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.
Santa Barbara County sent a letter saying the couple did not qualify for Medi-Cal. They then received a letter from Covered California stating that they no longer qualified for any subsidy. When I accessed the couple’s Covered California account, all of their income information had been erased. When I looked at the transaction history on the Covered California account, Santa Barbara County Medi-Cal office had accessed the account and submitted changes.
Health insurance, at a basic level, is asset protection similar to car, life, and home insurance. Most health plans have an annual maximum out-of-pocket amount that limits your liability to outrageous health care bills in the event of an accident or sudden illness. Once the maximum out-of-pocket amount is met, the health plan covers all in-network health care expenses for the rest of the year.
When you receive an inheritance of money, that cash is an asset, no different than a savings account. The inheritance is not counted as monthly income. It is generally considered a one-time lump sum distribution. Consequently, an inheritance of money should not impact your MAGI Medi-Cal eligibility.
The minimum annual income in order to become eligible for the Covered California health insurance subsidies for a single adult is $18,756 for 2022. That is $980 higher than the minimum annual income for 2021, approximately a 6 percent increase. The minimum amount for 2 adults is $25,269 annual income. Estimated income amounts below 138 percent of the federal poverty level on the Covered California application will make the household eligible for Medi-Cal.
You are first offered the chance to adjust the APTC subsidy from 100 percent to a lower percentage when you first enroll in a Covered California health plan. After the enrollment has been completed you must fish around in your account to find the APTC slider. The APTC slider allows you to reduce or dial back how much of the monthly APTC subsidy you are receiving from 100 percent down to 0.
Neither Covered California nor the sample Blue Cross letter being sent to members explains why the UC hospitals are no longer in-network. Someone, Blue Cross or UC, pulled the plug retroactively to January 1. Fortunately, Blue Cross expanded their EPO network to include Sutter doctors and hospitals for 2022.
For a single adult, the monthly Medi-Cal income was $1,482. In 2022, the monthly income will increase to $1,564. In other words, an adult can earn up to $1,564 per month and still qualify for no cost Medi-Cal. MAGI Medi-Cal annual amounts for a single adult increased to $18,755, from $17,775 in 2021, for a single adult.
PPO dental plans are more widely accepted than HMO plans. PPO plans will also reimburse you if you receive services from an out-of-network dentist. You will always minimize your out-of-pocket costs if you use an in-network dentist. PPO plans have higher monthly premiums because of the larger network of dentists and the out-of-network coverage provided. None of the dental plans will cover implants, tooth whitening, or adult orthodontics.
If you consider certified agents are an extension of the Covered California customer service staff, the different agent compensation models are like paying a different hourly wage based on the health plan enrollment. The varying compensation amounts introduces a certain level of bias. If you are paid $15 an hour for enrollments in health plan X and only $8 per hour for enrollments in health plan Y, which health plan would you favor?
The BlueCard program allows members to receive some health care services outside of California. This is an important feature for individuals who routinely spend weeks or months outside of California on business. With the exception of emergency services, if an individual needed small health care service in another state, they were almost forced to buy two health plans; one for California and one for the other state.
