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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.


April 2014 Archives


Qualifying Events?

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Question: Back in December, I applied for an off-exchange Blue Shield plan because our household income was well over the income range for subsidies. But now we definitely are eligible for a subsidy, because my husband just lost his job a few days ago. Can I still apply through Covered California.

Answer: Yes. A change of income that affects your eligibility for a subsidy is considered a qualifying event that make you eligible for a special enrollment period of 60 days from the date of the change - in this case his employment termination date. Here is a list of other qualifying events:

  • Getting married
  • Gaining a dependent or becoming a dependent through marriage, birth, adoption, or placement for adoption
  • Permanently moving to a new area that has different health plan options
  • Losing other healthcare coverage that is considered minimum essential coverage.
  • A change in income that would affect an enrollee’s eligibility for financial assistance
  • Becoming a U.S. citizen
  • As a result of an error, misrepresentation, or inaction by a QHP or agent

How to Pay Kaiser?

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Question: We were told to pay kaiser but whe we went to pay they needed a number for the account we didn't know it how do we pay the payment.

Anawer: If you have not received an invoice by mail within 15 working days of your application, you can call Kaiser Member Services at either of these phone numbers: 800-464-4000 or 800-290-5000.



CoveredCA HSA Qualified Plan?

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Question: I signed up for an Anthem Bronze PPO plan in December. Although it is not designated as a HSA plan, it fits the IRS definition of an HDHP, i.e. it is $5,000/$10,000 deductible, out of pocket limits $6,350/12,700. I already have an HSA account set up from my prior insurance and I would like to continue to fund this for my expenses this year. Why would Anthem/CoveredCA not list this as an HSA compatible policy and would I be breaking any rules to claim my HSA contributions on my taxes next year?

Answer: Only one plan in the individual market is designated as an HSA qualified plan, the Bronze HSA Plan. Apparently, you bought the other Bronze plan. You can try calling Covered California at 800-300-1506 to see if they will accomodate you with a plan change.


Question: My Mom has been receiving health care under Covered California since January 1st. She can no longer afford the home she is in and must sell to continue to live. From the sale she will make some money which she will need to live. Will this be considered income even though this will be a one time occurance? If this is so, then she will become disqualified for assistance. Am I correct?

Answer: Any profit above $250,000 will go into her adjusted gross income for the 2014 tax year. (Your mom can exclude from tax up to $250,000 in profit from the sale of her primary residence or $500,000 if she's married as long as she has owned and lived in the home for a minimum of two years.) So selling the home will have no effect at all. If the sale of the home raises her AGI, the advance tax credits she has received to help pay her 2014 health insurance premiums will be reconciled by the IRS when she files her 2014 tax return. Any undue advance tax credits will be added to her 2014 taxes due. This should not be a problem for your mom since she will have the cash from the sale of the home to take care of the additional taxes if there are any. She is not "disqualified" for health insurance premium assistance and she will continue to be eligible for subsidized coverage or Medi-Cal the following year based on her 2015 income.


Employer Coverage Over 9.5%?

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Question: How do I go to Covered Ca if my share of employer sponsored insurance is greater than 9.5% and receive the advance tax credits?

Answer: Complete a Covered California application online before April 15th. When you get to the Health Care Information section and this question, "Does this person have or has this person been offered affordable minimum standard value health insurance for 2014?", answer "None of the Above".


Medi-Cal Application Lost?

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Question: My wife and I have been covered on a Blue Shield Obamacare plan since January 1st. Our two kids are supposed to be on Medi-Cal but we haven’t gotten anything from them yet. We called the county office, but they are no help at all. Should we apply again before the deadline on April 15th?

