Covered California, the state health insurance exchange, will be the primary individual health insurance marketplace in California in 2014. Consumers will have new online tools to compare affordable coverage. Low-income individuals and families will be able to qualify for free health insurance through Medi-Cal and moderate-income families will qualify for premium assistance to help make private health coverage affordable.
Applying for Coverage
A consumer may begin the initial contact to Covered California through any one of many doors: online, by phone, or with an licensed agent or in-person assister. While some applicants will complete an online application, most consumers will end up talking to a Covered California Call Center Representative. The CCR will conduct a “quick sort” interview to establish family size and income level. If the customer’s income makes them eligible for free public health care through Medi-Cal, the CCR hands-off the call to a county-based network call center.
Income information can be complex and this part of the Covered California application process is important. The Exchange incorporates electronic verification direct from the IRS The income data from the customer’s last federal income tax return is available to the online applicant or the CCR. The CCR can use this IRS data to help determine the customer’s estimated income for the year, but the customer can override the income tax data if there have been significant changes in his or her income for the current year.
If the customer is eligible for advanced tax-credits to help pay their premiums, they will next be asked whether they receive or could receive “affordable” employer-sponsored group health insurance through their employment. If not, the customer is on the path to receive advance payments of the premium subsidy, Once the customer’s application is submitted, they receive congratulations, a list of programs for which they qualify and what the next steps are. With the application process complete, customers can enroll in a Covered California health plan and apply their tax credit right away.
Selecting a Benefit Plan
Shopping for health insurance coverage will also be esier for consumers because standardized benefit plans will make it easier to make side-by-side comparisons of plans. Health insurance companies will have to accept all applicants regardless of preexisting health conditions, opening access to many new applicants.