Category Archives: Covered California

Anthem Individual Health Insurance Changes Again

More Disruption Ahead For Anthem Individual Health Insurance Policyholders, As Anthem drops Covered California In Most Counties

Why is Anthem withdrawing from the exchanges in California?

Which Counties will Anthem keep?

(In Anthem’s own words…)

“While Anthem is reducing its 2018 Individual plan offerings in California, it is not withdrawing from the exchanges. We are pleased to be participating in three key areas”

“On-exchange and off-exchange EPO plans at all metal levels will be offered in three regions of Northern California…”

We give credit to DerendingerIns.com for covering this story:  Read the full article

Healthy California Makes Strange Bedfellows

What’s inside the Healthy California act? “It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state” (Californians For A Healthy California Act SB 562).

Ironically, California state politicians hope for the failure of Obamacare from opposite ends of the political spectrum: Liberal proponents argue Obamacare is proof that the private market cannot solve California’s health care problems. Conservatives argue Obamacare is proof that government regulation only makes California’s health care problems worse. It’s a “cluster.”

The Trumpcare-Obamacare fiasco in Washington captures this irony perfectly.  However, while national media makes money selling advertising on Washington politics, a committed group of Californians hope to steal the cake by convincing disgruntled Californians they are better off with a government-run plan for Californians.

The Healthy California Act:

SB 562 will move health care coverage to one publicly-run plan that covers everyone who lives in the state. Every California resident will have one plan.” [California Senator Ricardo Lara’s Legislative Fact Sheet].

  • Private Insurance through your employer would be replaced by a government-run plan
  • Nearly 40 million residents of California would be covered by a single plan
  • Traditional insurance premiums would be replaced with contributions based on your payroll and income

Although proponents are borrowing words from a federally-funded program when they use the phrase “Medicare for All,” in actuality, SB 562 contains no details at all.  Yet, a February 17th San Jose Mercury News story hints that the timing is right, while acknowledging this has been tried before, and failed.

And from the Los Angeles Times: “…seems like wishful fantasy, even in deep blue California.”

It remains to be seen if enough Californians would really give up their employer-sponsored coverage to take a chance on SB 562. Ironically, would enough millionaires be willing to give up their $15,000 annual Obamacare subsidies to vote for SB-562? Yes, it’s true: millionaires are receiving large Obamacare subsidies, because of the expansion of Medicaid via the Patient Protection and Affordable Care Act i.e. Obamacare. Political opponents make strange bedfellows.

Read related story:  The TrumpCare Legislative Process Begins

UnitedHealthcare To Quit Covered California

Another health plan joins the California wall-of-shame, as Covered California announces the departure of UnitedHealthcare. Existing members can continue on through December 31, 2016, allowing them time to find a new plan during the Fall 2016 Open Enrollment.

UnitedHealthCare quits Covered California

UnitedHealthcare Quits Covered California

According to Covered California, UnitedHealthcare’s presence in the Covered California individual marketplace is small, at one tenth of one percent. Yet the impact will be greatly felt in some Northern California regions, where only three plans are available to consumers.

Health plan consolidation is already contributing to the lack of viable options in California. For example, in 2005 United Health Group purchased PacifiCare, which had previously acquired FHP, who had acquired TakeCare in 1994.

Some long-time market stakeholders fear “consolidation” plays into the hands of California legislators who are pushing for a single, government-run plan. They wonder if some legislators go beyond “cheering” for the Affordable Act’s demise, and would stoop so low as to sabotage its successful implementation?  Are there more democrats than republicans, hoping for Obamacare’s demise? Really?

UnitedHealthcare Regions in California

  
Region 1Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba
Region 9Monterey, San Benito, Santa Cruz
Region 11Fresno, Kings, Madera
Region 12 San Luis Obispo, Santa Barbara, Ventura
Region 13Mono, Inyo, Imperial

As the individual marketplace continues to deteriorate, the small group market has gained a firmer footing, including stable PPO networks and easier participation rules with Kaiser and traditional PPO plans.  Is it time to review available small group plans?   Reserve your appointment early for Open Enrollment, which begins this November.  Find local assistance in San Jose, Santa Clara and the San Francisco bay area or via telephone, throughout Northern and Southern California..

or view online pricing, free of charge

9 Risk Factors Applying To Covered California

In addition to the advantages, we have documented at least 9 disadvantages i.e. 9 risk factors applying to Covered California.  Despite limited media attention, these factors require caution and understanding, because of the potential for problems after you apply to Obamacare.

9 Risk Factors Applying To Covered California

9 Risk Factors Applying To Covered California

We encourage California residents to study the balance of this report carefully, in order to make the best decision for your family.

