Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
On a weekly basis I get calls from people telling me they can’t find doctors who will accept Covered California health plans. The prospective patient is told that the doctor will only accept off-exchange health plans and not Covered California health plans. This is after the health insurance company shows the physician as in-network. Are doctors really discriminating against Covered California consumers or do we just have a failure to communicate?
I screwed up big time on behalf of a man with a serious illness. The end result is that he will be without health insurance for the month of December. Even though there are other people who failed in this situation, I have to take the ultimate responsibility that he might have to shoulder thousands of dollars in health care expenses that would have been covered by health insurance. I broke the business rule of never following your heart, and always trust your gut.
The formula for determining how much premium assistance, also known as the Affordable Care Act premium tax credits (PTC), to lower your monthly health bill is complicated. At its core the formula uses the inputs of your age, MAGI, a special contribution percentage and the annual cost of the Second Lowest Cost Silver Plan. Plugged into the formula, these inputs determine if any Advance Premium Tax Credits (APTC) will be awarded to reduce your health insurance premium. Some people are surprised to learn they don’t qualify for any APTC even though their MAGI is below 400% of the federal poverty level.
Consumers, agents and Covered California representatives have been flummoxed over how to change the household health insurance plan after the account has been automatically renewed by Covered California for 2016. It may have come as surprise to Covered California that not everyone wants to renew their current 2015 health plan. After Covered California automatically renewed the health plan there is no visible way to change the plan…unless you know the trick.
In the last week as I’ve been bombarded with feel-good press releases from Covered California about their grand and glorious bus tour across the state promoting themselves and open enrollment, I’ve also been working with several cancer patients trying to find a health plan. From a person who is in the trenches working to enroll consumers in the best fit health insurance, the Covered California road show displays how their bus has taken a wrong turn down Marketing Lane. Californian’s need help finding health plans that include their doctors, hospitals, and cancer drugs. They could care less about a bunch of people riding around on a bus promoting their selves.
Covered California is cancelling the Advance Premium Tax Credit subsidy that lowers a household’s monthly health insurance premium for 2016 for some consumers. Through Covered California’s automatic renewal process I’ve seen several families’ tax credits disappear for 2016. Without intervention or explanation, many families who had their health insurance automatically renewed may receive a bill for the full premium amount because the tax credit subsidy was eliminated by Covered California.
At some point you get tired of dealing with idiots. At some point you need to complain with the full understanding that nothing changes because government bureaucracies and private corporation sucking off a government contract never change. As my phone showed I had been on hold for over four hours with Covered California’s agent support Pinnacle Management, I was able to finish writing the following complaint forms to Covered California.
The Northern California mother was distraught to learn that her daughter, who she thought was attending college in San Jose, was in jail. The letter from Covered California clearly stated under her daughter’s name, “The records show that you are incarcerated (in jail or prison).” For this woman, for whom English is a second language, she was panicked that her daughter was in jail, her daughter had lied to her, and the whole family might lose their health insurance. In reality, this cruel hoax on the mother is the result of a miserably drafted eligibility letter using questionable data sources.
Mr. Polk learned from his CPA on April 7th, 2015 that he owed $13,230.43 for the repayment of excess APTC for 2014. The CPA had properly taken the Covered California 1095-A and completed IRS form 8962 Premium Tax Reconciliation. It was clear on form 8962 that the addition of the Polk’s social security retirement income and tax-exempt interest had pushed the Polk household income over 400% of the federal poverty line.
Covered California has awarded quality star ratings to health plans based on just two questions from a questionnaire surveying consumer’s experience in 2014. In addition, the quality ratings were based on a completed sample size of approximately 100 respondents out of 1,000 surveys sent out.
