The previous articles covered Part I and Part II, and this final segment describes the 3rd of 3 Actions To Keep Affordable Health Coverage- Private Insurance. [Small Employers should read about huge penalties beginning August 2015]
Going directly 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.
In our opinion, the only reason one would choose the Covered California exchange (Part II of story) over your 3rd option (private insurance) is the likelihood of receiving a subsidy or Advance Premium Tax Credt. Otherwise, CoveredCA is not worth the hassle, due to the burden of providing tax forms, proof of California residency, employment information etc.
Deadlines: Regardless of your choice among the 3 Actions To Keep Affordable Health Coverage, the 60 day limit applies.
In conclusion of this 3-part article, the easiest part of this process is choosing a plan, and the hardest is getting thetriggering loss of coverage form to the carrier (the specific document and method vary by health plan). Don’t risk losing your effective date, use a competent broker who is licensed and certified to help you compare your options under all 3 alternatives above, and will help you submit a properly completed application to the health plan of your choice!
Certified Insurance Agents are a free service to consumers under the ACA and California law. However, the best certified agents will also help you compare your private insurance (PPO, HMO) options vs. your CoveredCA options. Find a local office of one of these broker-agents, in order to keep affordable health coverage while looking for a 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:
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.
Time is of the essence during your qualifying event period (60 days). Yet some situations don’t qualify for special event consideration e.g. missing a COBRA premium payment. Either way, time is of the essence, consult with a Certified Agent as soon as possible. The ideal advisor is also an independent agent/broker:
Obamacare is Not Easy! ………………… Cake Pop?
An independent Certified Agent is knowledgable about private market health plans and Covered California plans.
An independent Certified Agent is also able to place you with temporary health insurance until the next regular Open Enrollment season begins.
“Special Enrollment” flyer from Covered California
This Instruction on Qualifying Life Events list is rather cumbersome. The Covered California web source is here, but we suggest you should get free assistance before using this information. Tip: If you don’t qualify for one of the following life events, then consider purchasing interim health insurance from HCC: Click To Quote
Qualifying Life Events
What Qualifying Life Event to Select from the Drop-Down Menu
How to Enter the Date of the Event
Lost or will soon lose my health insurance Examples:
You lose Medi-Cal coverage.
You lose your employer-sponsored coverage.
Your COBRA coverage is exhausted. Note: Not paying your COBRA premium is not considered loss of coverage.
You are no longer eligible for student health coverage.
You turn 26 years old and are no longer eligible for a family plan.
You turn 19 years old and are no longer eligible for a child-only plan.
Enter the date of the loss of coverage
Permanently moved to/within California Examples:
You move to California from out of state.
You move within California and gain access to at least one new Covered California health insurance plan.
Enter the date of the permanent move
Had a baby or adopted a child
(If you receive a child in foster care, you will also qualify for a special enrollment period but will need to indicate “adopted a child” in the drop-down menu.) Examples:
A child is born, adopted or received into foster care. The entire family can use the special enrollment period to enroll in coverage.
If you place your child for adoption or foster care, you can use a special enrollment period to enroll in coverage.
Enter the date of birth, adoption or foster placement
Got married or entered into domestic partnership Example:
One or both members of the new couple can use the special enrollment period to enroll in coverage.
Enter the date on the marriage or domestic partnership license
Returned from active duty military service Example:
You have lost coverage after leaving active duty, reserve duty, or the California National Guard.
Enter the date you returned from active duty
Gained citizenship/lawful presence Example:
You become a citizen, national, or permanent legal resident.
Enter the date on the immigration document
Federally Recognized American Indian/Alaska Native Example:
If you are a member of a federally recognized American Indian tribe, you can enroll at any time and change plans once per month.
Enter the date you apply for Covered California
Other qualifying life event Examples:
You are already enrolled in a Covered California plan and become newly eligible or ineligible for tax credits or cost-sharing reductions.
Misconduct or misinformation occurred during your enrollment, including: An agent, enrollment counselor, Service Center representative or other authorized representative enrolled you in a plan that you did not want to enroll in, failed to enroll you in any plan or failed to calculate premium assistance for which you were eligible.
Eligibility for COBRA coverage: If you become eligible for COBRA coverage due to the loss of employer-sponsored insurance, you can choose coverage under COBRA, or you can use a special enrollment period to enroll in a Covered California plan.
Misrepresentation or erroneous enrollment, including:Incorrect eligibility determination. This includes if you applied during open enrollment and were initially told you were eligible for Medi-Cal and then later determined not to be eligible forMedi-Cal.The health plan did not receive your information due to technical issues.An error in processing your immigration documents resulted in an incorrect eligibility result.Incorrect plan data were displayed when you selected a plan: Data errors on premiums, benefits or copay/deductibles were displayed; incorrect plans were displayed; or a family could not enroll together in a single plan.
Your health plan violated its contract.
Exceptional circumstances occurred on or around plan selection deadlines, including natural disasters and medical emergencies.
You received a certificate of exemption for hardship from Health and Human Services for a month or months during the coverage year but lost eligibility for the hardship exemption outside of an open enrollment period.
You are required by court order to provide health insurance for a child who was been determined ineligible for Medi-Cal and CHIP, even if you are not the party who expects to claim the child as a tax dependent.
You are a member of AmeriCorps/VISTA/National Civilian Community Corps:
If you entered AmeriCorps or one of the other organizations listed above outside of open enrollment.
If you ended your service with one of the organizations listed above.
You have a “grandfathered” health insurance plan outside of Covered California, and you would like to switch to a Covered California health insurance plan instead of renewing your current plan.
Your provider left the health plan network while you were receiving care for one of the following conditions:- Pregnancy.
– Terminal illness.
– An acute condition.
– A serious chronic condition.
– The care of a newborn child between birth and age 36 months.
– A surgery or other procedure that will occur within 180 days of the termination or start date.
You were released from jail or prison.
Enter the date you apply for Covered California
None of the above (Continue to review my application for Medi-Cal/AIM)If none of these qualifying life events apply, you should still apply using “None of the above,” because you may be eligible for Medi-Cal or California’s Access for Infants and Mothers (AIM) program for pregnant women based on your income. Regardless of which life event you select, your application will still be reviewed for coverage through Medi-Cal and AIM.