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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.

May 2014 Archives

Medi-Cal Ineligible?

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Question: I'm a 31 yr old single mother. My 3 month old is eligible for Medi-Cal until he is 1. My 12 yr old is ineligible because of my income, yet I can't enroll him on Covered CA. I'm making $39,000 a year. What can I do?

Answer: If your household is made up of 3 or more individuals and your income is less than $52k, then all of your children age 18 or less are eligible for Medi-Cal. Medi-Cal enrollment is open throughout the year. You may enroll through Covered California at 800-300-1506.

Question: We were approved for Covered California but I chose the wrong health insurance plan. It has not yet take effect (it takes effect in 5 days). Can I change the health plan, or should I terminate Covered California and start over again? Thank you!

Answer Don't terminate your current coverage. Open enrollment for 2014 has ended. You cannot change your plan unless you have a qualifying event which makes you eligible for a special enrollment period. Making the wrong plan selection is not a qualifying event. However, if you can make the case that you made the wrong choice "as a result of an error, misrepresentation, or inaction by an insurer or agent", then Covered California may grant you an exception.

Question: When open enrollment starts Nov. 15, 2014, can I get off covered CA and look for my own private plans or do I have to stay on the plan I am on now for a full year?

Answer: When you apply for another plan during the next open enrollment period starting next November 15, your new coverage will start January 1, 2015 at the earliest. You do not have to keep your present plan for a full year.

Catastrophic Plans

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Question: I have a client who is eligible under the federal guidelines for a catastrophic plan. He was recently approved by the federal marketplace and has the paperwork to prove it. To date, I have not discovered the mechanism to offer him anything other than the Bronze plan, either off or on- exchange. Is there now a streamlined process now by which I can help them enroll in a catastrophic plan?

Answer: If the applicant is eligible for a catastrophic clan because of age (19-30), then the catastrophic plan will show an an option in the enrollment section of the online Covered California application. However, since catastrophic plan are unsubsidized, you can go directly to the carrier's online application. If the client is eligible for a catastrophic plan but 30 or over, I don't know of any online mechanism on or off the exchange to get the app started. You can submit a paper application to the carrier with your eligibility documentation.

How to Verify Income?

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Question: I was told to verify my income for the covered california insurance plan. How do I do that?

Answer: You can upload documents from within your Covered California account, but few people seem to be able to do that so I have stopped providing directions. Instead, call Covered california at 800-300-1506 and talk to a customer service rep. He or she will tell you how to submit the relevant documents for your situation.

Question: My family of four has a Covered CA plan, which we purchased when both my husband and I were unemployed. I am listed as the subscriber. I recently began work and have employer coverage beginning June 1. If I terminate the entire CC plan will that act as a qualifying event to get off-exchange coverage for my family? I don't want them covered on my employer plan due to cost.

Answer: Once you and your family have been offered employer-based coverage, you are no longer eligible for premium assistance in Covered California. You are obligated to contact Covered California and change your status. You may opt out your family from your employer coverage, but they will only be eligible for unsubsidized individual coverage.

Question: About a week prior to the deadline they gave me for my conditional 90-day acceptance, I mailed Covered California a monthly bank statement with the preface form they asked me to return, but I am not sure how/if this will truly prove my eventual 2014 income. What will happen if they still think this is not proof? Will they end my coverage completely, or give me another chance to help them determine what they need and re-establish my policy after a lapse?

Answer: No. Your coverage will not be ended. If your income verification is not acceptable, your premium assistance will be recalculated based on the best information available.

Question: I am currently enrolled in covered california, MediCal, for 2014. I have been job hunting for a while, and I believe that I may be getting a job soon that pays above 138% of the poverty line (the limit for covered california). If I get this job, will I be required to drop MediCal immediately? By the end of the year? Within a certain number of months? Thank you.

Answer: Yes. it is your responsibility to notify Medi-Cal of your change in income. You will no longer be eligible for Medi-Cal once your household income exceeds 138% FPL. However, if your new household income is between 139% and 400% of FPL, you will be eligible for premium assistance and perhaps cost sharing reductions through Covered California.

Question: Has Covered California officially decided to implement the Special Enrollment Period through July 1, 2014, whereby the Feds allow folks who currently are under COBRA to switch to ACA Marketplace health insurance plans?

Answer Yes. Covered california adopted the COBRA SEP guidelines regarding SEP exceptions for COBRA beneficiaries on May 15. The SEP enrollment period in California will extend to July 15, 2014.


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Question: Is the COBRA SEP adopted by CA the same as the feds?

Answer: No. The COBRA SEP in CA extends from May 15 to July 15 (SEP in fed exchanges ends July 1st)So people currently enrolled in COBRA coverage have until July 15 to apply for coverage through Covered California or off-exchange in a ACA compliant plan.

Question: I currently qualify for premium assistance, falling just under the income limit for our 4-person household. My son expects to attain a full-time job with employer benefits in August. Will this reduce the income level to 3-person, meaning no premium assistance? If so, would it be effective in August or retroactive to Jan 1?

Answer: You are committed to notifying Covered California when your son's coverage starts, so you will stop getting advance premium tax credits at that point - not retroactively. It remains to be seen whether the IRS system has the sophistication necessary to reconcile the annual tax credit to reflect the midyear change like this.

