Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Consumers who purchased health insurance through Covered California may be receiving revised 2016 1095-As without requesting one. The revised 1095-As are popping up in consumer’s Covered California accounts and being mailed to them. Consumers should carefully compare the original 1095-A sent out by Covered California to the revised document to make sure it is correct.
After Covered California acknowledged at the January 2017 Board meeting that they had system issues that affected over 40,000 consumers, new enrollment problems seem to be boiling up. Some consumers have reported that household members who are ineligible for Covered California family dental plans have been automatically enrolled in dental insurance in 2017. In some very rare instances, the Covered California system is allowing consumers to actively enroll in two different subsidized health plans.
Covered California has been studying how different changes to the ACA will impact their ability to meet their projected budget and offer affordable health insurance to consumers. At the Covered California January Board meeting they released six reports they commissioned that studied consumer attitudes toward health insurance and potential changes to the ACA.
With all the discussion about congress repealing the Affordable Care Act, there is confusion over what exactly is an Obamacare health plan. Some people think the federal government is dictating the type of health plans that must be sold to individuals and families. It is up to each state to set the rules for their health insurance plans. The federal government under the regulations of the Affordable Care Act (ACA) stipulates what type of health plans are eligible for the Premium Tax Credits that make health insurance affordable for individuals and families.
The Western Center On Law & Poverty has put together a comprehensive guide to the Medicaid program in California known as Medi-Cal. Published in March 2016, there are bound to be changes to many of Medi-Cal’s programs, conditions, and eligibility in 2017. Titled Getting and Keeping Health Coverage for Low-Income Californians: A Guide for Advocates is 375 pages long and covers many topics from eligibility, citizenship, enrollment, re-determination, and the variety of programs Medi-Cal offers such as Children’s Health Insurance Program, Medi-Cal Access Program (MCAP) for pregnant women.
Like a mugger coming out of the shadows, San Diego County Medi-Cal worker(s) mugged a family enrolled in Covered California and stole their health insurance for 2107. The attack was unprovoked as the couple had not been in Medi-Cal and don’t have any children in Medi-Cal. However, Covered California reported the family to San Diego County because the family fit the profile of a household who they think aren’t smart enough to estimate their own income for 2017.
Consumers should be cautious when a health insurance agent wants to bundle a bunch of other products such as life and accident insurance with the Covered California health plan. These agents and marketing organizations are more interested in selling higher commission products such as life, accident, cancer, stroke, heart attack, and dental plans than they are health insurance. They may try to convince a consumer to drop the health plan to a Bronze level so they can sell questionable indemnity plan products as extra protection for the higher deductible.
As a Certified Insurance Agent for Covered California I am scrupulous when it comes to reading each question on the application for health insurance exactly as written, except when the Covered California application asks for the sex of the applicant. Instead, I ask for the person’s or dependent’s gender. Covered California should stop asking about a person’s sex and allow them to specify a gender.
California individual and family plan health insurance carriers have been combating fraudulent enrollment for open and special enrollment periods. Many of the health insurance companies have placed additional requirements on applicants to verify California residency. Unfortunately, enrollments through Covered California, which have virtually no verification of special enrollment eligibility, continue to be a source of high-cost claims from fraudulent enrollments.
Some Covered California consumers are receiving confusing letters stating they are either not eligible for health insurance or will be awarded no monthly tax credits for 2017. These letters are arriving after consumers have already successfully renewed their coverage or just enrolled for 2017 health insurance. The letters seem to be automatically generated in error as the consumer’s account still show enrollment with tax credits.