9 Risk Factors Applying To Covered California

9 Risk Factors Applying To Covered CaliforniaDescription of RiskPossible Solution
Risk Factor 1The State of California (via county social services agency) verifies the financial information on your CoveredCA application and has the power to make you “ineligible” for CovCA insurance if there are discrepancies between the application, filed income tax returns, immigration documents etc.Understand that CovCA uses last year’s tax return information to estimate your APTC subsidy, however the true amount will not be known until you file this year’s tax return. Work with a Certified Agent who can discuss these issues with you.
Risk Factor 2The verification of your application occurs during an indeterminate period of time, usually between January and August, but usually after you have cancelled your former insurance.
Risk Factor 3A frequent and undesirable outcome of the agency’s application verification process is that your insurance is revoked and you are temporarily placed in Medi-Cal, pending approval by a Medi-Cal eligibility case worker. Medi-Cal representatives will use the authority of the State of California to issue a system-generated freeze, named “soft-pause” on your file at CovCA. It effectively prevents Covered California IT engineers from “fixing” or undoing this Medi-Cal action. Your only recourse is to personally visit the county social services agency and attempt to determine the identity of your case worker, and then to arrange a meeting in the hope of opting out of Medi-Cal.
Risk Factor 4Placement into Medi-Cal, outside of “open enrollment” season is not a qualifying “special event.” This prevents you from re-applying elsewhere, since no health plan will accept your application until the next open or special enrollment.If this occurs during an open enrollment period, you can re-apply directly to Kaiser or another health plan. Otherwise, you will have to stay on Medi-Cal until the next Open or Special enrollment period.
Risk Factor 5Involuntary loss of health insurance could result in losing access to your personal physician(s).There is really no remedy, except to find a Medi-Cal doctor or specialist and transfer your chart.
Risk Factor 6Involuntary placement into Medi-Cal mid-year could occur during a course of treatment, surgery etc.We have observed cases where this has happened, and it is unfortunate.
Risk Factor 7Split Family Coverage: Since Medi-Cal eligibility for children is at 250% of FPL, compared to 138% for Adults (in most cases), a common outcome of a family application is that the adults are processed for CovCA insurance with a subsidy, but the children are declared ineligible and are pended for Medi-Cal.Work with a Certified Agent who can estimate the probability of this occurrence and will be prepared to submit child-only applications directly with the insurance carrier (off-exchange) to avoid Medi-Cal. It may be necessary to submit dual applications (on and off exchange) if the open enrollment deadline is near.
Risk Factor 8f your income increases during the year, your APTC subsidy could be less, resulting in you having to repay the IRS for part or your entire APTC subsidy.Ask your Certified Agent to lower the monthly APTC subsidy to give a safety margin. When you file your tax return, you will get the difference paid to you, assuming you are eligible for it.
Risk Factor 9If the IRS determines you were eligible for qualified, affordable employer-sponsored health coverage, your APTC subsidy will be reversed, subjecting you to penalties and interest.When an employer offers an employee health insurance, a report is sent to the IRS, identifying the employee by name and social security number, even when you decline the coverage. This is how the IRS cross-checks this information. If you declined coverage, you may still qualify for the subsidy via an exception. Work with a Certified Agent or your tax preparer to see if you qualify for the exception.

Caution is advised when you buy Obamacare through CoveredCA. To read more about the pros and cons of Covered California in general, and whether you should buy the Obamacare Kaiser plan, read this story at KaiserPlanet.org.

View online pricing, free of charge

Re-Shopping Obamacare For Better Covered CA Insurance

New York Times writer, Margot Sanger-Katz is suggesting consumers should be re-shopping Obamacare coverage. The article argues the savings could be substantial. Even the Health and Human Services agency discovered last year that “Returning Consumers Who Shop Save Money.”

Re-Shopping Obamacare

As the individual marketplace continues to deteriorate, the small group market has gained a firmer footing, including stable PPO networks and easier participation rules with Kaiser and traditional PPO plans.  Is it time to review available small group plans?

View online pricing, free of charge

“Returning Consumers Who Shop Save Money.”

Re-Shopping Obamacare

Re-Shopping Obamacare

Change Kaiser Group Health Insurance To Covered California?

FAQ Kaiser Group Health Insurance and Covered California

Question: We are a non-profit organization located in California: Is there any advantage if we change our Kaiser group health insurance plan to Covered California?

Answer: Yes, there are advantages of buying Kaiser group health insurance through Covered California. For example, many non-profits can take advantage of a special tax credit under the Patient Protection And Affordable Care Act, if eligible (read the rest of this article at KaiserPlanet.org).

Finding Help Locally

or view online pricing, free of charge

Compare off-exchange and Covered California Kaiser Small Business Plans using our free online rate calculator.

