Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Prior to the 19.4 update, I could always review the documents and correspondence for an account as an agent. This information was vital to see when letters were sent out and if they were returned to Covered California. It also showed which documents we had uploaded for verification purposes like income or residency. As of Monday, May 20, this section has vanished.
Until Covered California fixed the glitch, all women who reported they were pregnant were channeled into the Full Scope Medi-Cal for Pregnant Women program and had their Covered California health plans automatically terminated. This was a nightmare for many families as it completely disrupted their plans for the OBGYN they wanted to see and where they wanted to have their baby delivered.
The 1095-A is almost as important as filing taxes. Even if you did not owe taxes in 2017, but still received the APTC, you have to file a tax return. Covered California has been notified by the IRS if a current household, receiving the subsidy, has not filed a 2017 tax return. Covered California is sending out letters to consumers that their current monthly APTC subsidy will be terminated if they do not resolve the issue.
If the carriers feel threatened by the HCSM plans, they should lobby the legislature to ban those plans as well. Don’t use health insurance agents, under the guise of retribution from Covered California, to achieve the objective of limiting the enrollment in these plans. I completely get that if all the healthy people leave the pool, the carriers are going to have problems paying claims, and may exit the market altogether. We don’t want this to happen. But I’m just the agent. Don’t shoot me to protect your business model.
The Special Enrollment Period, Qualifying Life Events, and changes to income are VERY date sensitive. It can also be a little confusing in terms of what dates to use. If you don’t enter the correct dates, such as when income stopped or started, the application process can go sideways and you might be determined eligible for Medi-Cal. When in doubt, call your agent or the Covered California customer service line to determine the correct dates for your qualifying life event.
The benchmark 100% federal poverty level income for a single adult increased 3% from $12,140 in 2018 to $12,490 for 2019. The all important Covered California premium tax credit eligibility income (138% of the FPL) for a single adult increased from $16,754 for 2018 to $17,237 in 2019. This means a single adult now has to have an annual Modified Adjusted Gross Income (MAGI) of $17,237 to be eligible for Covered California if they apply for health insurance in 2019.
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.
