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Spouses Choose Different Plans in Covered California?

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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.


Max Herr wrote: ” Whatever happened to the promise that Americans would have access to the same health plan available to the members of Congress?”

The Republicans took that away in trying to prevent passage of ACA, by amending the law to require that members of Congress buy from exchanges. The Dems called their bluff by allowing that amendment to stand.

So yes, I do have the same health plan choices that my congresswoman, Jackie Speier, currently has.

” And why do members of Congress, who each earn well above 400% FPL, get a tax credit to pay for their health insurance?”

They don’t. They get an employer contribution by buying via the SHOP exchange. Just like most employed Americans who have employer-provided health insurance.

ACA is designed to reach the minority who are shut out of the employer-subsidized system. Congressmembers and their staffs are the only American’s who have been forced to give up their employer-provided health care.

Max Herr wrote: “In the redistribution of wealth represented by the PPACA, make just a little too much money, and the government labels you as “wealthy” and tells you that you don’t need any assistance.”

Before PPACA, the government gave me -0- to help with insurance premiums.

Now they might give me $5000 or more if I can keep my MAGI under $46K, but if I make more I won’t get that $5K.

That is NOT a case of the government taking something away from me.

Rather, it’s a very generous government benefit that happens to have a cut-off. All the other benefits also have cutoffs too — people on the lower end of the economic spectrum have been dealing with this for years. What’s the cutoff for income or assets to get food stamps? Before the ACA medicaid expansion, what where the income and assets cutoffs? Those policies have been very effective at encouraging poor people stay poor, given the loss of benefits for crossing above the cutoffs.

The difference with the ACA subsidies is that you don’t have to be dirt poor to qualify. You can be quite comfortable economically and still have federal dollars thrown your way.

If I manage to get that subsidy next year, I’ll be happy. If I don’t — then I will count myself very fortunate to have the higher income. Here’s an example of a computation showing how someone with a net self-employment income of $75K can bring their MAGI down to the requisite level: https://obamacareguide.wordpress.com/2013/10/20/figuring-your-household-income-part-two/ (Note that the math does NOT include the self-employed health insurance deduction — the real “net” number may be more like $85K)

Freelancer …

Your comments are spot-on!

“quite another for Covered California to coordinate multiple payments to different insurers. I’m not sure if there is a federal regulation that requires them to do so.”

There is no requirement to do this, and it makes no difference, ultimately, in the amount of money that one would spend on premiums, since each person’s premiums are based on location and age.

And it’s also true that the premium tax credits are simply a reduction in tax due, not a genuine entitlement subsidy. Most people do not understand the difference, but they will vote for the politician who tells them “the government will help you pay for your medical insurance”.

“If you want the government to help pay for your insurance, then you have to accept that the government is going to set some rules.”

In the redistribution of wealth represented by the PPACA, make just a little too much money, and the government labels you as “wealthy” and tells you that you don’t need any assistance.

Whatever happened to the promise that Americans would have access to the same health plan available to the members of Congress? And why do members of Congress, who each earn well above 400% FPL, get a tax credit to pay for their health insurance?

The old saying remains true: “Gold rules. Those who have the gold make the rules.”

Here’s the applicable federal regulation: http://www.law.cornell.edu/cfr/text/26/1.36B-3

It’s a long slog to read through that, but it is clear from the regulation and the examples that a taxpaying unit (spouses and/or dependents) will qualify for the premium tax credit even if enrolled in different plans. There’s enough ink spent on the problem of determining which of possible multiple 2nd lowest cost Silver plans would be the benchmark to make it clear that the situation is clearly anticipated.

But there is a difference between getting the year-end credit and qualifying for the advance premium credit. It’s one thing for IRS to make an allocation directly to the taxpayers based on numbers in a tax return; quite another for Covered California to coordinate multiple payments to different insurers. I’m not sure if there is a federal regulation that requires them to do so.

So it may be that a family buying a plan that way will need to prioritize - perhaps by opting to apply whatever advance credit they qualify for to the most expensive of the several plans they choose, and paying full price for the others, recouping any balance owed in the form of a tax refund the following year.

I’d add one thing: the premium support is a tax credit, not an entitlement. Like other tax credits and deductions, it may or may not be available to a taxpayer depending on other choices they make. We each have the right to buy whatever combination of policies we want and pay the full cost of the premiums — but when you add the government subsidy in the mix, then you may face some restraints. If you want the government to help pay for your insurance, then you have to accept that the government is going to set some rules.

What about purchasing policies from different insurance carriers? My wife and I are eligible for Silver 87.

My wife must pick an Anthem PPO because of the several different hospitals/doctors that are in network. She has several doctors that she needs to continue to see.

I want to pick Kaiser, as I don’t have the need for specific doctors, and Kaiser is very close to our home.

We enrolled in the online CC Anthem PPO to simplify the enrollment, but I want to switch to Kaiser.

Can I change to Kaiser Silver 87 and keep/split the subsidy?

I believe I have until March 2014 to make changes to our 2014 plans.

I have an update on my situation. (splitting up the plans)

My agent was on the phone with Covered CA for 4 hours yesterday to get all his customers’ questions answered. When he asked about my situation he was told that the split plans could be done, but the consumer needs to call direct.

So I called today exactly at 8:00am sharp, got through in 10 min, and the rep was quite nice. She went through all that was required to split it up..

and then came the bad news..

