Kevin Knauss: Health, History, Travel, Insurance
Posts specifically related to California health insurance, enrollment, premiums, plans, termination, Covered California, Medi-Cal, Medicare, small groups.
Most consumers would be surprised to learn that their health plans are being rated on how well their doctors treat them. Consumers don’t want their health plan involved in their health care decisions or interactions with their doctors. Consequently, some health plans are paying for the sins of some providers by being labeled with a low star rating.
There is a reasonable expectation that Bright HealthCare individual and family plans will fulfill all of their contractual obligations for paying claims and adhering to the member cost-sharing structure of the health plans. The weak spot for some health plans is the customer service department. An understaffed customer service unit can lead to long wait times on the phone or emails not being promptly returned. There can also be issues with prior authorization for medical procedures, durable medical equipment, and prescription medications.
The “California Premium Credit Program” is not an eligibility-based program. Starting plan year 2022, the $1 state premium credit will apply to both subsidized and unsubsidized Covered California QHP enrollees, including the catastrophic QHP enrollees but will exclude individuals in a dental-only plan.
Many people want predictable copayments for routine services and are willing to accept a large deductible and maximum out-of-pocket amount for the rare and unexpected hospitalization. Blue Shield of California has come pretty close to designing such a plan with their 2022 Bronze 7500 HMO individual and family plan. Services with a set copayment and not subject to the medical deductible are:
Adverse selection is wanting to enroll in health insurance under adverse conditions. The health plans, and society in general, wants everyone in the insurance pool from the beginning. When people climb out of the pool – drop coverage after getting treatment – the big health care bills must be covered by the remaining people in the pool. That raises the rates for everyone in the pool, and that’s not fair.
Health insurance is unique in that it not only protects you from catastrophic health insurance bills, it can also help reduce the costs of many routine health care services and prescription medications. It’s as if your car insurance gave you discounts on oil changes, tire rotations, or replacing your brakes. While some of us we need routine maintenance, most people don’t know when their transmission is going to die and it needs to be replaced.
Requiring health insurance policies to cover medically necessary prevention, diagnosis, and treatment of all mental health conditions, as well as substance use disorders, that are listed in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the mental and behavioral disorders chapter of the most recent edition of the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10).
The ACA states that if a married couple apply for the premium tax credit subsidy through Covered California, they must agree to a Married Filing Joint federal tax return status. If you are the victim of domestic abuse or your spouse leaves you, there is little interest in working with that person to file taxes jointly.
The big unknown is how you will use health care services in the next year. If you historically visit a doctor for the occasional sports injury, allergies, or to have wax removed from your ears, even if you visit the doctor more than 3 times (the Bronze 60 limit), you may still be money ahead with the Bronze plan.
There are a couple of different reasons why health insurance companies may be reluctant to extend a grace period beyond the current 30-day date range. The first reason is California’s expanded Medi-Cal option. If an individual or family has a sudden decrease of income – below 138 percent of the federal poverty level for adults – and they do not have employer sponsored health insurance, they can immediately apply for Medi-Cal and get coverage at no cost.
