Kevin Knauss: Health, History, Travel, Insurance
This same couple, based on 2021 rates, would have had a monthly subsidy of $788.47. If the couple were enrolled in the second lowest cost Silver 94 plan at $2 per month in 2021 – with the removal of the unemployment benefit – their new monthly premium will be $566 in 2022, that is a 28,000 percent increase. Plus, they will revert to a standard Silver 70 plan with higher cost-sharing.
I’ve been following the California Health Benefits Exchange and Covered California since their inception. They really have delivered on their mission to administer the Affordable Care Act subsidies to consumers. They have not become a black hole of taxpayer money to fix rotten and decaying computer systems. They have not become a cesspool of nepotism and cronyism that has characterized some California agencies. They have not become famous for indiscreet and corrupt employee expenses for parties and trips to Hawaii.
The ceremonial announcement of health insurance rate changes, usually a modest increase, is meant for the consumption of politicians, elected officials, regulators, special interest groups, and the media. You know, all those people who have group health insurance and are not subject to the vagaries of the ACA subsidy calculation. The reality of what most consumers pay for their health insurance through Covered California is far more complicated than a celebratory press briefing announcing a 1.8 weighted average percent increase.
The unemployment subsidy benefit further increased the subsidy. Because everyone was now eligible for the Enhanced Silver 94 plan, we switched this member from the Gold to the Silver plan. The new subsidy of $1,016.53 dropped the health plan rate to $1 per month. The better member cost-sharing for copayments and coinsurance will save the family even more money.
Covered California will begin processing the extra subsidy increase for applications that indicate unemployment benefits on June 21, 2021. The unemployment insurance benefit could have been for just one week in January. The household income will be taken down to 138.1 percent of the federal poverty level, regardless of the income estimated by the consumer. The 138.1 percent income level will prevent adults from being automatically determined eligible for Medi-Cal. The new subsidy will be based on the lower income and applied to the health insurance premium.
Based on the real-world comparisons I’ve done for individuals and families in small group plans, most would benefit from enrolling in Covered California. Anecdotally, I’ve talked to several employers who either have or are considering terminating their group coverage.
If you disenroll from your Covered California health plan and then try to enroll in a new plan, the system won’t give you the Advance Premium Tax Credit subsidy to lower the monthly premium. That is why it is crucial to use the change plan process in the Covered California system.
You don’t have to qualify for a Silver 94 to get a great deal. A 57-year-old individual with an estimated income of $30,000 in Nevada County will receive a subsidy large enough to make the lowest cost Silver plan from Anthem Blue Cross $1, the same as all the Bronze plans. Even the Blue Shield PPO Silver 73 at $85.11 is a better value than either the Gold or Platinum plans offered.
What is most distressing to parents is that they are learning of the loss of coverage from their health plans, not Covered California. One account showed the child was still eligible for health insurance through Covered California through May, but the carrier had sent a notice of termination for April 30th.
The Proof of Coverage form must be submitted by the app-based driver, or other gig worker entitled to the health insurance stipend, in order to receive the stipend from the company. Covered California has done a great job of putting an easy link on top of the member’s home page. With one click, the most recent quarter’s Proof of Coverage form is generated in a PDF document.
