Kevin Knauss: Health, History, Travel, Insurance
Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.
However, individuals and families who had a qualifying event for a special enrollment period, and applied in October or November, are not in passive renewal status. You will need to push through the application for the next year. Select Apply Now from your home page to start the process.
There are times when some regions get a huge windfall of subsidies. In Region 9, Valley Health Plan left the region. This dropped the expensive Blue Cross EPO into the SLCSP slot. This resulted in a 57 percent increase of the SLCSP rate in 2025 from Blue Shield HMO that was the SLCSP in 2024.
The Silver 73 has lower cost-sharing than a Silver 70 and is unchanged for 2025. There are no medical or pharmacy deductibles. The maximum out-of-pocket is $6,100. The most significant change is that it will be available to any Covered California enrollee with income over 250 percent of the federal poverty level.
For eligible households with income over 250 percent FPL, only the Silver 73 plan will be offered, which is a better value than a Silver 70. At least for 2025, there will be no Silver 70 for qualifying households. The Silver 70 will still be offered to consumers who opt not to be considered for the Advance Premium Tax Credit subsidies based on household income.
Covered California is using AI to expedite the verification process. Common documents are scanned by AI, determined valid, and then the account is updated that the requested verification has been provided. Of course, the quality of the image submitted to Covered California can play a large role in AI being able to recognize and verify it or fail the submission.
On May 2, 2024, I received an email, allegedly from Covered California, requesting I update my information for their store front program. The first clue that this was a phishing scam was that I never applied to the Covered California store front program.
Covered California has run a test using AI on several parts of the application process and found that the AI verification solution was successful 80 to 96 percent of the time in correctly identifying the documents submitted.
However, even though COBRA may be more expensive than a Covered California plan with the subsidies, there can be good reasons to opt into a COBRA plan. The COBRA plan will be the continuation of the employer plan, usually without any employer contribution to lower the monthly health insurance premiums.
Just because Joey’s 2023 final Modified Adjusted Gross Income was in the range for Medi-Cal, he will not lose his 2024 health plan and subsidies. The IRS does not report his income to Covered California to flip him into Medi-Cal. His 2024 subsidy is based on his good faith honest estimate of his 2024 income.
I have created this income table that has the monthly income numbers for Medi-Cal eligibility next to the 2024 annual income amounts for the Covered California subsidies.The Medi-Cal income columns of the Covered California income table are 138% FPL for adults, 213% FPL for pregnant women, 266% FPL for children 18 years and younger, and 322% FPL for children in certain counties of California.
