Before I start gathering coverage information, I create a table with preferred or “must have” providers, hospitals, and drugs in rows, with the available health plans across the top columns. I then mark which health plan has the providers in-network and if the drugs are covered and at which Tier.
After Covered California acknowledged at the January 2017 Board meeting that they had system issues that affected over 40,000 consumers, new enrollment problems seem to be boiling up. Some consumers have reported that household members who are ineligible for Covered California family dental plans have been automatically enrolled in dental insurance in 2017. In some very rare instances, the Covered California system is allowing consumers to actively enroll in two different subsidized health plans.
Millions of people have been enrolled into expanded Medi-Cal through Covered California based solely on their lack of income. Thousands of those same Medi-Cal beneficiaries went on to get jobs or other insurance and forgot to report this to their county Medi-Cal eligibility department. Many of these people fear they will have to repay Medi-Cal for the months they were really ineligible for the no cost health insurance. Do you have to repay Medi-Cal after your income increases and you were no longer eligible? The short answer is usually not.
With all the discussion about congress repealing the Affordable Care Act, there is confusion over what exactly is an Obamacare health plan. Some people think the federal government is dictating the type of health plans that must be sold to individuals and families. It is up to each state to set the rules for their health insurance plans. The federal government under the regulations of the Affordable Care Act (ACA) stipulates what type of health plans are eligible for the Premium Tax Credits that make health insurance affordable for individuals and families.
Like a mugger coming out of the shadows, San Diego County Medi-Cal worker(s) mugged a family enrolled in Covered California and stole their health insurance for 2107. The attack was unprovoked as the couple had not been in Medi-Cal and don’t have any children in Medi-Cal. However, Covered California reported the family to San Diego County because the family fit the profile of a household who they think aren’t smart enough to estimate their own income for 2017.
California individual and family plan health insurance carriers have been combating fraudulent enrollment for open and special enrollment periods. Many of the health insurance companies have placed additional requirements on applicants to verify California residency. Unfortunately, enrollments through Covered California, which have virtually no verification of special enrollment eligibility, continue to be a source of high-cost claims from fraudulent enrollments.
Covered California has finally been able to include family dental plan enrollment to consumers who have purchased a health plan through the exchange. The dental plans overall are pretty good but they come with some conditions that limit suitability for all families.
If you purchased an Individual and Family Plan through Covered California or off-exchange directly from an insurance company or health plan, I would like you to take a short, anonymous survey on your experience with your health plan in 2014. Your participation and responses are anonymous and in no way can they be used for […]
In the proposed rate increase filing with California Department of Managed Health Care (DMHC) on August 1, 2014, Anthem Blue Cross included 79 health plans that they would be terminating at the end of year. Titled Exhibit P – Terminated Plans, effective 2015, Anthem Blue Cross lists 39 pre-ACA and 40 post-ACA individual and family […]
There have been few changes to the standard benefit design between 2014 and 2015 health plans offered through Covered California. A comparison of the metal levels offered in 2014 to the standard benefit design announced by Covered California for 2015 individual and family plans reveals modest changes to copayment amounts for prescription drugs, maximum out-of-pocket […]