The family continued to wait, not paying any of the invoices they received because they figured that Covered California was working to resolve the issue. The health insurance plan was terminated by the health plan for lack of payment. If the consumer does not pay the all the premiums after 90 days, the consumer loses the right to make all the back-premium payments and reinstate the health plan. This is what happened to the family.
Post discussing premiums for health insurance, subsidy, how they are calculated, increases.
The HIPP program pays the medical insurance premiums, coinsurance, deductibles, and other cost-sharing obligations for the individual. The annual cost of the premiums and member cost-sharing is compared to the estimated cost of an equivalent set of Medi-Cal services. Outlined in in an ACWD Letter 09-02, DHCS uses a specific formula to determine the cost-effective nature of the private insurance over Medi-Cal FFS.
Not all family members have to have the same carrier either. Some family members can enroll with a more expensive PPO plan while other individuals enroll in an HMO from the same company or completely different carrier. I have clients where some family members have chosen the Blue Shield PPO plan and other household members are with a less expensive Kaiser plan.
For individuals transitioning into Medicare in 2019 they will see a higher Part B premium. The new Part B premium will be $135.50, up from $134.00. Many Medicare beneficiaries already in Medicare will not pay the full Part B premium because certain provisions limit the Part B premium increase to be no greater than the increase in their Social Security benefits.
So why is this significant? Because Kaiser was sending statements to the Covered California household for past due balances greater than one month. They were also sending termination notices even though they had already sent Covered California cancellation of the plan and Covered California terminated the enrollment. But Covered California will not investigate the erroneous terminations. They just tell the agents and consumers they have to deal with the health plan. In this case, the family has sent voluminous amounts of documents to Kaiser showing they made their premium payments.
The increased revenue is also in light of reducing health plan assessment from 4% of the gross premiums down to 3.75% for the individual and family plan market. The proposed operating budget for FY 2018-19 is $340.2 million. This represents a 6.55 increase over the FY 2017-18 budget or an increase of $20,686,242.
In December, during the Open Enrollment Period, she enrolled in the previous health plan for the 2018 year. The health plan took her first month’s premium payment, applied it to her past due balance, and then terminated her coverage at Covered California. Under the new rules the health plan is within their rights to take her money and deny her coverage for 2018.
Families don’t all have to be with the same carrier either. Some parents have chosen a PPO plan for their children because certain doctors who are treating their children are in-network with the PPO plan. The parents then choose a less expensive HMO plan for themselves. It could be that a family member needs surgery during the next year. That person might opt for a Gold or Platinum plan to reduce out-of-pocket expenses while the other family members hang out in the Bronze or Silver metal tier level.
Since the beginning of health care reform under President Obama there has been intense speculation about how the health insurance companies will react when setting rates for the various health plans they offer. Health insurance is not a commodity like wheat, oil, or pork bellies where the market place of buyers and sellers agree upon a price. While competition does impact the rates to a certain degree, health insurance prices are largely determined by the health care services to be covered, the cost of health care services, and the expected claims for those services within a geographical location where the plan is being offered.
Hidden within every health plan sold through Covered California is a fee to fund their operation. This per member per month (pmpm) fee applies to both individual and family plans, small group plans sold through the exchange and adult dental plans if they are ever offered. These fees, paid by the health plans and insurance […]