Kevin Knauss: Health, History, Travel, Insurance
Unfortunately, consumers should not have to go through this byzantine process of becoming private detectives to learn why they were denied enrollment or the subsidies. Covered California should spell out the specific reason either in a letter or on the phone. However, when all else fails you can file an appeal to kick the human process in gear to review your account.
In the second half of 2023 and continuing into 2024, we have seen some cases where the subsidy has mysterious disappeared. The estimated income is high enough for subsidies and nowhere near Medi-Cal range. The household member is enrolled in the selected health plan, but the subsidy has vanished.
Commissions from the various health, dental, and vision plans I represent totaled approximately $87,000 in 2023. Insurance commissions equaled 92 percent of my total revenue. Google and YouTube advertising revenue accounted for 2 percent of income and a few crumbs from book sales.
The ethical dilemma or conflict occurs because the household has agreed to report increased income streams, which will necessarily translate into higher health care costs. It is normal consumer behavior to minimize costs while maximizing benefits of any goods or services. The decision to report a higher income is clouded by issues such as the income is only an estimate and excess subsidy (Advance Premium Tax Credit) will be captured when the household files their federal income taxes.
Whether you purchase your health insurance through Covered California or off-exchange direct from the carrier, you can use the Covered California Shop and Compare tool to search for doctors and hospitals. The Covered California provider search tool will display the network status of the doctors and hospital you select for all the different plans offered.
In March of 2021, Blue Shield approved the plan member to receive gender dysphoria health care services from an out-of-network provider. Unfortunately, Blue Shield, according to the press release, inappropriately adjusted several of claims submitted by the health care professional. The payment dispute led to the health care professional suspending continued treatment until the claims dispute was resolved.
Platinum plans can save money because they have health care and prescription drug costs half of the Gold and Silver plans. The Platinum plan only makes sense if you can reliably predict the health care and prescription drug utilization in the next year. For everyone else, without that crystal ball, a Silver or Bronze plan work better at containing health care costs.
You will want to check your Covered California account. If the 2024 year is highlighted and it says Apply Now, you are not enrolled for 2024. You need to push the application through the process. All of the information is in the system, you just have to resubmit the application so you can select a plan for the new year.
Starting on January 1, 2024, assets, such as bank accounts, cash, a second vehicle, and homes, will no longer be counted when determining Medi-Cal eligibility. Income and income from assets, such as income from property, will continue to be counted. If you’re already a Medi-Cal member, this rule applies to you now, and you don’t need to report assets during your renewal.
IEHP appears to have very competitive rates for the Bronze and Silver metal tier health plans. They are less competitive at the Gold and Platinum levels. IEHP is the primary Medi-Cal managed care plan for the 2 counties. With the end of public health emergency, many Medi-Cal beneficiaries may no longer be eligible and will be transitioned to Covered California private health plans with the health insurance subsidies.
