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Covered California Application

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

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Combining Employer Health Plans and ACA Subsidies for Spouse and Dependents in 2023

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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.

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Breaking Down Covered California Health Plans By Coverage Sections

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The one wildcard with outpatient services is the coinsurance. Coinsurance is a percentage of the invoiced services that the health plan member is responsible for. For outpatient procedures, the coinsurance is not subject to the medical deductible for Silver plans. However, you may find yourself getting billed for coinsurance when you thought the health service had just a set copayment. For example, imaging with the injection of a dye to enhance image contrast. The machine imaging scan will have a set copayment, but the injection of the dye is considered an outpatient procedure subject to coinsurance.

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2023 Covered California Open Enrollment Income Chart

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The income chart uses columns with specific percentages to display the annual income amounts necessary for different program eligibilities based on household size, rows. What can be confusing is that an income chart will be published where the math doesn’t work. For example, the federal poverty level (FPL) income for an individual is the 100% column. The next column is 138% FPL. On the 03/2022 income chart, the annual income amount in the 138% FPL column, $18,755, is higher than the 100% column of $12,880 x 1.38 = $17,774.

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Will Your Covered California Premiums Increase Next Year?

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Of course, if the annual premium for the second lowest cost Silver plan increases more than the other plans, it increases the subsidy for all consumers. In this example, the consumer would see monthly premiums for most plans below the 2022 levels. However, the second lowest cost Silver plan would have no increase from 2022 to 2023, even with the larger annual unsubsidized premium increase.

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Parents Can Be Added To Covered California Health Plan for 2023

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There are many good reasons to include qualifying adults such as parents and stepparents within a Covered California household. There can also be unintended consequences such as making the entire household eligible for Medi-Cal and ineligible for the Covered California subsidies. The best approach is to understand all of the IRS rules regarding a qualifying relative and how the inclusion of the parent or stepparent will modify the eligibility of the household for the subsidies and Medi-Cal.

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Active Renewal vs. Passive Renewal for Covered California 2023

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Consumers can change their health plans even if they have been passively renewed. If a household has been passively enrolled into a new plan, because their 2022 health plan is not offered for 2023, the consumer can change plans. If changes are made by December 27, the new plan will become effective January 1, 2023. Plan changes in January will become effective in February.

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What is Covered California?

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Covered California is not a health plan or health insurance. Covered California is more like a farmer’s market. The market place is organized by Covered California. Insurance companies then bring their health plans to the market place for people to review. Consumers enter the market place and purchase health insurance directly from the vendors. Covered California is just creating the space for the health plan transactions.

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The Pregnancy Pre-Existing Condition Question on Covered California

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I have always felt uncomfortable asking the Covered California applicant if they or anyone in the household is pregnant. Basically, it is none of my business. It is additionally awkward asking a mother or father if their adult daughter is pregnant. Now that reproductive health care is under assault in our country, I’ve become even more sensitive to asking the question.

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How Many People Are In Covered California and Where Do They Live?

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Of course, 1.7 million people is a sizeable number of individuals and most of them are receiving a subsidy to reduce their monthly health insurance premiums. Covered California provided a breakdown of the enrollment by region. There are 19 different rating regions in California, some of which encompass more than one county. Covered California also provided the average health insurance premium rate change for 2023 for each region.

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The Importance of Properly Terminating MAGI Medi-Cal

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Your children could be flipped into Medi-Cal if you return to Covered California without having properly terminated Medi-Cal earlier. On numerous occasions, children were flipped from Covered California to Medi-Cal, even if the stated estimated income was high enough to make everyone eligible for the subsidies.

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