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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


December 2013 Archives


Can't Sign in to CoveredCA?

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Question: My husband and I have been working on our CoveredCa application & submitted ALL necessary IRS forms, etc. & qualify for the Fed. Tax exemption. We get to keep Kaiser as our insurance but at a much more affordable premium…however, I have tried both last night and just 10 min. ago to sign unto CoveredCa. website and I get sent immediately to a “page does not exist..blah, blah, blah”…I have my “username & password” but still get kicked off…what do I do?????

Answer: The coveredca.com website is down right now. Middle of the day on a Thursday. No warning, no explanation. Just wait I guess.


Question: Peter Lee is quoted in the Wall Street Journal saying if you made a good faith effort to start, you can finish up later. What is actually being offered in the way of an extension beyond December 23rd?

Answer: Covered California’s Certified Insurance Agents have been notified that they can continue to assist consumers to enroll for a January 1st effective date of coveragefor applications keyed into the CalHEERS system by 6:00 p.m. on December 28th.


Question: I just signed up for Health Net PPO - Enhanced Silver. I am confused by the conflicting info on provider networks. EG, on CC website California Pacific Medical Center (CPMC) is NOT in network. On HNet website, using CC-PPO as the filter, CPMC is IN network for 2014 for that plan. CPMC’s own website says it is “in process of negotiating” with Healthnet. Who do I rely on? When will I be able to know FOR SURE whether Hnet covers this hospital? Any guidance will be appreciated. Is it safe to think that Health Net will honor its OWN provider directory for its Covered California plans?

Answer: I can provide guidance, but not a definitive answer. In this scenario, the Health Net website listing of its Covered California PPO network is more likely to be up to date than the other choices. My guess, we won’t be “sure” about the accuracy of the carrier network listings until mid-January. As for Health Net “honoring” an inaccurate listing: they will not provide in-network coverage for a provider who was erroneously listed. You will however have the option of changing plans,including carriers, even beyond the open enrollment period if you erroneously picked a plan without your desired provider(s).


Question: What happens after my Covered California application is complete? I have received nothing from them?

Answer: You will not get any response from Covered California (CC) beyond what you can find in you online CC account. Login to your CC account. The “Progress Bar” is that horizontal line across the top of the page with checked boxes.

Confirm Enrollment: The “Enrollment” box should be checked. If not click on the “Eligibility” box and now you should see a check the enrollment box. If your application is complete, you will see an enrollment summary page with the health plan selected, effective date of coverage, and net premium due. You may want to print that page for your records. If you do not see your enrollment summary, your application is not complete. Complete it by going through the plan selection step again.

Confirm Eligibility: From the progress bar, select “Eligibility”. You will see a very busy page with your eligibility results. Each family member is listed separately and you may find that eligibility varies by individual. Most commonly, for example, parent(s eligible for APTC (Advance Premium Tax Credit - AKA Subsidy) and CSR (Cost Sharing Reduction) and child(ren) eligible for Medi-Cal. Do not be concerned if you see that you are “Conditionally Eligible”, that just means that you will have to provide verification documents within 90 days.

Once your enrollment is confirmed, your next contact will be from the insurance carrier you selected by automated phone message and mail, with instructions to pay your initial premium by January 6th.


How Long for Document Verification?

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Question: Only proof of citizenship was needed for my family - docs uploaded now 2 wks ago - when will verification of docs occur so that enrollment can occur? Thanks!

Answer: You are conditionally eligible now. What that means to you is you will have coverage on Jan. 1st. The conditional part is submitting the required verification documents within 90 days of the date of your application. I guarantee you that whatever you have submitted so far has not even been looked at. So don’t stress. You probably will not get any response to your submittal until well into January.


Applying with 0$ Current Income?

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Question: My son is going to be 26 on 1-3-2014. He is covered on my insurance until 1-31-2014. He is living at home and is between jobs and does not have income. Covered California does not allow him to enter information without showing an income. Also, askes for number of people in household. My husband and I have our own insurance so we would not be applying. How does he fill in this information. He does not need his insurance until 2-1-2014, however, he needs to be covered. We have both tried calling but to no avail as the system is super busy. Please explain how my son proceeds.

Answer: Your son should apply for coverage through Covered California anytime after December 23rd and before January 15th for his coverage effective 2/1/2014. He is a one-person household and since he is estimating his income for 2014, he must enter in income figure even though he is earning $0 today. A number under $16,000 will make him eligible for Medi-Cal. He must promise to file a tax return for the 2014 tax year. (I am assuming that his parents no longer claim him as a dependent.)


