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Covered California

Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.

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I Lied About Covered California Open Enrollment

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I was in attendance at a Covered California meeting in Sacramento where agents asked if Covered California was going to publicize the individual mandate penalty in their marketing campaign for open enrollment. Executive Director Peter Lee told the audience that Covered California marketing would focus on the new California Premium Subsidy and not the penalty. But now, Covered California is using the argument that thousands of people don’t know about the penalty, when they are in charge of making California residents aware of the individual mandate penalty.

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2020 Individual Mandate Penalty Special Enrollment Period Off-Exchange Consumers

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Consumers who are currently insured in the individual market directly through an insurer “off-exchange” may be eligible to receive financial help if they purchase coverage through Covered California during this new SEP. It is important to note that consumers who earn from 138 percent FPL through 600 percent FPL may receive state and/or federal subsidies which means they would be more likely to retain their coverage.

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IRS 2019 Health Insurance Subsidy Tax Credit Reconciliation

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For most tax payers, the income they estimated on their application for health insurance will not be exactly the same amount as their final Modified Adjusted Gross Income (MAGI) on their 2019 federal tax return. Part II of form 8962 compares the subsidy you received (column f) to the amount of subsidy you are entitled to (column e) from data supplied by the market place exchange on form 1095-A.

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What is Covered California? FAQs for Individuals and Families

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Is Covered California the only place to buy health insurance? No. You can buy a plan directly from one of the health insurance carriers available in your region. But there will be no subsidy to lower the monthly premiums. Enrollment into a health plan directly from the carrier is called off-exchange, as opposed to purchasing a plan on-exchange through Covered California.

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Medi-Cal Income Levels for 2020

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What is interesting is that these 2020 FPL income levels are higher than what Covered California posted in their program eligibility income chart at the start of the 2020 open enrollment period. Covered California listed the single adult Medi-Cal annual income level, 138% of FPL, at $17,237 and for a two-adult household at $23,226. The DHCS 2020 FPL income chart lists a higher amount of $17,609 for a single adult and $23,792 for two adults.

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MAGI Medi-Cal Is Good Health Insurance

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The Medi-Cal HMO plans are very similar to private health insurance plans. The plans have member ID cards, a provider network, and a drug formulary. One of the biggest complaints I hear is that the Medi-Cal HMO plans have few primary care providers and specialists that are accepting new patients. I also hear the same complaint from my clients in private health plans.

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Oscar Misleading California Consumers of Health Plan Costs

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Regardless, an advertisement that misleads consumers to think they will just get a health plan for $1 per month is the sort of marketing that reinforces the public’s perception that the health insurance industry is sneaky and deceptive. If you are on Medi-Cal, you cannot get an Oscar health plan for $1. If you earn too much money to qualify for the federal Premium Tax Credit subsidies through Covered California, you cannot get a health plan for $1. If you want an Oscar health plan with UCLA or Hoag providers, offered only in the Circle network off-exchange, you cannot get health plan for $1.

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California Individual Mandate Penalty Cheap Compared To Cost of Health Insurance

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This disparity between penalty and the cost of health insurance is driving people to enroll in indemnity plan, discount health care plans, and the health care sharing programs. None of these programs are a substitute for real health insurance. But if a family can save $20,000, even after paying the penalty for not having coverage, that sort of cash goes a long way to meeting basic living expenses in California, plus a few trips to urgent care. And if the family is not subject to the penalty because the coverage is considered unaffordable, the individual mandate penalty is moot.

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Medi-Cal Won’t Enroll You In Covered California

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If Medi-Cal makes any changes to your account through Covered California, and you have family members who are in a private health plan through Covered California, you need to finalize the new plan. In the above scenario, an additional subsidy was applied to lower the health insurance premium.

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How The 2020 California Health Plans Actually Work: Deductibles, Copays, Coinsurance, Maximum Out-of-Pocket Amounts

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But as you can see, there are far more services with a specified copayment or coinsurance percentage, not subject to the deductible, than health care services subject to the medical deductible. It’s possible to meet your maximum out-of-pocket amount without ever meeting the medical deductible.

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