Jericho Share, a purported Health Care Sharing Ministry, fined and ordered to cease operations in California.
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Kevin Knauss: Health, History, Travel, Insurance
Posts specifically related to California health insurance, enrollment, premiums, plans, termination, Covered California, Medi-Cal, Medicare, small groups.
Platinum plans can save money because they have health care and prescription drug costs half of the Gold and Silver plans. The Platinum plan only makes sense if you can reliably predict the health care and prescription drug utilization in the next year. For everyone else, without that crystal ball, a Silver or Bronze plan work better at containing health care costs.
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.
There are non-standard benefit design health plans offered by carriers off-exchange. You cannot enroll in a non-standard benefit design plan through Covered California. The off-exchange non-standard benefit design plans are usually in the Bronze and Silver metal tier categories. There are more High Deductible Health Plans (HDHP) that are health savings account compatible offered off-exchange.
Effective January 1, 2023, a new California law expands the definition of “dependent” for the purposes of enrollment in a Qualified Health Plan (QHP), to include a parent or stepparent of a qualified consumer. Rules for this benefit include that a dependent parent or stepparent must:
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.
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.
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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