Covered California Application

Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.

Native American health plans misrepresented on Covered California

January 28, 2016 By Kevin Knauss Leave a Comment

American Indians and Native Alaskans have access to special $0 cost share health plans that are available through Covered California. A recent enrollment by a member of a federally recognized Indian tribe was offered four different Anthem Blue Cross PPO $0 cost share plan where each one had a different premium rate. This is odd since regardless of the metal tier level of the $0 cost share American Indian-Native Alaskan (AI-NA) health plan, they all have the same exact benefits: zero dollar cost share for all services.

ABCs of the 1095 health insurance coverage and tax credits

January 25, 2016 By Kevin Knauss 4 Comments

All individuals and households who had health insurance during 2015 will receive a Form 1095-x. How you received your health insurance will determine who sends the 1095-x to you. You may receive different 1095s based on whether you had Medicaid, private health insurance purchased through a Marketplace exchange like Covered California, or through employer based health insurance plan. Each of the 1095s will be appended with a different letter ( -A, -B, -C) depending on the issuer of the form.

Bronze 60 100% coinsurance after the deductible confusion

January 8, 2016 By Kevin Knauss 30 Comments

One of the most baffling health plan descriptions is the 2016 Bronze 60 health plan that states that the member is responsible for 100% coinsurance after the deductible. Most people who read this immediately shake their head and think, “I have to pay for all of my health care services EVEN AFTER I meet the deductible?” There really is no reason to buy health insurance if it never helps with the costs. The second part of the equation, not always referenced, is the calendar year maximum out-of-pocket amount of the Bronze plan which does limit a health plan members health care expenses.

Medi-Cal Individual Household Size Flowchart

December 26, 2015 By Kevin Knauss 7 Comments

The Department of Health Care Services (DHCS) has developed a Medi-Cal household size flow chart. The DHCS Guide for Calculating MAGI Medi-Cal Individual Household Size was originally developed to help county eligibility workers ascertain the actual household size under the new Affordable Care Act (ACA) rules. The newly expanded Medi-Cal eligibility under the ACA revolves around on IRS definitions for tax dependents and non-filer rules. Because families can be so diverse and the rules regarding what constitutes a tax family so complicated, the flow chart for determining household size was created.

Anthem Blue Cross denies Covered California consumers agent representation

December 20, 2015 By Kevin Knauss 1 Comment

Anthem Blue Cross, following internal policies to protect agents, prevents their members from selecting their preferred health insurance agent through Covered California. The Blue Cross policy of not recognizing an agent delegation made by a household in their Covered California account prevents the selected agent from properly representing the family members and being compensated for his or her time. The Blue Cross agent of record policy occurs when the Covered California member originally enrolled with another agent or without an agent and the member is considered a house account.

Are doctors discriminating against Covered California health plan members?

December 13, 2015 By Kevin Knauss 33 Comments

On a weekly basis I get calls from people telling me they can’t find doctors who will accept Covered California health plans. The prospective patient is told that the doctor will only accept off-exchange health plans and not Covered California health plans. This is after the health insurance company shows the physician as in-network. Are doctors really discriminating against Covered California consumers or do we just have a failure to communicate?

How I failed as a health insurance agent

December 5, 2015 By Kevin Knauss 8 Comments

I screwed up big time on behalf of a man with a serious illness. The end result is that he will be without health insurance for the month of December. Even though there are other people who failed in this situation, I have to take the ultimate responsibility that he might have to shoulder thousands of dollars in health care expenses that would have been covered by health insurance. I broke the business rule of never following your heart, and always trust your gut.

Subtle and overt discrimination pervades Covered California health insurance

November 22, 2015 By Kevin Knauss 3 Comments

Both the health plans and the doctors practice subtle and overt forms of discrimination against people with Covered California health insurance. Some of the discrimination is legally built into the health plans. Other discrimination takes place in the form of denying health care services because the prospective patient has a Covered California health plan.

How to change plans after the Covered California automatic renewal

November 17, 2015 By Kevin Knauss 8 Comments

Consumers, agents and Covered California representatives have been flummoxed over how to change the household health insurance plan after the account has been automatically renewed by Covered California for 2016. It may have come as surprise to Covered California that not everyone wants to renew their current 2015 health plan. After Covered California automatically renewed the health plan there is no visible way to change the plan…unless you know the trick.

How does Covered California help cancer patients?

November 15, 2015 By Kevin Knauss Leave a Comment

In the last week as I’ve been bombarded with feel-good press releases from Covered California about their grand and glorious bus tour across the state promoting themselves and open enrollment, I’ve also been working with several cancer patients trying to find a health plan. From a person who is in the trenches working to enroll consumers in the best fit health insurance, the Covered California road show displays how their bus has taken a wrong turn down Marketing Lane. Californian’s need help finding health plans that include their doctors, hospitals, and cancer drugs. They could care less about a bunch of people riding around on a bus promoting their selves.

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Covered California Application