Kevin Knauss: Health, History, Travel, Insurance
The real story is that rates, especially for older people, have risen so much in the individual and family market that health insurance under the IRS definition of being unaffordable can happen at a very young age. Below are examples of the least expensive Bronze plan rates in Region 1 and Region 3. Within a thirty minute drive between Auburn (Region 3) and Grass Valley (Region 1) in Northern California the rates can be sharply higher.
Upon submitting your application for 2018, the Covered California system checks your eligibility for 2017. If the system finds you ineligible, which you mostly likely are because you are not applying for 2017 coverage, the system automatically generates a letter informing you that you are not eligible for 2017 coverage.
I don’t mind enrolling people into Medi-Cal. I’m a one-person operation and I enjoy chatting with people. But I have to draw the line with people who insist on me answering a million questions and then failing to give me the appropriate information to complete their Covered California Medi-Cal eligibility application. I also will not knowingly participate in any misrepresentation or fraud so a person can either be enrolled in Medi-Cal or be determined eligible for the tax credits through Covered California.
In the case of this specialty genetic laboratory test, the lab billed $8,000 for the test. The health plan determined that the Allowable Amount was $3,000 for the test. The health plan paid 50% of the allowable amount in the form of a check to the plan member. Oddly, the Evidence of Billing indicated that none of the $8,000 claim was covered, even though they sent a check to the plan member for 50% cost-sharing for the test. Regardless, the plan member is still responsible for full $8,000 to the lab for the test.
Health insurance companies are smarter than your average house cat. They have reams of data about health care claims and demographics. They can forecast, with reasonable confidence, that altering some of the member cost-sharing benefits may reduce their final exposure to pay member claims. It has also been suggested that consumers who purchase health insurance off-exchange, paying the full premium rate with no subsidy, may be more judicious in how they use health care services. In other word, off-exchange consumer mays tend to file fewer health care expense claims. This results in lower rates to the consumer.
The Covered California agent service representative said I was about the fifth agent he worked with to identify the missing dependent tax status question. He could see the question in his system, but I couldn’t see the question on my client application. When he indicated that Debbie was to be claimed as a dependent of Susan, the APTC monthly subsidy was awarded.
Families don’t all have to be with the same carrier either. Some parents have chosen a PPO plan for their children because certain doctors who are treating their children are in-network with the PPO plan. The parents then choose a less expensive HMO plan for themselves. It could be that a family member needs surgery during the next year. That person might opt for a Gold or Platinum plan to reduce out-of-pocket expenses while the other family members hang out in the Bronze or Silver metal tier level.
If you try to terminate the 2018 enrollment, you will get an error code if date you are specifying is in December or earlier. This is because you can’t terminate an enrollment that has not started. If you try and change the effective date, while the enrollment year is still listed as 2018, you will be told the termination date will be 1/31/2018. If you follow through with the termination, you will be enrolled for the month of January for a plan you don’t want.
Because of all of the numerous ways a provide network search can give incorrect results, I am now recommending that people print out a list of providers in their area. Usually the list can be created in a PDF format that is searchable with Adobe Acrobat Reader. You can look through the list of doctor names alphabetically. You might see Dr. Balabat and realize that is your doctor when you thought the name was spelled Baladat.
But once you cross the border, some plans can be a little coy in whether they will cover any health care services. For both travel in the United States and abroad, you really need to study the health plan’s member agreement also referred to the Evidence of Coverage (EOC). The EOCs are those big documents that tell you have the plan works, what’s included, and what’s excluded. Some EOCs are specific about foreign travel coverage while others that I have studied make no mention of coverage outside the U.S.
