I was in attendance at a Covered California meeting in Sacramento where agents asked if Covered California was going to publicize the individual mandate penalty in their marketing campaign for open enrollment. Executive Director Peter Lee told the audience that Covered California marketing would focus on the new California Premium Subsidy and not the penalty. But now, Covered California is using the argument that thousands of people don’t know about the penalty, when they are in charge of making California residents aware of the individual mandate penalty.
Consumers who are currently insured in the individual market directly through an insurer “off-exchange” may be eligible to receive financial help if they purchase coverage through Covered California during this new SEP. It is important to note that consumers who earn from 138 percent FPL through 600 percent FPL may receive state and/or federal subsidies which means they would be more likely to retain their coverage.
This disparity between penalty and the cost of health insurance is driving people to enroll in indemnity plan, discount health care plans, and the health care sharing programs. None of these programs are a substitute for real health insurance. But if a family can save $20,000, even after paying the penalty for not having coverage, that sort of cash goes a long way to meeting basic living expenses in California, plus a few trips to urgent care. And if the family is not subject to the penalty because the coverage is considered unaffordable, the individual mandate penalty is moot.
Under California legislation SB 78, employees of small groups who had previously waived coverage will have a Special Enrollment Period to sign up for health insurance through their employer for 2020.
Covered California has partnered with the Franchise Tax Board to produce a 2020 Individual Mandate Penalty Fact Sheet that includes how to calculate a potential penalty.
California’s individual mandate penalty will require residents to prove they either had minimum essential coverage during the year, have a valid exemption, or pay a penalty. The penalty will be the greater of $695 per adult ($347 per child) OR 2.5% of the household income. The verification of creditable minimum essential coverage and/or the ultimate penalty will be reconciled when residents file their state income tax returns with the Franchise Tax Board.