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Covered California

Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.

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Original income and deduction data haunt Covered California applications

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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.

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Calculating the value of the maximum out of pocket amount for health insurance

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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.

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Should you report your pregnancy to Covered California and Medi-Cal?

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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.

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Covered California supports a uniform agent commission structure

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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.

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Can Covered California Obamacare survive a Republican President?

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Because of all the rhetoric from Republican Presidential contenders about repealing Obamacare I’ve fielded many calls from people wondering if Covered California will survive a Republican President. The fear instilled by the shrill comments of conservative politicians that hate the Affordable Care Act (ACA) is that families who rely on the premium assistance provided by Obamacare through Covered California will suddenly end if a Republican is elected President.

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Covered California Take Action to Keep Premium Assistance notice

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Some individuals and families who enrolled through Covered California have received a letter notifying them they are at risk of losing financial assistance in 2016. The letters being sent out include three reasons why a household might lose the premium assistance to lower their monthly health insurance bill. They are also frightening consumers who actually compiled with all the conditions they list in the letter.

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Native American health plans misrepresented on Covered California

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American Indians and Native Alaskans have access to special $0 cost share health plans that are available through Covered California. A recent enrollment by a member of a federally recognized Indian tribe was offered four different Anthem Blue Cross PPO $0 cost share plan where each one had a different premium rate. This is odd since regardless of the metal tier level of the $0 cost share American Indian-Native Alaskan (AI-NA) health plan, they all have the same exact benefits: zero dollar cost share for all services.

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ABCs of the 1095 health insurance coverage and tax credits

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All individuals and households who had health insurance during 2015 will receive a Form 1095-x. How you received your health insurance will determine who sends the 1095-x to you. You may receive different 1095s based on whether you had Medicaid, private health insurance purchased through a Marketplace exchange like Covered California, or through employer based health insurance plan. Each of the 1095s will be appended with a different letter ( -A, -B, -C) depending on the issuer of the form.

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Bronze 60 100% coinsurance after the deductible confusion

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One of the most baffling health plan descriptions is the 2016 Bronze 60 health plan that states that the member is responsible for 100% coinsurance after the deductible. Most people who read this immediately shake their head and think, “I have to pay for all of my health care services EVEN AFTER I meet the deductible?” There really is no reason to buy health insurance if it never helps with the costs. The second part of the equation, not always referenced, is the calendar year maximum out-of-pocket amount of the Bronze plan which does limit a health plan members health care expenses.

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Medi-Cal Individual Household Size Flowchart

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The Department of Health Care Services (DHCS) has developed a Medi-Cal household size flow chart. The DHCS Guide for Calculating MAGI Medi-Cal Individual Household Size was originally developed to help county eligibility workers ascertain the actual household size under the new Affordable Care Act (ACA) rules. The newly expanded Medi-Cal eligibility under the ACA revolves around on IRS definitions for tax dependents and non-filer rules. Because families can be so diverse and the rules regarding what constitutes a tax family so complicated, the flow chart for determining household size was created.

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