Kevin Knauss: Health, History, Travel, Insurance
Covered California has taken some of the guesswork out of selecting a plan by allowing only standard benefit design health plans on the market place exchange. First, all plans must cover the same health care services from routine office visits, maternity, to mental health services. You will not find plans that are lower cost because they do not cover maternity or cap the benefits for cancer treatment.
The total annual premiums for the entire household are used for the affordability test for the other household members. (This calculation can be made on a monthly basis as well.) The total annual premiums for everyone offered the lowest cost health insurance is $15,147.84 That annual premium is 18.93 percent of the $80,000 estimated household income. Because the health insurance expense percentage is greater than 9.12 percent, it is deemed unaffordable, Pat, Bobby, and Catlin can enroll in a market place ACA health plan with the subsidies.
From my car at the Oregon Bar parking lot, to the point where I estimated the first tunnel was located, is a little over 2.65 miles. However, those 2 miles, along the river, over the river cobble, cliffs, and sand bars is some of the most challenging and strenuous terrain I have hiked over. There are points where bare rock juts into the river and you must literally climb up and over the slate or granite.
The one wildcard with outpatient services is the coinsurance. Coinsurance is a percentage of the invoiced services that the health plan member is responsible for. For outpatient procedures, the coinsurance is not subject to the medical deductible for Silver plans. However, you may find yourself getting billed for coinsurance when you thought the health service had just a set copayment. For example, imaging with the injection of a dye to enhance image contrast. The machine imaging scan will have a set copayment, but the injection of the dye is considered an outpatient procedure subject to coinsurance.
The income chart uses columns with specific percentages to display the annual income amounts necessary for different program eligibilities based on household size, rows. What can be confusing is that an income chart will be published where the math doesn’t work. For example, the federal poverty level (FPL) income for an individual is the 100% column. The next column is 138% FPL. On the 03/2022 income chart, the annual income amount in the 138% FPL column, $18,755, is higher than the 100% column of $12,880 x 1.38 = $17,774.
That smile means I had climbed out of the hole of depression dug, by me, when I became an insurance agent. Selling insurance, from my perspective, is a soul crushing experience. Until I learned how to reset the table where I stopped selling insurance and started educating consumers, did I find a path in the insurance industry. Because, you see, I’m the guy who will take a phone call in a field of lavender to answer your health insurance questions.
Of course, if the annual premium for the second lowest cost Silver plan increases more than the other plans, it increases the subsidy for all consumers. In this example, the consumer would see monthly premiums for most plans below the 2022 levels. However, the second lowest cost Silver plan would have no increase from 2022 to 2023, even with the larger annual unsubsidized premium increase.
As of October 2022, there were no announcements that Stanford Health Care primary physicians would be in-network with any other individual and family plans. Blue Shield HMO states that Stanford hospital is in-network, but not the physicians. Valley Health Plan can make referrals to Stanford specialist doctors, but not for primary care.
There are many good reasons to include qualifying adults such as parents and stepparents within a Covered California household. There can also be unintended consequences such as making the entire household eligible for Medi-Cal and ineligible for the Covered California subsidies. The best approach is to understand all of the IRS rules regarding a qualifying relative and how the inclusion of the parent or stepparent will modify the eligibility of the household for the subsidies and Medi-Cal.
Consumers can change their health plans even if they have been passively renewed. If a household has been passively enrolled into a new plan, because their 2022 health plan is not offered for 2023, the consumer can change plans. If changes are made by December 27, the new plan will become effective January 1, 2023. Plan changes in January will become effective in February.