Question: What will happen if I have not sent proof of income and request for social security validation by stated deadline, for my 90-day conditional acceptance?

Answer: Your eligibility for premium assistance and enhanced benefits could be withdrawn.

Premium Locked For How Long?

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Question: If I purchased a Covered California health insurance plan for my family that was effective on May 1, 2014, will my premium stay "locked" at this level until May 1, 2015? That is traditionally how my health plans have operated in the past...with 1 Year Guarantees.

Answer: No. The rates for individual health insurance purchased in 2014 will change on January 1, 2015.

Question: I just got a rate increase on my grandfathered individual plan. It going up 24% effective July 1st. Can I still buy an Obamacare plan?

Answer: Yes. This is a qualifying event for a Special Enrollment Period (SEP). According to Covered California, “You have a health insurance plan outside of Covered California, and your renewal date is not between Nov. 15, 2014, and Feb. 15, 2015, or future open enrollment dates and you would like to switch to a Covered California health insurance plan instead of renewing your current plan.” Here’s how it will work: You can apply for coverage either through Covered California or directly with the insurer of your choice when your non-calendar-year individual plan renews. You can report to your insurer that you will not renew their plan up to 60 days before the renewal date. Your current carrier must provide a limited open enrollment period beginning on the date that is 30 calendar days prior to the date the policy year ends in 2014 to select and ACA-compliant individual plan. If you choose to enroll through Covered California, you will have up to 60-days from the renewal date to select a plan in the exchange. Reference: https://www.coveredca.com/coverage-basics/special-enrollment/qualifying-life-events/

SEP for COBRA Enrollees?

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Question: I got on COBRA when I lost my job last month because my former employer pushed me to do it. I didn’t look into Obamacare because I thought it was over. Can I still switch to a Covered California plan?

Answer: Probably, but not for sure yet. The Department of Health and Human Services is concerned that people newly-eligible for COBRA, as well as COBRA beneficiaries, may have had insufficient information to understand they only can enroll in the exchange during an open enrollment period, when initially eligible for COBRA or when COBRA coverage expires. So HHS is providing an additional special enrollment period based on exceptional circumstances so that persons eligible for COBRA and COBRA beneficiaries are able to select QHPs in the exchange. Affected individuals have through July 1, 2014, to select QHPs in the exchange. This is for federal exchanges. At this point, Covered California has not decided whether they will follow the recent CMS regs. Reference: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/SEP-and-hardship-FAQ-5-1-2014.pdf

Question: My husband was laid off mid march. The insurance at the company he worked for was valid through 3/31. As part of his severance package...the company is paying for COBRA till 7/1 which is when we would then be responsible for paying COBRA payments. The insurance through his current plan is very expensive and we would like to "shop" for our own insurance. We will not qualify for assistance as our income is just above the cut off. When is the last date we can apply/start paying for our own coverage other than the COBRA in order to take complete us. COBRA says we can drop them at anytime so that is not a issue.

Answer: You have a special enrollment period due your eligibility for COBRA until 6/1/14 (60 days from termination of group coverage), during which you can purchase an individual plan either in-exchange (subsidy) or off-exchange (no-subsidy). You can drop COBRA anytime, but you must apply for individual coverage before 6/1/14. If you apply through the exchange, indicate that "loss of coverage" is your qualifying event. If you opt for COBRA instead, it will remain your only option for the rest of 2014.

Changing Doctors?

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Question: I live in Amador County and my only 2 options thru Covered CA were Anthem PPO or Blue Shield EPO. The doctors/imaging specialists I saw all last year were in network with my Blue Shield PPO. Despite telling me they would take the EPO, turns out they don't and they don't accept Anthem. Can I get a PO Box in Sacramento and use that as my (mailing) address so I can have the option of getting the Blue Shield PPO next time around? Or do you know of any other way around such a dilema?

Answer: Putting aside the fact that you would be breaking the rules, using a Sacramento mailing address to enroll on a Blue Shield PPO will not accomplish what you want. The "old" Blue Shield PPO network that was available in Amador County is not the same as the "new" PPO network available in Sacramento county.

I have no doubt that this will touch a nerve with some of my readers and I invite you to comment to this post with your opinions, but I wonder if keeping the same doctor and imaging facility you used last year is of such great value. Obviously, using a different imaging facility is no problem at all but what about the doctor? How much does he know about you that could not be passed on to another equally competent doctor? Seriously, what's the big deal?

Find Family Doc?

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Question: I need family doc for my plan - Anthem Blue Cross Silver PPO

Answer: To view a list of doctors that are in-network for your Anthem individual plan, go to:
(Note: Copy and paste this link exactly as it listed here and paste it into the address bar of your internet browser. Other links will take you to a page that looks the same but is not.)
2a. Leave "Name" field blank
2b. Leave "Specialty" field set to "Family/General Practice, Internal Med"
3. Enter your city or zip code
4a. Enter state "California"
4b. Select the network called "Pathway X - PPO / Individual via Exchange"
4c. Select Plan "Anthem Blue Cross Silver DirectAccess"

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