Covered California enrollment in health insurance and the subsidy can be complicated. There are many different moving parts and they can change during the year. If you get a letter from Covered California that you don’t understand or your health insurance premium has suddenly spiked up, contact you agent to help answer your question or resolve the problem. If you wait, or you miss your premium payments because they are too expensive, you could lose your health insurance for the rest of the year.
The customer service representatives at Covered California are very good at resolving a variety issues quickly and effectively. But there are situations that they cannot address, such as taxes, and as informed as the representatives are, they sometimes give nebulous answers or lead consumers to believe an issue will be corrected and then it doesn’t happen.
Call Your Agent With Any Questions
Here is an anecdote of where a simple issue snowballed out of control leaving the family without health insurance. One of my clients received a notice from Covered California that they had to renew their consent for verification. The consent for verification is necessary within the application to allow Covered California to verify certain household information through federal and state databases. Without the consumers consent to verify the information, Covered California cannot issue the Advance Premium Tax Credit subsidy to the health plan to reduce the consumer’s monthly premium.
In this situation, my client, who is just one of the sweetest people I have ever talked to, chose not to bother me, the agent, and call Covered California directly. Covered California did update the consent for verification but the family had already received a premium invoice for the full amount of the health insurance because Covered California could not issue the subsidy. Had the family called me, their agent, as soon as they received the notice, I could have adjusted the application so on the next billing cycle the subsidy would have been in place.
The client told me that the Covered California service represented informed them that they would attempt to change the application in a manner that would cause the health plan to issue a new invoice for correct amount, or an amount with the subsidy included. The family was left with the impression that they need not pay the invoice because they would be receiving a corrected version.
Family’s Covered California Health Insurance Terminated
The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
It has been my experience with Covered California that under certain conditions, once an invoice has been generated, and no subsidy applied because there was no consent for verification, there is no mechanism to retroactively change the billed amount. If the consent for verification is given before the 15th of the month, then the subsidy is applied the next month. While I am sure Covered California most likely has the ability to force a retroactive billing, the bureaucracy involved creates significant doubt, from my experience, that it will actually occur.
I was called by the client six months after the initial conversation they had with Covered California to correct the issue. They wanted me to fix the problem. The family’s attempt to get the health plan involved to correct the subsidy issue – and now the total termination of the health plan – was hitting a wall. They had filed an appeal. Covered California was unwilling to reinstate the health insurance coverage even though the health plan said they would honor a current enrollment date.
Even though I was completely out of the loop, I was able to get into the client’s Covered California account and download all the letters that had been sent and changes to the account, including the termination. Because I was not the agent of record who filed the appeal, I could not get involved with that avenue for correction. All I could do was play a support role for the client and the health plan to plead with Covered California to reinstate the coverage.
I don’t know how other agents monitor their clients in Covered California. There is an agent extract that agents can download from Covered California that lists all the current and upcoming deadlines for things such as consent for verification or providing proof of income or immigration status. To be honest, I don’t download the extract because it is cumbersome to work with and there are many false flags. Covered California sends out letters that consumers need to upload a document for verification when I had already done it months previously after I enrolled the consumer.
The other issue is time. The commissions paid by the health plans are so low that spending time to track down false flags by the agent just does not make economic sense. Some of the carriers will email agents when members are behind on their premium payments. But only a few carriers do this. Some of the health plans will flag consumers in their agent portal, if the carrier even has an agent portal, who are late paying their premiums.
However, for agents who represent 10 different individual and family health plan carriers through Covered California and potentially hundreds of consumers, this monitoring can be time consuming as well. Plus, when I did follow up with clients who showed they were late, I was informed they had either already made the payment or they were terminating coverage because they had received employer-based health insurance. Finally, I don’t like to harangue my clients. They are all adults and they don’t need me to be their mother reminding them to make their payments or send in their documents to Covered California.
Most Agents Can Quickly Resolve All Issues
BUT!…if a client calls me with a question or problem, I jump. Most issues can be quickly resolved. Other household issues need more discussion such as a dependent leaving the household, a sudden increase or decrease of income, or other tax related issue. These sorts of issues require time to explore all the different implications primarily because consumers are estimating their income for the future. There are also questions involving Medi-Cal and Medicare that need to be studied. Covered California participation requires planning on the part of the family and that is where an agent can be immensely helpful.
Unfortunately, if I am not contacted, I can’t address the issue or take care of it within the Covered California system. And if the problem drags on and leads to termination of the health insurance, we are talking hours of work to attempt to resolve problem and get the family reinstated, if that is even possible.
I would much rather spend 10 minutes with a client explaining a ridiculous and confusing Covered California letter than spend hours trying to get the family’s health plan reinstated. No question is to frivolous or small not to call your agent. Again, Covered California is complicated. Agents like myself deal with Covered California on almost a daily basis. We follow the updates to their system and notifications they send out. No one expects consumers in Covered California to keep abreast of all the changes or understand the important, albeit small, conditions that need to be met such as the consent for verification.
Hence, just call your agent when you have a question. If they tell you that your questions are annoying or too time consuming, go find another agent. Your health insurance agent is your advocate at Covered California. But if you don’t communicate with your appointed advocate, they cannot help you.