3 Actions To Keep Affordable Health Coverage- CoveredCA

While Federal or Cal-COBRA is the conservative choice (as discussed in Part I of this article), the negative aspects are “higher costs.”  This is true because Federal COBRA administrators add 2% to the premium and Cal-COBRA administrators add 10%. If finding a low cost health plan is your priority, your 2nd action to keep affordable health coverage- CoveredCA should be requesting information from Covered California [Small Employers should read about huge penalties beginning August 2015]

  • Covered California provides access to most private health plans e.g. Kaiser Permanante, Anthem Blue Cross, Blue Shield of California, HealthNet EPO and PPO plans and some regional providers as well (although availability varies among each of California’s counties- check here for assistance): extra caution is advised, because you must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage, and the 60 Day Limit also applies.

Warning:  failure to enroll within the special event 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st!  (This is a lessor known problem with the Affordable Care Act).

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Yet there are other reasons to skip CoveredCA and go directly to a private carrier.  Read more about the 3rd of 3 Actions to keep affordable health coverage while looking for a job in Part III of this article.

Return to Part I of this article or proceed to Part III or request assistance now.

3 Actions To Keep Affordable Health Coverage While Looking For A New Job

Time is of the essence to find or keep affordable health coverage while looking for a new job, and you must take action fast. In this three-part series, here are 3 important steps to find or keep affordable health coverage under the Affordable Care Act:

  1. If all else fails, use CAL-COBRA or Federal COBRA as a backstop, although it may not be the lowest price option: Warning, there is a maximum 60 Day Time Limit To Respond or you could lose your COBRA rights and eligibility;

Failure to enroll within the special 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st!  (This is a lessor known problem with the Affordable Care Act).  Read more about Special Events here or request assistance.

If you cannot afford the high cost of COBRA premiums, and really want the most affordable health coverage, then CoveredCA, the Covered California health exchange market may work better for you. Read about the pro’s and con’s of CoveredCA in Part II of this series, or proceed to Part III, “Private Insurance” options.

 

 

Proceed to Part II of this article or skip to Part III.

Leaving School: 2 Actions To Find Affordable Health Coverage

Time is of the essence in order to maintain or find affordable health insurance when leaving school.   You must take action fast or risk being “locked-out” of the health insurance market for several months, due to a little publicized defect in the Obamacare legislation. We suggest 2 actions to find affordable health coverage when leaving school, which have been made possible under the Affordable Care Act:

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First, if you have not yet turned Age 26 and have been covered on your parent’s health plan, the Affordable Care Act  allows you to continue on through age of 25.  Is this your best option? Maybe, but there are two reasons to look at other options available through the Affordable Care Act:

  • Your parent’s health plan may have limited medical facilities e.g. Kaiser where you live, or
  • The monthly insurance rate may be lower through Covered California with a subsidy, if you qualify

Second, the following are two new options made available through the Affordable Care Act:

  1. Covered California provides access to most private health plans e.g. Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, HealthNet EPO and PPO plans and some regional providers as well (availability varies according to each of California’s counties- these folks will give you free assistance).

    Extra caution is advised, however:  You must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage, plus a 60-Day time limit applies. Warning: failure to enroll within the special 60-day period will not only incur a possible IRS tax penalty, but will consequently lock you out of the U.S. health insurance market until the following open enrollment period i.e. January 1st! (This is a lesser known problem with the Affordable Care Act) Read more about your special enrollment qualifying event here;

  2. Apply Direct- to the insurance carrier (Kaiser Permanente, Anthem Blue Cross, Blue Shield of California, Cigna, HealthNet and others) is easier than going through Covered California and the prices are virtually identical under California law.

The only reason you would choose the Covered California exchange (above) over this 3rd option is if you were to qualify for a subsidy or Advance Premium Tax Credit. Otherwise, CoveredCA is not worth the hassle of providing personal tax forms, proof of California residency, employment information etc.

  • Deadlines: The same warning applies as above i.e. you must complete and submit your application prior to the desired 1st of the month coverage start date to avoid a gap in coverage; the 60 Day Limit also applies.

The easiest part of this process is choosing a plan, and the hardest is getting the triggering loss of coverage forms to the carrier (the required document and method vary by health plan). Don’t risk losing your effective date on a technicality:  Use a competent broker who is licensed and certified to help you compare all your options, on or off the exchange.  Especially valuable is the broker will help you submit a properly completed application forms to the health plan of your choice!

Certified Insurance Agents who offer educational meetings are a free service to consumers under the ACA and California law. Find a local meeting here.  If you don’t use a certified agent, then you could run into the problems publicized by KPIX 5 (San Francisco):  Watch this news story here.

Everybody’s Happy With Obamacare In California

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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.

Obamacare Press Releases

U.S. TREASURY DEPARTMENT OFFICE OF PUBLIC AFFAIRS

 

 

Questions About Special Events?  Get Local Assistance Now

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