Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Except for the initial funds from the federal government to establish Covered California back in 2011, they receive no federal or state money to fund their operations. While they do work under the Department of Managed Health Care, Covered California is an independent agency. They are funded by participation fees paid by the health plans.
We will see some health plans not be offered if there is a parallel marketplace with non-subsidized plans that have gaps and caps. Healthy people will migrate to the lower cost health plans leaving people who need health care services in the subsidized plans. This will cause the death spiral of the health plan as claims expenses increase with shrinking premium dollars.
However, individuals and families who had a qualifying event for a special enrollment period, and applied in October or November, are not in passive renewal status. You will need to push through the application for the next year. Select Apply Now from your home page to start the process.
The summary of benefits of the health plans indicates 100 days of skilled nursing facility residency per member per benefit period. The benefit period begins when you enter the facility and ends when you leave or 60 days after you are discharged. This is where the descriptions get a little hazy. One interpretation is that you can have multiple 100-day stays during the year as long as there is a 60-day span between admissions.
There are times when some regions get a huge windfall of subsidies. In Region 9, Valley Health Plan left the region. This dropped the expensive Blue Cross EPO into the SLCSP slot. This resulted in a 57 percent increase of the SLCSP rate in 2025 from Blue Shield HMO that was the SLCSP in 2024.
The Silver 73 has lower cost-sharing than a Silver 70 and is unchanged for 2025. There are no medical or pharmacy deductibles. The maximum out-of-pocket is $6,100. The most significant change is that it will be available to any Covered California enrollee with income over 250 percent of the federal poverty level.
For eligible households with income over 250 percent FPL, only the Silver 73 plan will be offered, which is a better value than a Silver 70. At least for 2025, there will be no Silver 70 for qualifying households. The Silver 70 will still be offered to consumers who opt not to be considered for the Advance Premium Tax Credit subsidies based on household income.
Not all the below options may be available to you because some are contingent on your age, employment, or income. Those health insurance alternatives available to you are worth investigating and considering if they meet your budget or adequately address health care challenges you may be facing.
Covered California is using AI to expedite the verification process. Common documents are scanned by AI, determined valid, and then the account is updated that the requested verification has been provided. Of course, the quality of the image submitted to Covered California can play a large role in AI being able to recognize and verify it or fail the submission.
On May 2, 2024, I received an email, allegedly from Covered California, requesting I update my information for their store front program. The first clue that this was a phishing scam was that I never applied to the Covered California store front program.
