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 […]
Most people are under the impression that if they purchase health insurance through a Marketplace exchange such as Covered California they have to accept all the monthly tax credit offered. Individuals and families don’t have to have any of the tax credit applied to their monthly health insurance premium. Covered California has introduced a new link on consumer’s […]
How health insurance companies and health plans determine premium rate increases is a little bit of a mystery. Covered California didn’t add to the consumer’s understanding of this process when they released their 2015 health insurance booklet. The plan rates booklet is mostly marketing material and fails to provide specific rates by region, carrier, and […]
The IRS has released drafts of the tax forms that will be used to reconcile the amount of Advance Premium Tax Credit (APTC) received from an insurance exchange against how much the individual or family was entitled to based on their modified adjusted gross income. The various components used to determine the APTC (income, household size, dependents, employer sponsored insurance, […]
Covered California enrollments assisted by Certified Insurance Agents are producing a minimum of $9.2 million per month in commissions as estimated from enrollment statistics released by the states ACA exchange. While this number may sound impressive, a good chunk of the enrollments were for individuals and families who already had health insurance. With many health […]
With a peek at the enrollment statistics released by Covered California after the end of the ACA open enrollment we are able to visualize just how large the health insurance industry is in the state. While the enrollment data is only for individual and family plans (IFP) purchased through Covered California, the 1.3 million individuals […]
One of the biggest questions I get is, “When will Covered California send me a bill for the health insurance?” Unfortunately, Covered California doesn’t invoice for the health insurance, that is left up to the insurance companies. If your application has been successfully transmitted to the insurance company you can make your first premium payment over the phone. Some applications have not, and may never, actually make it to your selected insurance company.