Question: I’m little confused about deductible for Bronze Plan.I understand I have to pay $30 each for primary care visit when I choose gold plan. Covered CA website also states that gold plan primary care copay is not subject to deductible. Health insurance benefits chart posted on Covered CA website states that Bronze plan cares copay are subject to deductible. What does it mean? I though copay is cost for services to which deductible does not apply. For example, standard benefits says specialty care visit copay is $70 and deductible is $5,000. Hospital charge me $300 for specialty care visit. Do I have to pay $300 before deductible $5000 met? And then pay $70 for specialty care visit after deductible met? Or do I have to pay $70 regardless of deductible?

Answer: The Bronze plans copays are not subject to the deductible for up to 3 office visits, including pre-natal and post-natal visits, mental health and substance abuse visits, and urgent care visit. What that means to you is you pay only the copay. The emergency room and ambulance copays only come into play once the deductible has been met for a given calendar year. So if you have already spent $5,000 in covered medical expenses for the calendar year and you go to the emergency room, you will pay the $300 ER copay only. Now let’s say you’ve already met the out-of-pocket maximum, having spent $6,350 for the calendar year, you will pay nothing for emergency room services or any other covered expense.


CC Pediatric Dental?

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Question: I’ve gotten conflicting answers about this (pediatric dental). Covered CA rep said they were required to offer it but I was not required to buy it. But Anthem won’t let me buy a policy through them without the added PD policy (its not included in the medical policy). Anthem rep says its the state law & that possibly Covered CA has an exemption even though they are offering identical policies. The State Dept of Insurance could not explain why the difference in answers. What gives!?

Answer: Months ago, Covered California decided not to require carriers seeking to participate in the exchange to include pediatric (-19) dental benefits in their medical plans offered through the exchange. So the carriers set their rates without accounting for pediatric dental benefits. Later, the exchange realized they made a mistake and are actually out of compliance with, at least, the ACA’s intent on this issue. Too late, the rates were set. In the meantime, the carriers’ off-exchange plan offerings learn must include pediatric dental. What a paradox, the exchange is not including pediatric dental and out-of-compliance with the law and the non-exchange got it right.


Question: What do I do if I’ve never accepted my employer’s health insurance and now I want to enroll for 2014 but the open enrollment period isn’t until July of 2014.

Answer: Interesting question! Since you do not have access to employer-based coverage at this point in time and you decided to opt-out of your group coverage before the ACA mandate was fully implemented, I believe that you can apply for Covered California coverage, answering “None of the above” to the question about access to other forms of minimum essential coverage. But remember, to be in compliance with the ACA, you have to accept your employer’s coverage at your company’s next open enrollment period and drop your Covered California coverage at that time.


Question: If my spouse and I each have different needs insurance wise, are we each able to select our own separate plans or must we sign up for the same plan?

Answer: The paper application (page 25) has always had the option for separate selections for each family member. There is no way to do it online. Some have said that a Call Center Rep can do it over the phone, but the outcome is unsatisfactory because the subsidy cannot be distributed properly.


No Invoice?

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Question: I enrolled in Blue Shield Silver PPO 7 days ago and have an applications number and a case number. Have not received invoice from Blue Shield. I called them and they said they have no record of my case and to call Covered CA. I called many, many, many times and they do not answer their phones nor do any of there Certified Counselors answer their phones either. Help!

Answer: It could be that your application data is still “in transit” between CC and Blue Shield. I would check to make sure your CC online account to see if your online application is complete. Login and click on the “Eligibility” tab. You will see a summary of your eligibility status for CC coverage, APTC, and CSR. If that looks OK, click on the “Enrollment” tab and you should see the plan you selected. If your Covered California online application is complete, continue checking with your carrier until they have it in their system. Call your agent if you don’t understand what the heck I’m talking about.


Question: My two sons had been on Healthy Families, their annual review is this month. I submitted proof of income and now received a letter requesting proof of property, and then another stating they have been approved for medi-cal with a $4800 share of cost. Should I not submit the info. they requested and just apply through Covered CA? ( I’m applying for coverage through CC for my husband and myself and the calculator shows they qualify for medi-cal). I’m worried if I complete the annual review we’ll be stuck with that share of cost.

Answer: Right. Ignore the proof of property request from Healthy Families and apply through Covered California for the whole family. The kids will be on Medi-Cal but your assets will not be considered if you apply through CC.


Pay Premium with HSA?

