Even though the Covered California programs indicated one subsidy amount, a higher amount was actually applied to the first family member’s health insurance premium. It is clear from the displays that Covered California is applying too much APTC. In the first illustration, John was eligible for $272.12 per month, but Covered California applied $377.12.
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
When your son or daughter is earning money from a job, but still living at home, it can be a bit confusing when applying for health insurance through Covered California. When do you count your child’s income for Medi-Cal or Covered California? Should your child have their own health plan? Do they file their own taxes? Are they still going to school?
If you have to move out of your county because of the wildfires you may be entitled to a Special Enrollment Period. California is broken into 19 different rating regions. Los Angeles County is actually two regions, 15 and 16. If you move to a different region, you have a qualifying event for a Special Enrollment Period IF you already have health insurance.
So here is the third subsidy bonus for large families. Not only are you billed for only three children, but you get a larger subsidy based on the entire household size. When you combine that with the inflated Silver plan rates, relative to the lower off-exchange Silver plans, large families get a nice subsidy to lower their health insurance premiums. You don’t pay for any more than three children, but you get the Premium Tax Credit as if the whole family were being billed for health insurance.
Upon review, the consumer was now listed as an American Indian or Alaska Native, there was no selection for current health insurance or Medicare enrollment, and the application showed a higher income than we had estimated for 2019. This is not the first time I have seen individuals and whole families being flipped into American Indian or Alaska Native designation. As mentioned earlier, Covered California seems to automatically erase the current health plan information during the renewal. But this was not a renewal, just a correction to Medi-Cal eligibility.
The proposed rule is complicated and has many conditions and exclusions. Because of this complexity, many individuals and families with lawful permanent status, and enrolled in Covered California, or who have children enrolled in Medi-Cal, are fearful as being labeled as a Public Charge. Covered California has sought to allay the fears of people who might be affected by the proposed rule that their participation in Covered California and monthly premium tax credit subsidy they receive will not adversely impact their status.
Not all family members have to have the same carrier either. Some family members can enroll with a more expensive PPO plan while other individuals enroll in an HMO from the same company or completely different carrier. I have clients where some family members have chosen the Blue Shield PPO plan and other household members are with a less expensive Kaiser plan.
You can’t assume that all hospitals part of a larger network are all in-network with the same carrier if one is in-network. In Butte County, Blue Shield contracts with all the Enloe associated hospitals. But Anthem Blue Cross only contacts with Enloe Medical Center – Esplanade. The converse is also true. Blue Cross doesn’t typically contract with Sutter hospitals for their individual and family plans. However, in Amador County, Sutter Amador is an in-network hospital for Blue Cross.
Once all the income is entered in the different sections of the Covered California application, the program has a little link titled, Click here if this looks wrong. That takes you to the Adjust Project Annual Income (PAI) window. You can then type in an amount that is higher or lower than the number calculated from the income sections. Unfortunately, once you have used the PAI feature, the Covered California system won’t alert you to the override if you need to update your income in the future.
Caution! There are known data miss-match issues between SAWS and Covered California CalHEERS software. When a consumer is released from Medi-Cal it is necessary to scrub the application and look for missing or inaccurate data and conditions. The missing data could prevent the individual or family from getting the subsidy. It could be as simple as the application no longer indicating that the consumer will file taxes. This is simply fixed by checking Yes, the consumer will file taxes. Both Covered California and Medi-Cal are working to resolve this issue.