Kevin Knauss: Health, History, Travel, Insurance
Posts related to health insurance for individuals, families, small groups, enrollment, eligibility in California, plans, coverage, benefits.
Why can’t people who earn too much money to qualify for either MAGI Medi-Cal or the subsidies through Covered California just be allowed to pay the monthly capitation rate for these plans? They are less expensive than private insurance and would offer some protection from the corona virus health care costs.
Occasionally, I am asked whether I am an insurance agent or a broker. The underlying premise of the question is that the person does not want their insurance options limited to only those insurance companies the agent represents. The assumption is that a broker will not steer the client into an insurance policy that he or she receives the highest commission for. For the purposes of this discussion involving health insurance, there are no brokers, we are all agents. But not all agents are equal when it comes to the health plans they represent.
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Regardless, an advertisement that misleads consumers to think they will just get a health plan for $1 per month is the sort of marketing that reinforces the public’s perception that the health insurance industry is sneaky and deceptive. If you are on Medi-Cal, you cannot get an Oscar health plan for $1. If you earn too much money to qualify for the federal Premium Tax Credit subsidies through Covered California, you cannot get a health plan for $1. If you want an Oscar health plan with UCLA or Hoag providers, offered only in the Circle network off-exchange, you cannot get health plan for $1.
But as you can see, there are far more services with a specified copayment or coinsurance percentage, not subject to the deductible, than health care services subject to the medical deductible. It’s possible to meet your maximum out-of-pocket amount without ever meeting the medical deductible.
In the spirit of Covered California and an open market place, agents should be offering information on all health plans available to the individual or family in their region. If a marketing program is designed to restrict consumer information or attempts to steer consumers into a specific health plan, the loser is the consumer. This sort of devious marketing arrangement is made even more egregious when the bait to entice a consumer is a government funded subsidy.
The underwriting holiday only excludes the Statement of Health questionnaire, other conditions may prohibit enrollment. For example, Mary, may have cancelled her Medicare Advantage plan during the Medicare Open Enrollment. Mary suffers from rheumatoid arthritis. With the underwriting holiday, she does not have to answer the Statement of Health questions, one of which is if she has rheumatoid arthritis.
What all the deductibles, coinsurance, and copayments have in common is that they all accumulate toward meeting the plan maximum out-of-pocket amount (MOOP). When you reach your MOOP, then all the services and prescription drugs are covered 100% by the health plan. But it can seem like forever to reach your MOOP when you are going through lots of tests, procedures, and swallowing drugs like candy on Halloween.
Sutter Health Plus is expanding its service area to include 15 new ZIP codes in Santa Clara County effective Jan. 1, 2020. access to care for members in the South Bay who live or work in Santa Clara County, primarily around San Jose
I share Covered California’s concern that health care sharing ministry programs are a mine field waiting for someone running from ridiculously high health insurance premiums to step on and have the bomb explode. However, I disagree with Covered California’s proposed use of certified agents to be their foil to limit the enrollment in these products. Agents are not the jailers charged with keeping the citizens within the health insurance pool.
