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.
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.
Annual income. When entered on income section, Covered California will take the total amount and divide it by 12 and distribute an equal amount in each month. For example, you enter an annual income amount of $12,000 beginning in January. Each month through December will be allotted $1,000 to add to your monthly income and annual income totals.
If you never check your Covered California secure email box, opt to receive important letters delivered to your home address. The notices will alert you if you are losing your subsidies, health insurance, or being put into Medi-Cal.
Health insurance agents are not paid by Covered California. We are paid by the health plans, either PMPM or a percentage commission. There are 13 different health insurance carriers and 13 different agent commission structures.
Sue and Bob received $3,840 in excess Advance Premium Tax Credit for the year. Because their final income is over 400 percent of the federal poverty level, they must repay all the excess health insurance subsidy.
Is it equitable that a married couple with substantial savings and high net worth receive significant health cost savings while a similar married couple with no savings but slightly higher income is subjected to higher health care costs? No, it is not equitable. It is a government program that is missing the mark on equity. Stated another way, the reduced cost sharing and no deductible health plans are not fair because the household income does not reflect the real financial state of the individual or family.
However, if you are in a region where Aetna CVS Health is the second lowest cost Silver plan, you may see a dramatic premium increase. This is because the Aetna CVS Health is slated to increase approximately 0.2 percent. This means that the subsidy with the Aetna CVS Health second lowest cost Silver plan will only slightly increase for 2024 over 2023. If you have the Blue Shield PPO with a 15 percent increase in that region, your 2024 subsidy will not change by much and you may be paying a considerably higher amount for your health insurance if you keep the Blue Shield plan.
When the income estimate was increased in their Covered California application, the subsidy was properly calculated for the remainder of the plan year. The first thing Sandi and Thom notice is that they lost the Silver 87 plan and with the higher income are now only offered a Silver 70. Another disturbing problem for them is that instead of $336.57 monthly premium, their new premium for the Silver 70 is $657.31. They went from paying $16 a month for a great Silver 87 plan to $658 per month for Silver plan that has higher copays, coinsurance, and deductibles.
