Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Outside of open enrollment there will be few opportunities to switch health plans unless the individual or family has a qualifying event such as moving to a new region. In all cases, if you are making the change through your Covered California account, you’ll need to terminate participation in the current health plan, create a change report and then select a new health plan.
In what has become routine for Covered California, they alerted agents to another CalHEERS enrollment website problem late on a Friday afternoon. The latest email notified agents that the system has been calculating the wrong Advance Premium Tax Credit (APTC) on submitted applications. While the Covered California email blast wasn’t real specific, it sounds like the APTC number is wrong when the applicant confirms the health plan purchase, but correct in the “Eligibility Results” page.
With no website and no functioning customer service, Covered California’s SHOP for small groups has ceased to exist. There may be a glimmer of hope for a return, but it is painfully apparent that SHOP is wrestling above its weight class. Whether their total melt-down is a function of poor vision and management from Covered California executive management and Board is anyone’s guess. That is a moot point when small groups that earnestly wanted to support and participate in the ACA have been handed plate of food contaminated with mold and weevils.
At the dawning of a new era in the United States as we lurch and stumble forward to fulfilling a dream of affordable health insurance for all our residents, I have been disappointed at how many Democratic leaders that helped pass President Obama’s signature first term accomplishment have been missing in action now that the Affordable Care Act is being implemented. When we need political and representational leadership most, the Democrats have abandon ship. To the Democratic Party I say, “Don’t ask me for money for your campaigns.”
In an effort to dull the impact of the bad news, Covered California released a statement late on a Friday afternoon detailing how many applications were effected by the previous week’s crash of their website. Covered California estimated that 14,500 applications that were started before the CalHEERS enrollment website went dead for five days may have to be resubmitted. Agents and consumers that started applications on February 17, 18, and 19, while the site was functioning but experiencing problems, before it completely crashed on the 20th may need to resubmit or start a whole new health plan application.
One of the strategies for enrolling hundreds of thousands of California residents in new Covered California health plans was to have an army of in-person Certified Enrollment Counselors. While these folks are trained on how to fill out the Covered California application, they don’t necessarily have any background in health insurance or how it works. Are the Certified Enrollment Counselors (CEC) qualified to answer simple to complex questions about health insurance and will they be there next month when their client has issue?
The Small Business Health Options Program (SHOP) from Covered California has unfortunately proved itself to be just as inept at processing enrollments as the individual and family plan side. What promised to be a stream lined and easy process for small employer groups to offer health insurance to employees through Covered California is beset with a dysfunctional enrollment website and poorly trained support staff. They make Anthem Blue Cross’ decision not to offer plans through SHOP absolutely prophetic.
With more working Americans eligible for expanded Medicaid health insurance there is also a growing fear that some government agency will want to seize a recipient’s assets to pay for the health care expenses. Fortunately, the expanded Medicaid, Medi-Cal in California, works under slightly different rules and provides some protection against “claw back” of assets to satisfy health care debt. However, one age group may be subject to Medi-Cal estate recovery rules under expanded Medicaid.
What should be a simple task of changing from one Covered California health plan to a new one is proving to be no easy switch. The Covered California CalHEERS internet based program seems incapable of handling the switch between health plans for residents. People are complaining of retroactively cancelled policies, odd effective dates and a system unable to handle simple billing issues.
Covered California is finally scrapping their error filled doctor search feature on their ACA enrollment website. Initially conceived to help match families with health plans that supported their current physicians, it had problems from the start. Covered California announced in a press release they will be taking their provider directory offline until further notice.