2 adults bronze would cost the same as combined 2+1 bronze, and moving the child on silver would be totally additional without subsidy as it would be a separate application.

It didn’t make any sense to me. But we were at an impasse. She told me I could change the plans before March deadline. So I asked her to put all of us on Silver for now, which was only marginally more expensive than just my son on silver.

I am going to try again after the New Years when there is a lull period when sanity resumes.

In these last days of open enrollment for the January 1 start date, it is becoming clear that there is no one who has any answers to any questions at Covered CA or the SHOP. Sacramento directs agents to call SHOP, and SHOP tells agents they don’t have information about individual plans and to call Sacramento.

Spend hours in the CHAT queue on multiple occasions only to reach the #1 position and then have the session cancelled because there is “no agent available”. Oh to be paid a salary to wait on hold.

CSRs are not empowered to resolve problems at all — so they really are not justified in being labeled Customer Service Representatives — they are telephone answerers who have no answers. Speak with two different CSRs and get at least two different and (usually) wrong answers.

Complaints should be sent to each and every member of the State Senate and Assembly to demand that CoveredCA be held accountable to the public it was supposed to serve. We did not need another bureaucracy that is empowered to act as its own policeman. We already have too many of those in CA.

Covered California’s application is different for some, and different for others. Thereby illegal, of course.

I have clients for whom the Covered California application offers the option of providing one plan for the family, or option for different plans to each or a group of household members.

Yet other clients of mine are never provided such option, and are provided only one choice to select one single plan for the household.

I have a very online-Covered-California-frustrated client who gave up with Covered California altogether. Her household wanted three different plans for each of the three family members. An HSA for each adult to avoid the combined family deductible, and a stronger plan for their child. They have AGI income above the 400% threshold, but were applying through CovCal with their financial info as a just-in-case measure should their 2014 income be lower than anticipated.

Her household via the CovCal application was provided NO OPTION to split family members into different plans.

With bitter mumbling from her tedious and tiresome CovCal experience she enrolled directly with Anthem Blue Cross foregoing potential subsidy eligibility.

Insult to injury, and unexpected to her with her appropriate assumption that plans are mirrored to CovCal, Anthem has decided to additionally charge adults for pediatric dental non-coverage. Nice one.

Krish …

You should definitely contact the insurer —forget about CoveredCA — and discuss your need to distinguish the coverage. Don’t rely on your agent to take care of this. Do it yourself!

If it’s not right on January 1, you may not be able to change it after the fact, regardless of what you have uploaded to CoveredCA — they won’t be verifying those items for weeks, months, or never.

I think they are making up rules as they go. I have never heard of this hard requirement and always thought of this as a shortcoming in the website implementation.

My agent told me that this is definitely possible; His point of reference is that this is possible in the paper application — so there can’t be any fundamental issue with it.

I informed my agent of my choice and sent him the completed page 25. He has tentatively entered us in one single plan, but has promised to change it as soon as he figures out how to do so(!).

I have uploaded a scanned copy of completed page 25, as part of my income verification document for good measure!! This way, my intent is on the record before the deadline should there be an issue later on.

In our case, the insurer is the same, but we are trying to have different metal levels of plans.

The only way to “split” online insurance enrollments that I figure out is to file separate applications for each spouse. This causes some difficulty in calculating/applying premium tax credits. I haven’t actually tried this, but in my mind it should work, knowing that I have filed more than one application for one of two married persons in a household because the working spouse had employer-sponsored coverage and was otherwise ineligible for APTC.

Theoretically, reporting each spouse’s income in separate applications could work, as could dividing income 50/50. I believe the answer Sharon received is correct in one particular scenario. And that has to do with Cost-Sharing Reductions which qualify a person for a Silver 94, 87, or 73 plan. Dividing income could skew that eligibility, which would be a problem. When a household qualifies for that, there may be a requirement to enroll everyone under the same plan.

But I believe there is a trick in doing this when no CSR applies (that is, income solves for basic bronze 60, silver 70, gold 80, and platinum 90 plans).

If a joint application results in $250 APTC qualification, then when submitting separate applications, you list both spouses and mark NO for the husband on one app and NO for the wife on the other app relative to the question: “Does this person want health insurance?”

When selecting a plan after completing the application, determine how the APTC should be split between the two apps. You can use the adjustment feature to increase or decreas the APTC amount before completing the “purchase”.

It should not be this difficult, but I don’t know of any other “workaround” since no one at CoveredCA apparently gave thought to the possibility that people would choose different levels of coverage or different health plans in the same household, regardless of the fact that a 22-year-old might be perfectly content to be enrolled in a bronze plan while Mom needs a silver plan and Dad needs a platinum. Or a 40-year-old husband with a 25-year-old pregnant wife would choose a silver plan for himself but a platinum plan for his wife and future child.

Another valid reason is when a person’s existing PCP is in one network only and the spouse’s PCP is in another network only.

Instead of the “choice” of an affordable health plan by each person, the combined online application traps the entire household in one plan. It’s a little more work to do two apps, but it could save a household some out-of-pocket expense over the course of one year.

Question: I am a Certified Agent and I spoke with Covered California about families selecting different plans. I was told that if they are receiving the Premium Assistance that the family would have to be on the same plan. That does not make sense to me since the credit is the same. What is true? What should I be saying to my customers?

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