Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
In another situation I, as the agent on behalf of a client, had made a routine address change. Everything was going smoothly until we went to update the plan selection. That’s when we got the error message. Nothing I could do (logging out of the system and logging back in) changed the error code. We could not select the plan for the new region the clients were moving to.
The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
Covered California takes a dig at the federal government correctly pointing out that rate increases, because of the removal of the individual mandate, means the subsidy amounts for consumers in Covered California will increase, “…the federal government will end up paying an estimated $250 million more in higher tax credits.” The loss of consumers will also impact Covered California. They estimate that enrollment in Covered California could decrease by as much as 162,000 individuals. Covered California is funded by a health plan fee for every member who enrolls through Covered California.
Over the last couple of years Covered California has been redesigning different parts of their online application to be less confusing to consumers. They have also enhanced sections such as the income portion to help guide consumers in selecting the correct entries. The document upload section is one of the last sections to get a face lift.
When I looked at the submitted application – there it was – I had to have selected the permanently moved to California QLE which is below loss of coverage. The permanent move to California QLE triggers the standard effective date of the 1st of the following month, in this case August 1st. So the family really did not have insurance for July!
So why is this significant? Because Kaiser was sending statements to the Covered California household for past due balances greater than one month. They were also sending termination notices even though they had already sent Covered California cancellation of the plan and Covered California terminated the enrollment. But Covered California will not investigate the erroneous terminations. They just tell the agents and consumers they have to deal with the health plan. In this case, the family has sent voluminous amounts of documents to Kaiser showing they made their premium payments.
Covered California consumers are penalized for having the good fortune of their household income’s increase. To add another layer of insult, if the consumer makes over 400% of the federal poverty level, they have to repay all the monthly tax credit subsidies they received during the year and pay for an artificially inflated Silver plan rate. Ouch!
The steps for reporting a change in CalHEERS have been significantly reduced. It is no longer required to provide reason and event date information multiple times when reporting a change for your consumer like address change, income updates, etc. Currently, if a household reported a change, the user was prompted to enter the reason and date multiple times, and even when not warranted. This has been updated to only ask reason and date if a household member is to be removed from the application or the plan. If the member is a primary contact or primary tax filer or primary care giver, then an option will be provided to identify a current household member in the role.
The increased revenue is also in light of reducing health plan assessment from 4% of the gross premiums down to 3.75% for the individual and family plan market. The proposed operating budget for FY 2018-19 is $340.2 million. This represents a 6.55 increase over the FY 2017-18 budget or an increase of $20,686,242.
In their conclusion, Covered California notes that health plans have already begun their decision-making process for participation and rates for 2019. The decisions the health insurance companies make will be based on existing federal rules. If the rules and policies to stabilize the marketplace are not implemented in the next couple of months, consumers will most likely face premium increases of 12% to 32% in 2019.
