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.
While some incorrect information may be corrected by calling the Covered California customer service line, other errors can only be fixed by filing a dispute form. The data that can be disputed are coverage start and stop dates, health insurance premiums, monthly subsidy forwarded to the health plan, missing family members, or household members who should not be in the tax family 1095-A.
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.
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.
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.
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.
While the health insurance companies calculate your monthly health insurance rate based on your age and where you live, the Silver plans strongly influence your monthly health insurance premium through Covered California. Specifically, the subsidies through Covered California are based on making the second lowest cost Silver plan (SLCSP) affordable, regardless of what you plan […]
Silver 73, 87, and 94 health plans, available through Covered California based on household income, have no medical deductible. That does not mean you escape any patient responsibility for health care services subject to coinsurance. With the enhanced Silver plans, you go straight into the coinsurance percentage for inpatient hospitalization and skilled nursing facility stays because there is no medical deductible.
The orange percent column titles represent dollar amounts pertaining to the eligibility for Medi-Cal programs. For example, adults with incomes under 138 percent of the federal poverty level are eligible for Medi-Cal. There are specific columns for Medi-Cal for Pregnant Women, Medi-Cal for children under 19 years of age (266%), and Medi-Cal Access Program that corresponds with expanded children’s Medi-Cal in certain Bay Area counties (322%.)
The family did not understand what was going on. Why was their subsidy unilaterally changed by Covered California with no warning? They did not trust Covered California to get the numbers correct. I created a spreadsheet to see if the new subsidy and subsequent totals matched what they were eligible for at the estimated income.