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Question: Can a person make payments of premium of ACA plans through its health saving accounts and claim deduction of its share of premium?

Answer: No. HSA funds cannot be used to pay premiums. HSA withdrawals are not taxed if they are used to pay for qualified medical expenses that does not include insurance premiums.


Question: Is there a tax penalty for opting out of pediatric dental? We have one 2 year old and a baby on the way. We bought the whole family insurance on the exchange but it did not come with pediatric dental. The add-on PPO dental plans are very expensive for what they include and our beloved dentist does not take any HMO plans (which are the cheaper options). It seems it would be far less expensive for us to pay for dental check ups out of pocket than to buy the insurance… at least for the next few years while the kids are very young.

Answer: Insurance works best and rates are lower for all, if everyone is in the pool. That’s the reason behind making pediatric dental mandatory. There is no penalty for not taking it, but you will not be able to get medical coverage without it if you have a child under 19.


Unmarried Parents Household?

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Question: We have a son that is not currently covered, are never married parents living together. Do we have to include both incomes in the household? Or just the head of household?

Answer: It depends on whether you file taxes jointly. Remember, "if you file together, you buy together".


CC Application Pending?

By on | 4 Comments

Question: I submitted my prior year taxes, which do not reflect current income (had some stock sales) but I appended an explanation in the comments. My verification is “pending”. However, it says all documents must be submitted by 12/23 and I don’t know if they need anything else since they have not reviewed it or contacted me. Is it okay to just wait and see what happens for APTC and CSR as long as I attempted to provide supporting documents?

Answer: If your application is “pending” it’s because it’s not complete, not because of verification issues. Login and see what you need to do to complete it. It’s not because they don’t like your verification efforts. I can safely say that the documents you’ve submitted so far won’t be looked at for some time. You actually have 90 days from the date of your application to submit verification documents and you can be covered in the meantime.


Question: Covered CA has a paper app that does not include income info(online you click that you do not want help from the government). If a person bypasses the income information but applies thru Covered CA…can they still qualify for a tax credit at end of the year if their income was such that they would have qualified for a subsidy?

Answer: No. They must provide income information (and verification if requested) in order to be eligible for the tax credits retroactively. So, the long form of the paper app would be required in order to keep the option for tax credits.


Question: Can a senior citizen who is paying for Part A of Medicare because he has not worked in the US cancel Medicare and sign up ACA to take advantage of qualified subsidy?

Answer: This question was answered earlier in the CAHBA Q&A Forum by Premier Agent Max Herr. He is Max’s unedited answer.

Courtesy of the PPACA, persons age 65 and older are now required to enroll in Medicare unless covered by another health plan (generally employer-sponsored). As a result, no one over age 64 is eligible for premium tax credits regardless of income.

The exception to the Medicare enrollment is based on residency. Legal immigrants over age 65 are eligible for enrollment in Medicare if they have been in the US at least 5 years. Prior to that, they must obtain “minimum essential coverage” in some other manner.

Persons over age 65 who do not have fully insured status (40 credits) pay a premium of up to $426 in 2014 (less than 30 credits, the premium is reduced for persons with 30-39 credits). Failure to enroll in Medicare Part A when first eligible (at age 65 for most, or when the five-year residency threshold is crossed if later) means a 10% premium penalty for twice the length of time a person was not enrolled in Part A.

The Part B premium penalty remains a lifetime penalty. The 1% per month premium penalty for Part D is also a lifetime assessment.

So the temporary solution for this German couple, if they have not been in the US for five years is to obtain any form of minimum essential coverage. Once eligible for Medicare Parts A and B, the monthly cost, even at the maximum of $426 for Part A + $104.90 for Part B, is likely to be a lot lower than a Gold plan for a 64-year-old (or older) person.

At $75,000 income, they are well below the joint MAGI threshold for a Part B premium “enhancement”.


Life Triggering Event?

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Question: In final disclosure when purchasing plan, it states that I can’t change plans unless a life triggering event occurs. Does this mean I am wedded to this plan forever or just for the year. Also, what constitutes a “life triggering event”?

Answer: I believe you are referring to a “qualifying event”. Conception would be a “life triggering” event. Just kidding. There are certain qualifying events that must be met in order to be eligible for special enrollment (outside open enrollment) in Covered California. The length of the special enrollment window is 60 days after the qualifying event. If you do not meet one of these qualifying events, you must wait until the next open enrollment period. Here is a list of qualifying events that will trigger (there’s that word) a special enrollment.

