off-exchange plans altogether?
The first comparison was of two individuals at a Sacramento company enrolled in a Sutter small group HMO Silver plan. The rate for the 60-year-old employee is $838 and $688 for the 56-year-old employee. An IFP Silver plan directly from Sutter Health Plus HMO is $1,115 for the 60-year-old and $958 for the 56-year-old. The IFP rate is 25% and 28% higher than the small group plan at the respective ages. The lowest IFP plan available to these employees in the Sacramento region is a Kaiser Silver HMO plan at $990 for age 60 and $851 for age 56.
The $1 increase in wages per hour between 2018 and 2019 is an 8% increase. The FPL has been increasing approximately 1% every year. But if we assume the FPL increases 2% that would put the new Medi-Cal monthly income level at $1,425. The increased minimum wage for 2019 still makes the individual working 30 hours per week ineligible for MAGI Medi-Cal.
Where a primary source of confusion starts to creep into the preliminary eligibility determination for either Medi-Cal or Covered California hinges on when the new FPL amounts are considered for eligibility. This is where the rules concerning determining eligibility are not necessarily aligned between Medi-Cal and Covered California. The rules put forth by the ACA govern how Covered California applies the FPL amounts for determining eligibility for the Premium Tax Credit subsidy, which are slightly different than Medi-Cal. The Department of Health Care Services, the agency that administers Medi-Cal, must abide by older federal rules for eligibility determinations.
On the old 1040 tax forms you report any repayment of excess Premium Tax Credit on line 46, and any additional PTC owed to you on line 69. For 2018, repayment of the PTC subsidy is reported on Schedule 2 Tax (line 46) and additional subsidy tax credit is listed on Schedule 5 (line 70) Other Payments and Refundable Credits. It’s important to know where to find these numbers if you are trying to forecast for the next year and are using the past figures as a guide.
Basically, the redesigned 2018 form 1040 has made it more difficult to quickly locate all the necessary information for estimating a household’s MAGI. Virtually all of the dollar amounts were listed on the first page of the old form 1040. Now Covered California participants will have to review page 2 of the 1040 and Schedule 1 income and deductions to get most of the information for their estimated MAGI.
Even though the Covered California programs indicated one subsidy amount, a higher amount was actually applied to the first family member’s health insurance premium. It is clear from the displays that Covered California is applying too much APTC. In the first illustration, John was eligible for $272.12 per month, but Covered California applied $377.12.
When your son or daughter is earning money from a job, but still living at home, it can be a bit confusing when applying for health insurance through Covered California. When do you count your child’s income for Medi-Cal or Covered California? Should your child have their own health plan? Do they file their own taxes? Are they still going to school?
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
So here is the third subsidy bonus for large families. Not only are you billed for only three children, but you get a larger subsidy based on the entire household size. When you combine that with the inflated Silver plan rates, relative to the lower off-exchange Silver plans, large families get a nice subsidy to lower their health insurance premiums. You don’t pay for any more than three children, but you get the Premium Tax Credit as if the whole family were being billed for health insurance.