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On May 13, 2015, Jamie emailed me late at night to ask what it would cost to change from a Covered California PPO plan and re-enroll directly with the same insurance company, off the exchange. [Check out our latest article for students leaving school]
I asked, “Jamie, it’s the same total premium, either way, but don’t you want to keep your $199 per month subsidy? “…because you can’t have a subsidy unless you go through Covered California.”
Jamie responded, “My CPA told me we have to re-file my tax return and pay back hundreds of dollars because Covered California sent me a revised 1095-A form on May 1st.” I offered to help and Jamie completed the Insurance Help Form for 1095-A Questions.
“No problem, I thought.” I phoned Covered California at the special agent line and was placed in line as number 34. 15 minutes later, Dale answered the phone: “Dale, your customer received no 1095-A form and was unable to file taxes in early January. We followed your instructions and filed a 1095-A-Dispute-Form. As promised, after 60 days (March 31st to be exact), we received the 1095-A form and all the numbers looked correct.” So Jamie filed her taxes.
“Dale, guess what, on May 1st, CoveredCA issued a “corrected 1095-A form” that is unfortunately incorrect. In fact, there are zeros in all the boxes.” The customer is upset, naturally, and is faced with additional tax preparation fees for the amended return. Dale’s solution: We need to file a new 1095-A-Dispute-Form and wait two more months.
Being a diligent agent, I pushed back and asked him to look in the system log to see what may have generated a new 1095-A form. Dale responded with “Medi-Cal has this case under review.” I asked, “what does that mean? Today is May 14th and the application was enrolled and paid for last December…is there insurance or not?”
Dale suggested he transfer me to another unit in Customer Service who may help further. So he did…I went back to the end of the line and waited 15 minutes before Valerie picked up. In the meantime, I phoned the insurance company directly and asked if coverage was in-force. They said “yes, but Covered California has not yet sent the eligibility information to us…but sometimes they don’t send it if the case renews with no changes.”
I confronted Valerie with this information and she very nicely responded, “our records show the customer has not yet paid the first month (January) premium and that is why we have not sent over the enrollment information.” (I quickly checked the insurance company’s website and it shows all premiums paid to May 1st).
Valerie was not sure how this could be happening, but also noted Medi-Cal has the case under review since March. I laughed, “if Medi-Cal has been reviewing this for 1.5 months, then it is going to take them 15 years to get through this season’s new enrollments.” Valerie responded, “the insured is suppose to contact the local county to help the case worker finish their review.” “Really, and when did you tell the customer this?”
Valerie said there was an “eligibility determination” in late April and a letter was sent out. I looked it up on their website and she was right. It reads,
“Congratulations! You qualify for health insurance through Covered California. You also qualify for up to $199 per month in premium assistance to help pay for your health insurance coverage”
I said (nicely) to Valerie, “let me summarize this.”
- Covered California never provided a 1095-A form until the customer filed a dispute (which is the only way to get a 1095-A form when it is lost or missing)
- You issued the correct form in March and the customer filed their taxes
- In May, you sent a revised 1095-A form for no reason and the client has to pay back the tax credit according to the CPA and pay to re-file the tax return
- You say there is no person at CovCA who can tell us why this happened, and our only remedy is to file another Dispute form and hope for the best
- You also say the first premium payment (January) was never paid and therefore you have not sent enrollment data to the insurance company
- Meanwhile, the insurance company says they are indeed receiving premium payments, but you have never sent them the enrollment data
- The icing on the cake is you say the case is under review with Medi-Cal for the last six weeks, but nobody has informed the customer to call Medi-Cal to speed it along. Moreover, the letter you supposedly sent to inform them actually says everything is fine and “congratulations.”
Congratulations! Everybody is happy with Obamacare in California.
- Note: if you would like an advocate to assist you in the new healthcare system, just fill out this form: Insurance Help Form for 1095-A Questions. There’s no cost- it’s great to have an advocate on your side.
- Read our related article, titled “Keeping It Simple, Why Obamacare is not delayed.”
- Here’s some local media coverage from KPIX TV
- For additional information from the U.S. Department of Treasury, read their recent bulletin, 1095-A Help.
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