  • Lose Minimum Essential Coverage;
  • Gain a dependent or become a dependent;
  • Become a U.S. citizen, U.S. national or lawfully present
  • Cancellation or lapse of coverage in a Covered California is unintentional, inadvertent, or erroneous as a result of an error, misrepresentation, or inaction of Covered California or Health and Human Services.
  • Covered California substantially violated a material provision of its contract in relation to the enrollee.
  • Become newly eligible or newly ineligible for advanced premium tax credit (subsidy) or has a change in eligibility
  • Employer-sponsored plan will no longer be affordable or provide minimum value.
  • A permanent move
  • Recently released from incarceration.

Insure Child Only?

By on | 7 Comments

Question: I want to sign my son up for child only insurance. i cannot find any information on how to do this on this very confusing site.

Answer: Create an Covered California account, list all household members, all members except child decline coverage.


Can I Switch Insurance Company?

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Question: I have completed the CC application process and have selected Anthem Blue cross Silver. Is it too late for me to switch to Blue Shield?

Answer: No. You can login to your Covered California account, withdraw your application, and select another carrier’s plan. You can do this anytime within the open enrollment period.


Mid-Year Household Change?

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Question: My son will graduate from college in June 2014 and expects a full-time job with employer health care. How will this impact my family’s eligibility for ACA subsidy that we otherwise will meet.

Answer: It is your responsibility to notify Covered California when your son has coverage. Covered California will recalculate your subsidy at that time. If your son files his own income tax return in 2014 and you do not claim him as a dependent. You will continue to pay your same “fair share” of the premium for the remaining household.


Getting Confirmation of Coverage?

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Question: I applied 10/25. Never heard anything from CC. Realized proof of income needed to be uploaded 11/21 when I was just clicking around the site. Uploaded last years taxes with an explanation as to why certain income no longer will apply. No response. I can see the upload in the documents and verification section so I know they have it. People are talking about receiving approval letters or requests for ID, etc., but I have heard nothing. NO secure message either. I can’t get through to CC to ask by phone or chat. Blue Shield has no record of me. My enrollment web page shows BS starting 1/1/2014 although the summary page says enrollment is pending (with conditional eligility). Should I worry that I have heard absolutely nothing? I desperately need insurance in January.

Answer: You shouldn’t be worried, but for your peace of mind call this number at Blue Shield to confirm your coverage - 855-836-9705.


Fair Share?

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Question: If you look at the income chart on CoveredCA, it looks like a household of 3 will qualify for a subsidy as long as their household income is under $78,120. But only one family member of the household needs coverage. According to the shop and compare tool, this family member does NOT qualify for a premium subsidy. If I recalculate and say that all three members of the family need coverage, then they do qualify for a subsidy. What gives?

Answer**: “Your fair share” of the premium is established as a percentage of your income. For a 3-person household with an income of $78,000, your fair share is 9.5% of income. That equates to about $620 per month. This number is a constant regardless of who is to be covered. If all three members of the household need coverage and the premium is $1120 per month, you’ll get a subsidy of $500 per month to cover the difference. If only 2 people need coverage, your fair share is still $620, and if the premium for 2 people is $720, you’ll get a subsidy of $100 to cover the difference. But if only one person needs coverage, your fair share is still $620, but the premium is only $300. So you pay the $300 without a subsidy.


Out-of-Pocket Maximum?

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Question: Nobody at Covered California can tell me what my out of pocket maximum would be. The website says 2250 per my income and plan choice, but when I call Healthnet directly they told me my out of pocket max could be up to 12K if I go out of network. Nowhere is any of Covered CA does it state that. What is the right answer?

Answer: Apparently your income makes you eligible for an Enhanced Silver Plan with an out-of-pocket maximum of $2250. That's a great deal. If you are smart about utilizing your benefits, you should never have an out-of-network bill of any kind much less have to worry about the out-of-network annual maximum, but the Health Net rep was right, you would have to spend $12,000 out-of-pocket before you are covered 100% out of network.


Can Over-65 Get PPO Off-Exchange?

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Question: Could German couple 79 & 77 making $75k get any subsidies with Blue Shield PPO? would a short term plan make any sense. They’re coming from $1800/mth Health Net 3000ded PPO.

Answer: Based on their income they are not eligible for subsidized coverage in Covered California. I suggest they shop for replacement coverage off-exchange. They can get better coverage with Blue Shield or any carrier including Health Net for less money.


