Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
In the spirit of Covered California and an open market place, agents should be offering information on all health plans available to the individual or family in their region. If a marketing program is designed to restrict consumer information or attempts to steer consumers into a specific health plan, the loser is the consumer. This sort of devious marketing arrangement is made even more egregious when the bait to entice a consumer is a government funded subsidy.
Under California legislation SB 78, employees of small groups who had previously waived coverage will have a Special Enrollment Period to sign up for health insurance through their employer for 2020.
The women who called me were appropriately irked that the change to their husbands being the primary applicant conveyed a perception that they were not qualified to be the primary account holder for the management of their health insurance plans.
As many people enrolled in Covered California have found out, the folks at Covered California will not talk about taxes. Most consumers have also learned the dirty little secret about the federal and state subsidies for health insurance; it’s all about your tax return. The Internal Revenue Service (IRS) and the California Franchises Tax Board (FTB) don’t care how you estimated your income to Covered California to become eligible for the monthly subsidies. They only care about the final income number (MAGI) that entitles you to a subsidy.
What all the deductibles, coinsurance, and copayments have in common is that they all accumulate toward meeting the plan maximum out-of-pocket amount (MOOP). When you reach your MOOP, then all the services and prescription drugs are covered 100% by the health plan. But it can seem like forever to reach your MOOP when you are going through lots of tests, procedures, and swallowing drugs like candy on Halloween.
Covered California has partnered with the Franchise Tax Board to produce a 2020 Individual Mandate Penalty Fact Sheet that includes how to calculate a potential penalty.
I share Covered California’s concern that health care sharing ministry programs are a mine field waiting for someone running from ridiculously high health insurance premiums to step on and have the bomb explode. However, I disagree with Covered California’s proposed use of certified agents to be their foil to limit the enrollment in these products. Agents are not the jailers charged with keeping the citizens within the health insurance pool.
If you want to keep either UCLA or Hoag in your Oscar health plan, you will have to enroll in an off-exchange Oscar plan that is designated with the Circle network. The Circle network that includes UCLA and Hoag will only be available in the metal tier plans of Bronze and Silver.
California’s individual mandate penalty will require residents to prove they either had minimum essential coverage during the year, have a valid exemption, or pay a penalty. The penalty will be the greater of $695 per adult ($347 per child) OR 2.5% of the household income. The verification of creditable minimum essential coverage and/or the ultimate penalty will be reconciled when residents file their state income tax returns with the Franchise Tax Board.
Will I be able to keep my current health plan? If you have a health plan bought directly from a health insurance company – also known as off-exchange – you might be able to enroll in the same plan. Not all health plans offered direct to consumers off-exchange are available through Covered California. For example, if you have a Kaiser Silver HDHP HSA compatible plan, it is not offered through Covered California. You would need to select one of the plans Covered California offers in order to get the subsidy.
