Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Covered California is not very health insurance agent friendly when it comes to managing an agent’s book of business. Agents seem to be the last to know when Covered California or Medi-Cal makes changes to a client’s account and either strips their premium assistance or dumps them into Medi-Cal. Covered California has developed book of business and conditional eligibility reports for an agent’s clients enrolled in health plans through Covered California.
As of April 2016, when a consumer makes their first month’s payment for their Blue Shield health plan, the money is never applied to their account.
For independent health insurance agents, such as me, who don’t have access to an already established secure network through a large agency, we have to be more diligent in securing all the different parts of the internet communication puzzle.
Built into the Affordable Care Act is the loss of the health insurance subsidy when the household income exceeds 400% of the federal poverty line. For older adults whose income might be greater than 400% of the federal poverty line they face losing the Advance Premium Tax Credits that makes their health insurance premiums affordable. In some instances the health insurance premiums can shoot up to over 20% of their income.
Medi-Cal advocate Beth Capell smeared the reputation of all health insurance agents by insinuating that agents enroll Medi-Cal eligible children in private plans just for the commissions they derive from those enrollments. Ms. Capell is assuming, incorrectly, that all health agents put money above the best interest of their clients. It’s unclear where Ms. Capell’s animus towards health agents springs from when thousands of agents have assisted tens of thousands of families with enrollment in Covered California and Medi-Cal health plans.
In a March update to the Covered California enrollment software, individuals and families who indicated their preferred method of contact was email will actually start to get notifications from Covered California to their email addresses. The email will alert the consumer that there is an electronic letter in their secure Covered California Mailbox. This doesn’t mean Covered California will stop sending out reams of confusing letters to members, it just means that people can read them or delete them online.
There are a variety of reasons why a household member needs to be removed from a family’s Covered California account. In some unfortunate instances a family member has died. Other times a young adult ages-off the plan or a spouse gains other coverage such as Medicare.
Two years after the launch of Covered California and expanded Medi-Cal, California’s Department of Health Care Services and each of California’s fifty-eight counties, that individually administer Medi-Cal managed health plans for eligible residents, are still grappling with numerous questions regarding eligibility, enrollment, and the integration with the Covered California application.
On March 7 Covered California updated their online enrollment program with adjustments to how changes to income are calculated, plus new required fields for attestations from former foster youth. The Covered California CalHEERS program was also updated with new federal poverty level (FPL) incomes. A significant update will affect children in San Mateo, San Francisco, and Santa Clara counties where the higher household income of 322% of the FPL makes more children 18 years and younger in those counties eligible for Medi-Cal.
Covered California has released a form for consumers to attest that they are not in jail or incarcerated. Consumers who purchase health insurance are ineligible for the premium assistance tax credits if they are in jail or incarcerated in a prison. It’s unclear how Covered California knows if an individual is in jail or why, if they have been released, they aren’t alerted that a person has been released from custody.