Question: I am at the last stage of the enrollment process and for some reasons I receive a message - “Your enrollment could not be processed at this time. Please try again later.” I have been trying for 3 days now and the problem still remains. Two of my friends also have the same situations. We all choose Blue Shield Silver 70 PPO. We are not sure this is a Covered CA technical issue or Blue Shield related.

Answer: This is definitely a Covered California issue, not Blue Shield. Despite the error message, if you were able to select a plan, it is quite possible that your application is complete. Check with Blue Shield at 855-836-9705.


Question: How and when will I be notified by my insurer in order to make the first premium payment? My Covered California registration for Anthem BC Silver is complete. It says my first premium payment is due December 26. Will Anthem mail me an invoice, or will they contact via email? Since there appears to a noticing backlog to insurance carriers, will the payment date be extended?

Answer: Yes. The initial premium payment deadline for January 1 coverage has been extended to the second week in January. I recommend calling Anthem customer service at 866-820-0765. If you are in their system, they can take your premium payment online.


Covered for 90 Days?

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Question**: If I applied for Covered Ca and came back pending verifications for either Magi or APTC and am told to wait for a letter in the mail. Is it true that I am eligible and covered for the first 90 days and if verifications are not submitted I can will be discontinued?

Answer: Yes. You are approved for APTC for 90 days of coverage. APTC beyond 90 days is contingent on providing the requested income verification.


Will I Have Coverage January 1st?

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Question: Considering that Blue Shield does not know that I selected them as my insurance carrier, what happens come 1.1.14 for those of us who have completed all we’re supposed to do on our end? Hopefully there are no medical issues in early January but with not a lot of time remaining to receive an acknowledgment notice from BS and premium statement to make a payment by the 1st ~ where does that leave us “if” we do need medical services come 1.1.14?

Answer: Although I believe Covered California will find some way to make sure everyone who applied on time is covered on January 1st, nobody can guarantee it at this point. Claims can be handled retroactively if necessary.


Plan Selection Deadline?

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Question: My eligibility results say this: “You must choose a health plan by December 07, 2013.To choose a health plan, click the “Choose a Health Plan” button below.” I do not understand why I have to choose a plan by Dec 7th. I thought the deadline for coverage to start on Jan 1 2014 was Dec 23rd. If open enrollment lasts until March 31st why do I have to choose by Dec 7th? If I don’t will I lose my chance to enroll in a plan for 2014?

Answer: Upon conditional approval, you are given 30 days to select a plan. (That may account for the first date - Dec. 7th). By design, 30 days was thought to be more than enough time to select a plan. Now that the application deadline for January 1, 2014 coverage has been moved back to December 23rd, a person applying today has 16 days to select a plan and complete their application. A plan must be selected before your application data can be forwarded to the appropriate insurance carrier - Anthem, Kaiser etc.. It’s the carrier’s responsibility to collect your initial payment, so they’d like to have that done ASAP. It was intended that your coverage would not start until you had paid your first premium. Given the first month or so of the open enrollment period was FUBAR, the date for collecting the initial premium for 1/1/14 coverage was extended into the 2nd week in January. So, yes you can drag your plan selection to Dec 23rd and be officially covered on Jan 1 (though I don’t know why you’d want to create that kind of stress), but don’t expect to get your insurance card until late January. If you do not complete an application by March 31st you will lose your chance to be covered in 2014.


Question: Can I purchase a qualifying “metal” plan outside of CoveredCA (e.g. directly from a carrier or through a broker) for 2014 and claim a premium subsidy when I file 2014 taxes in April 2015, if my 2014 MAGI qualifies me for a subsidy? May I retroactively claim at 2014 tax filing time a rebate on overpayment of other expenses (copays, deductibles, etc.) on Enhanced Silver plans, if my 2014 MAGI would have qualified me?

Answer: No. A person cannot retroactively qualify for tax credits on a health plan purchased outside of the Exchange. The exchange determination of subsidy eligibility entails more than simply verifying income, for example there’s residency, household size. and employment status as well, things the IRS can’t do as part of your tax return.


Refuse Agent Delegation?

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Question: In terms of paper applications submitted to Covered CA by agents; if the agent doesn’t accept the online agent delegation, will Covered CA still process the application for the applicant minus the agent? We are loosing confidence in CC, and are considering our options including cutting ties, but want to make sure our clients applications are properly processed.

Answer: If you submitted a paper app for a client and then refuse the delegation online, you would be doing your client a great disservice. There’s no telling how long that application would remain in limbo if you refuse to enter it online. Not matter how you feel about Covered California, you know you have to put the client first.


Doctors On and Off-Exchange?

