Not all family members have to have the same carrier either. Some family members can enroll with a more expensive PPO plan while other individuals enroll in an HMO from the same company or completely different carrier. I have clients where some family members have chosen the Blue Shield PPO plan and other household members are with a less expensive Kaiser plan.
Once all the income is entered in the different sections of the Covered California application, the program has a little link titled, Click here if this looks wrong. That takes you to the Adjust Project Annual Income (PAI) window. You can then type in an amount that is higher or lower than the number calculated from the income sections. Unfortunately, once you have used the PAI feature, the Covered California system won’t alert you to the override if you need to update your income in the future.
Caution! There are known data miss-match issues between SAWS and Covered California CalHEERS software. When a consumer is released from Medi-Cal it is necessary to scrub the application and look for missing or inaccurate data and conditions. The missing data could prevent the individual or family from getting the subsidy. It could be as simple as the application no longer indicating that the consumer will file taxes. This is simply fixed by checking Yes, the consumer will file taxes. Both Covered California and Medi-Cal are working to resolve this issue.
If a consumer does not like their plan or rate, they must make changes to their account and actively renew their coverage by December 15th for a plan effective date of January 1, 2019. Changes to the account and plan selection between December 16th and January 15th will have an effective date of February 1, 2019.
For the family of a small business owner, the reduction of the MAGI because of the 20% deduction could drop any dependents under 18 years old into Medi-Cal. A family of four earning $70,000 makes all the household members eligible the tax credit subsidy through Covered California. If the family reduces their income by the 20% deduction, the new income is $56,000. That is below 266% of the federal poverty level for a family of four and all dependents 18 and younger are then deemed eligible for Medi-Cal.
Anthem Blue Cross started out as carrier with the largest enrollments in 2014 and 2015. They dropped to 26% market share in 2016. They dropped again 2017 down to 19%. Part of the drop, from my perspective, was related to the cost of the health plan versus their EPO network. People didn’t see the value of the smaller network and no out of network coverage relative to other alternatives. Then in 2018 Blue Cross pulled out of most of California. They offered plans only in region 1 (Northern California), region 7 (Santa Clara County) and region 10 (Central Valley counties). This dropped their market share down to 5%.
The Medi-Cal representatives also confirm that erroneous information can pop into Covered California applications after an individual or family has been terminated from Medi-Cal. Once a person is deemed no longer eligible for Medi-Cal, the SAWS Soft Pause is released and the individual and family can then enroll in a Covered California plan with the tax credit subsidy. Unfortunately, the data on the Covered California can be missing or in accurate from what was originally entered.
In another situation I, as the agent on behalf of a client, had made a routine address change. Everything was going smoothly until we went to update the plan selection. That’s when we got the error message. Nothing I could do (logging out of the system and logging back in) changed the error code. We could not select the plan for the new region the clients were moving to.
The big change for the Gold plan was an increase in the MOOP from $6,000 in 2018 to $7,200 in 2018. That is a 16% increase. Before 2018, the Gold plans did not make a lot of financial sense considering they were so much more expensive than Silver plans. In 2018 the Gold plan MOOP was reduced to $6,000 and the Silver plans offered through Covered California were artificially inflated by approximately 10%. This meant for consumers receiving very little monthly tax credit subsidy, they were better off enrolling in a Gold plan because for some carriers the rate was less than the Silver plan.
Covered California takes a dig at the federal government correctly pointing out that rate increases, because of the removal of the individual mandate, means the subsidy amounts for consumers in Covered California will increase, “…the federal government will end up paying an estimated $250 million more in higher tax credits.” The loss of consumers will also impact Covered California. They estimate that enrollment in Covered California could decrease by as much as 162,000 individuals. Covered California is funded by a health plan fee for every member who enrolls through Covered California.