Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
The Covered California Premium Subsidy for health insurance is in addition to any federal ACA subsidy. It is also available for households who don’t qualify for the federal subsidy such as incomes over 400% of the federal poverty level. The subsidy estimator is an online tool to determine if your household might qualify for the […]
When the Covered California system is in the renewal mode, changes to your household will affect enrollment and subsidies for 2020. If you need to make changes for 2019, you will want to go through the Report A Change function on the home page.
For the California Premium Subsidy, you will reconcile that subsidy amount with the Franchise Tax Board when you file your state income tax return. And this is where it gets complicated and a potential headache for tax prepares. If your income is between 200% and 400% of the FPL you potentially could be receiving 2 subsidies, one from the feds and one from the state. If you earn over 400% of the FPL you will only get a subsidy from California.
I was surprised by the 60% increase in the Silver 70 medical deductible from $2,500 in 2019, to $4,000 in 2020. The Silver 73 plan increased 68% from $2,200 to $3,700 and the Silver 87 went from $650 to $1,400 – a 115% increase.
From my perspective, universal basic monthly income is already happening. Covered California gets money from the federal government and then sends it to the health plans. Whether the average amount is $424 or the real-world case of $2,094 per month, the Covered California subsidy is a real dollar amount that helps thousands of families in California. Perhaps Yang and Harris should study how the ACA and Covered California work and not tout their proposals has new or groundbreaking. The federal government is already paying out money on behalf of millions of health insurance consumers to make the monthly premiums affordable, which frees up money to pay all the other bills.
Covered California has developed a reprieve from immediate reporting to SAWS in the event of an error on the application that triggers Medi-Cal eligibility. The one-day delay in reporting the eligibility results to Medi-Cal is outlined in the CalHEERS 19.7 release scheduled to be implement on July 22, 2019.
The rallying cry in the 2020 presidential primaries is Medicare For All. But Original Medicare is the sort of health insurance that the Affordable Care Act set out to ban from the market place. Original Medicare has no annual caps on the maximum out-of-pocket a consumer must pay for either hospitalization or outpatient services. People can incur multiple Part A hospitalization deductibles during the year. The 20 percent coinsurance for medical services can mean some tests, imaging, and procedures can cost the consumer hundreds of dollars. Plus, there is no prescription drug coverage.
It is not intuitive that a person who is not automatically enrolled in Medicare must contact the Social Security Administration (SSA). However, the SSA is the gatekeeper of your employment and income records and therefore can make the determination of who is eligible for Medicare based on their work history.
The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
The brochure also outlines the rights and responsibilities of the Medi-Cal beneficiary. Eligibility determinations, either enrollment or termination, can be appealed. myMedi-Cal discusses the time periods for the appeals and the right to a State Fair Hearing.