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Question: Some of the doctors listed on Healthnet site say they are only on the ON - exchange Bronze PPO plan, but not on the OFF exchange Bronze PPO plan which is more expensive and the same coverage. Can Healthnet have a distinction of doctors covered if you buy the same exact plan just off the exchange?

Answer: No. Health Net’s provider network for any given plan is the same on-exchange and off-exchange. That’s true of all carriers that are part of the exchange. The provider network issue is like quicksand right now. There’s no solid ground on which to make a decision because carriers are still inn negotiation with medical providers to fill out their networks and like most negotiations, they come down to the wire - Dec 31st. The networks that the carriers are presenting to the public are confusing too. You could be looking at Health Net’s current provider directory and comparing it to their 2014 directory. You can’t get reliable information from your doctor either. For example, you doctor says they are in the on-exchange network, but not the off-exchange network. Do they even know what on-exchange and off-exchange means. They could be comparing their small group network with their individual network. It may be February or March before the providers networks are resolved to the point that a consumer can make an accurate comparison between provider networks among carriers in the individual marketplace. Until then it’s a crapshoot.


Wait for Subsidy?

By on | 6 Comments

Question: With variable investment income, I decided not to wait for income verification. If I pay the full premium thru 2014 and then my 2014 Income Tax Return is below the income level, can I receive the subsidy on a retroactive basis?

Answer: Yes. In fact that would be the ideal way to handle your variable income issue.


How to Handle Paper App Backlog?

By on | 25 Comments

Question: I have submitted over 100 paper applications by mail and fax since Oct 1st. I have yet to get confirmation or any other response from Covered California. What can I do?

Answer: You should start seeing them as new delegation notices in your agent account on Covered California in the next day or so. Covered California staff are are creating online accounts for applicants who already submitted paper applications. All CC is doing is creating the account and delegating the writing agent. The agent will have to complete the applications online from their copy of the paper application. A Covered California spokesperson told me that if delegation notices are not showing up in an agent’s portal by Friday morning, “agents should create a new account for that applicant and enter the entire application online”.


Question: We applied on the CoveredCA website on November 1st and still have not received an invoice from Blue Shield. Should we contact Blue Shield directly or what other actions should we take to determine our status. Covered CA website indicates that our enrollment is complete.

Answer: Covered California has yet to install a working data link to the carriers to transfer applications to them. The carriers get a report from CC on the number of applications processed for them, but CC has yet to send application one. So in your case, Blue Shield does not know that you have applied, much less be in a position to confirm your coverage and send you an invoice. This will get resolved eventually, but it’s a huge bottleneck, particularly because so many paper applications have been submitted.


Don't Want Kids on Medi-Cal?

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Question: I have clients whose kids are ending up on Medi-Cal, but because they are attending college outside the state, they don’t want Medi-Cal. Is there a mechanism by which they can have their kids on their plan and avoid Medi-Cal? Covered California suggested calling the County and refusing Medi-Cal, but most counties have no idea what I’m talking about.

Answer: The family’s household income must exceed 266% of FPL (approximately $52,000 for a 3-person household or $64,000 for a 4-person household) for a family’s kids to qualify for a subsidy in Covered California rather than Medi-Cal. If your 2014 income estimate is under that threshold, the kids cannot qualify for a subsidy in Covered California and are expected to enroll in Medi-Cal. If that is unacceptable for any reason, I think the best way to avoid it is simply not to apply for Medi-Cal for the kids. They can purchase their unsubsidized coverage either in Covered California or off-exchange directly from a carrier. In this example, there is a potential advantage to purchasing through the exchange. If the household income ends up being greater than expected and places the family over the 266% FPL threshold after all, then the family would receive additional tax credits retroactively for the portion that was not advanced for the kids in that tax year.


Question: Has Blue Shield re-priced their Exchange Plans? A month ago their Platinum (aka Ultimate) PPO was $1631/mo. That price was the same, in and out of the Exchange, and was the price quoted to me within Covered CA when I submitted my application. Meantime, I log into Covered CA and guess what - that $1631 is now $1777. It’s still $1631 on the Blue Shield site for the regular market. What’s up with that?

Answer: Blue Shield did not raise its 2014 rates. The first rate adjustment will be 1/1/15. Covered California rates can differ from off-exchange rates in some cases, but that usually involves pediatric dental and if so the off-exchange rate would quote higher not lower. I’m cannot account for the results you describe. Include your email address and personal information - age, zip, number of family member - for a more specific answer and send it to info@cahba.com.

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