Health insurance agents are not paid by Covered California. We are paid by the health plans, either PMPM or a percentage commission. There are 13 different health insurance carriers and 13 different agent commission structures.
Covered California
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Why Are PPO Health Plans So Expensive?
PPO and EPO plans generally have a larger network of hospitals and medical groups. They will include popular providers such as Cedars Sinai, Hoag, Providence, Sutter, and UC hospitals and medical group. The members of PPO and EPO plans can travel great distances to see their favorite specialist.
Do You Have To Repay Covered California Subsidies AFTER You Leave with Higher Income?
Sue and Bob received $3,840 in excess Advance Premium Tax Credit for the year. Because their final income is over 400 percent of the federal poverty level, they must repay all the excess health insurance subsidy.
Inequity Continues at Covered California with No Deductible Health Plans
Is it equitable that a married couple with substantial savings and high net worth receive significant health cost savings while a similar married couple with no savings but slightly higher income is subjected to higher health care costs? No, it is not equitable. It is a government program that is missing the mark on equity. Stated another way, the reduced cost sharing and no deductible health plans are not fair because the household income does not reflect the real financial state of the individual or family.
2024 Covered California Health Insurance Rate Increase Marketing
However, if you are in a region where Aetna CVS Health is the second lowest cost Silver plan, you may see a dramatic premium increase. This is because the Aetna CVS Health is slated to increase approximately 0.2 percent. This means that the subsidy with the Aetna CVS Health second lowest cost Silver plan will only slightly increase for 2024 over 2023. If you have the Blue Shield PPO with a 15 percent increase in that region, your 2024 subsidy will not change by much and you may be paying a considerably higher amount for your health insurance if you keep the Blue Shield plan.
No Gap or Short-Term Health Insurance in California
Loss of coverage is a Qualifying Life Event for a Special Enrollment Period into an individual and family plan. The problem for many people is the timing of the enrollment and the effective date of coverage. You must apply for an individual and family plan in the month prior to the effective date. Individual and family plans – in most instances – always become effective on the 1st of the month. There is no retroactive effective date offered.
Why Your Covered California Health Insurance Subsidy Dramatically Drops with an Income Increase
When the income estimate was increased in their Covered California application, the subsidy was properly calculated for the remainder of the plan year. The first thing Sandi and Thom notice is that they lost the Silver 87 plan and with the higher income are now only offered a Silver 70. Another disturbing problem for them is that instead of $336.57 monthly premium, their new premium for the Silver 70 is $657.31. They went from paying $16 a month for a great Silver 87 plan to $658 per month for Silver plan that has higher copays, coinsurance, and deductibles.
Your Medi-Cal Is Terminated! Now What?
If there is no existing enrollment of any family member into a Covered California health plan, the default plan selection in most cases will be the lowest cost Silver plan. For many people with low incomes, there may be no monthly premium for the lowest cost Silver plan. If you don’t like the plan selection, you can change it.
Your Tax Return Is Not Linked To Your Covered California Account
No one at Covered California calls the IRS for information and the IRS does not send Covered California any of your information. No one at Covered California will ever see your federal tax return unless you provide it to them.
Revised Covered California 2023 Income Table
The income columns that have been updated to reflect the higher federal poverty levels are 138%, 213%, 266%, and 322%. All those income columns, based on household size, correspond to Medi-Cal eligibility for adults, Medi-Cal for Pregnant Women, Medi-Cal for Children, and Medi-Cal Assess Program and CCHIP for children in counties in San Francisco, San Mateo, and Santa Clara counties. The other income columns that are not tied to Medi-Cal eligibility remain unchanged from the 2023 open enrollment period.
