Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
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.
Covered California sent out a notice that some children in the Bay Area will be deemed Medi-Cal eligible and will be taken off their parent’s health plan as of April 1, 2016. The expanded Medi-Cal kids’ option only applies to the Bay Area counties of San Mateo, San Francisco, and Santa Clara. Because these counties have a higher cost-of-living, they have higher income eligibility for the Medi-Cal kids program. Whereas most families have their children dropped in Medi-Cal if their Modified Adjusted Gross Income is below 266% of the federal poverty line (FPL), in these Bay Area counties children qualify for Medi-Cal with a household income of 322% of the FPL.
Covered California has struck a deal with VSP vision insurance plans to offer Covered California members vision insurance. The VSP vision insurance plan is only available to Covered California members. For the bare essentials of vision coverage, the VSP – Covered California plan is very competitive when compared to other insurance plans on the market. However, there are some eye wear options that don’t have specific copayment amounts and could cost the plan member more in the long run.
Medi-Cal county eligibility workers continue to tamper with the estimated income of Covered California consumers. The result of these unauthorized adjustments to household income is families continue to get dumped into Medi-Cal with no warning. Covered California continues to allow these anonymous bureaucrats to make unauthorized income adjustments with notification to the member. These nameless and faceless bureaucrats, making sometimes life and death decisions about a families’ health insurance, are the embodiment of government power run amok that scared so many opponents of Obamacare.
One of the most important parts of the Covered California health insurance application is making sure that the household monthly and annual income is correct. Some consumers may encounter problems with incorrect income information through no fault of their own. As Covered California has updated and improved their CalHEERS online application, older information may get orphaned. This is the only explanation for a consumer whose Covered California account showed a negative monthly income, but a positive annual income.
All individual and family health insurance plans include a maximum out-of-pocket amount that is the most an individual will pay on in-network health care services for a calendar year. This is particularly important for sole proprietors and self-employed people as one emergency room visit can easily top $20,000, and without health insurance, can imperil the person’s business. The value of the maximum out-of-pocket benefit can be measured and compared between different metal level health plan tiers and carriers as one guide in selecting a health plan.
If a woman indicates on her Covered California individual and family plan account that she is pregnant, the application will be automatically screened for eligibility of certain Medi-Cal pregnancy programs. Some women have found that they are kicked off their private health plan with the premium assistance and relegated to the health care services only from Medi-Cal. This means they may not be able to see their regular OBGYN for pre-natal visits. However, you do not have to report your pregnancy to Covered California and risk being forced onto Medi-Cal.
Over the course of two different letters to U.S. Department of Health and Human Services (HHS) Secretary Burwell, the Executive Director of Covered California, Peter Lee, outlined the benefit of Certified Insurance Agents to their enrollment activities and suggested there should a uniform commission structure for health insurance agents. Mr. Lee’s comments come at a critical time when many health insurance companies are reducing and even eliminating agent commissions.
