Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Based on the real-world comparisons I’ve done for individuals and families in small group plans, most would benefit from enrolling in Covered California. Anecdotally, I’ve talked to several employers who either have or are considering terminating their group coverage.
If you disenroll from your Covered California health plan and then try to enroll in a new plan, the system won’t give you the Advance Premium Tax Credit subsidy to lower the monthly premium. That is why it is crucial to use the change plan process in the Covered California system.
You don’t have to qualify for a Silver 94 to get a great deal. A 57-year-old individual with an estimated income of $30,000 in Nevada County will receive a subsidy large enough to make the lowest cost Silver plan from Anthem Blue Cross $1, the same as all the Bronze plans. Even the Blue Shield PPO Silver 73 at $85.11 is a better value than either the Gold or Platinum plans offered.
What is most distressing to parents is that they are learning of the loss of coverage from their health plans, not Covered California. One account showed the child was still eligible for health insurance through Covered California through May, but the carrier had sent a notice of termination for April 30th.
The Proof of Coverage form must be submitted by the app-based driver, or other gig worker entitled to the health insurance stipend, in order to receive the stipend from the company. Covered California has done a great job of putting an easy link on top of the member’s home page. With one click, the most recent quarter’s Proof of Coverage form is generated in a PDF document.
The Department of Health Care Services (DHCS), the agency that manages the county based Medi-Cal system, has worked, and struggled, to efficiently determine MAGI Medi-Cal eligibility from the income section of the Covered California application. In a February 19, 2021, All County Welfare Directors letter, No. 21-04, DHCS outlined some of the changes to Modified Adjusted Gross Income (MAGI) calculations for MAGI Medi-Cal eligibility determinations.
Covered California has worked with the health plans to transfer any accumulation of member health care expenses from the off-exchange plan to a new on-exchange plan through Covered California. For example, if you have spent $1,000 toward meeting your deductible under your current plan, that $1,000 accumulation would be transferred to the new plan. Many health plans have announced they will participate in the transfer.
Taxpayers who have already filed their 2020 tax return and who have excess APTC for 2020 do not need to file an amended tax return or contact the IRS. The IRS will reduce the excess APTC repayment amount to zero with no further action needed by the taxpayer. The IRS will reimburse people who have already repaid any excess advance Premium Tax Credit on their 2020 tax return.
The income ranges in the revised table did not change because they were based on the already released 2021 federal poverty levels for income. What has changed is that the California Premium Assistance Subsidy is no longer listed. This is because the new federal Premium Tax Credit subsidies are larger than anything California was offering. Also note that the Federal Premium Tax Credit extends beyond 600 percent of the federal poverty level.
The household contribution percentages progressively increase until they reach 8.5 percent when the Modified Adjusted Gross Income is at 400 percent of the FPL. There is no cap on the household income in order to receive the federal Premium Tax Credit subsidy. As long as the Second Lowest Cost Silver Plan exceeds 8.5 percent of the household income, there will be a subsidy to lower the cost.
