Because Medi-Cal workers don’t understand or comprehend some of these sources of income, they terminate the Covered California enrollments of adults and children. This creates chaos for these families. An unknown, uninvited, and unauthorized individual accesses a Covered California application and makes an uneducated determination of the household’s income. Then this same elusive individual terminates coverage for individuals and families, some of them undergoing health care treatment with specific providers not in any Medi-Cal HMO network.
Covered California Application
Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.
The subsidy benefit for families burdened with crippling employer group health insurance premiums can be enormous. Unfortunately, acquiring the necessary employer information and calculating the affordability percentage can be daunting for some families. However, Covered California has created some worksheets and tools to help in the process.
In this particular case, the user ID of System-CW-San Diego alerted us that a case worker at San Diego County Medi-Cal had reviewed the application. I cannot say that the case worker changed the tax filing status. There are instances when the Medi-Cal system does not properly mesh with the Covered California CalHEERS software. There are times when conditional information is just erased or changed because of an incompatibility with the data fields.
Effective January 1, 2023, a new California law expands the definition of “dependent” for the purposes of enrollment in a Qualified Health Plan (QHP), to include a parent or stepparent of a qualified consumer. Rules for this benefit include that a dependent parent or stepparent must:
Where households realize a dramatic increase in Blue Shield PPO Covered California premiums is when the SLCSP has a small increase or negative rate change. Consumers in regions 2, 3, 4, 6, 7, 15, 16 and 18, where the SLCSP rate increases were in the low single digits will see a smaller subsidy. In other words, the Blue Shield PPO plan rate increases in those areas was greater than the SLCSP that the subsidy is based upon. The subsidy did not keep pace with the Blue Shield PPO rate increase like they did in regions 1 and 10.
Many people do not update their income every year. While the income stays static, the threshold for Medi-Cal creeps up. The 2022 federal poverty levels are being applied for the 2023 Covered California subsidy and Medi-Cal eligibility. Many families are being caught by surprise that their current income is too low to maintain subsidies for their children.
People mistakenly believe that their past federal income tax return is used for their future income estimate. The past tax return can be a guide to estimating the income, but it is not final determination. One problem with federal tax returns is they usually don’t capture Social Security retirement benefits or tax-exempt interest, both of which are included in the Modified Adjusted Gross Income.
When you continue to review the plan options, the next screen is a confirmation of your existing health plan. Click on Back to Shopping. Another popup window will show and is sort of a warning. However, to review the options, click on Remove Existing Plans & Go Shopping. You will then be shown all the plans for the entire household or selected individual with the applicable subsidy applied.
Covered California has taken some of the guesswork out of selecting a plan by allowing only standard benefit design health plans on the market place exchange. First, all plans must cover the same health care services from routine office visits, maternity, to mental health services. You will not find plans that are lower cost because they do not cover maternity or cap the benefits for cancer treatment.
The total annual premiums for the entire household are used for the affordability test for the other household members. (This calculation can be made on a monthly basis as well.) The total annual premiums for everyone offered the lowest cost health insurance is $15,147.84 That annual premium is 18.93 percent of the $80,000 estimated household income. Because the health insurance expense percentage is greater than 9.12 percent, it is deemed unaffordable, Pat, Bobby, and Catlin can enroll in a market place ACA health plan with the subsidies.