Answer: No. I recommend against applying again. It could really mess things up for you at this point. Your children’s MediCal application is probably not lost. About 800,000 people who applied for Medi-Cal coverage through Covered California still are awaiting approval because of software glitches. State officials say the backlog of Medi-Cal applications was caused by problems with a system that was supposed to link county and state computers to confirm applicants’ eligibility for the program. Even though the glitches have been fixed, workers at the county social services offices face a large backlog of applications. Unfortunately, if your Medi-Cal applications are awaiting approval you could be foregoing needed medical care for your children or paying out-of-pocket for health care services. You do have the option of requesting a temporary Medi-Cal card from county services but some MediCal providers might not accept them because of concerns about whether they will be reimbursed for the care.


Change EPO to PPO?

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Question: I currently have Anthem Blue Cross (Silver Plan) EPO and it's come to my attention that my regular doctors only accept PPO. I can use the EPO except the service would be considered out-of-network. Do I need to wait until the next open enrollment cycle before I can change to a PPO? And, when would this be?

Answer: You must make your plan change by April 15th, or wait until the next open enrollment period starting in November. Be sure to research the carrier provider networks for your doctor(s) before you change. Anthem Blue Cross does not offer both EPO and PPO plans in the same geographic area. You would have to select another carrier with a PPO available where you live.


Still Covered After 90 Days?

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Question: I received the conditional 90 day coverage from Blue Shield, through CC. I needed to verify my income, but was not able to pull together any of the required documents in time. I have been working as an independent contractor in this past year (for the first time ever) and am definitely on a learning curve for documentation. I have been billed (by Blue Shield) for the month of April, so I went ahead and paid it, but I am not sure if I am still covered from CC's point of view. I tried calling CC a number of times before the March 31st deadline to try to resolve the matter but was never able to reach anyone. As luck would have it, I have need to see a doctor now, due to injuries from a fall, but I am reluctant to proceed, for fear I will find myself without coverage and facing exorbitant bills which I cannot afford. Is there a grace period or a next step when the provisional coverage period ends?

Answer: Yes. You are still covered. Neither Covered California nor Blue Shield will cancel your coverage for failing to comply with a request for income verification. At worst, CC could take away your premium assistance, but that would not happen until you have been given additional opportunities to comply. For starters, they have to start providing adequate customer service before they can hold you to your reporting obligations. Wait until you can get through to 800-300-1506 and ask the Customer Service Rep for assistance in providing the necessary documentation.


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By on | 29 Comments

Question: I have enrolled and been conditionally accepted for 90 days and I have signed up and paid for a health plan. Now I am thinking of cancelling the plan and get out of the Covered Cal exchange altogether. How do I do that, and if I do, when will my current account with the insurance company end?

Answer: If you applied on your own, log into your CC account and select "Terminate Coverage". You can cancel your coverage as soon as 14 days from that date. If an agent signed you up, ask him or her to do it for you.


Is Employer Coverage Verified?

By on | 4 Comments

Question: How does Covered CA obtain information from individuals who have affordable employer coverage and submit application for coverage through exchange.

Answer: There is no requirement for employers to supply information about their employees' health care coverage, at least for the 2014 tax year. Nor have I seen any verification requests from Covered California to applicants.


Wait Two Weeks to Reapply?

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Question: I had already applied and got a plan and payed, but my payment was not accepted. I had to terminate and wait 14 days to apply again, but this will take me past the march 31st deadline. Any advice? Can't get a hold of customer service.

Answer: After terminating your current coverage at least 14 days from that day, you can choose a new plan immediately using the same application. You do not have to wait 2 weeks to reapply. I think that misinformation may have originated in our Q&A comments section, but that person was wrong.


Question: I signed up for anthem ppo & paid for it on March 25 (which at that time appeared to be the deadline), then found out that my doctor has just been added as a provider on the blue shield epo. I am in the midst of some complex treatment issues and will be forced to pay out of pocket to see my current doctor about these matters (forced to put these payments on credit card because I am currently out on disability leave from my job). Is there a way to switch from Anthem to Blue Shield?

Answer: Yes. You can terminate your Anthem Plan effective April 30th and choose the Blue Shield plan you want effective May 1st. This is a quirky process in the Covered California online application system. I suggest you delegate a Certified Insurance Agent to help you with it.

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