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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.


When Can I Get Off Covered CA?

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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.

15 Comments

My doctor says he accepts the Anthem Blue Cross EPO plans in Orange County, but NOT if you purchased your plan with Covered CA. He says he gets paid less for the subsidized plans in Covered CA. Is this supposed to happen?

Krish writes: “If he can find some other insurance, he can get out of whatever insurance he thinks he is locked in.”

At the next open enrollment, yes. Now, probably not, not without a “Qualifying Life Event.”

Walt cannot get out of Medicaid “now” without a QLE or an appeal to DHCS.

The “SELF-PAY” comment is condescending and unworthy of additional comment.

It doesn’t make sense.. because the question itself was borderline didn’t make any sense category.

Every word of my first reply still stands — others’ comment not withstanding.

Nobody is holding him back. If he can find some other insurance, he can get out of whatever insurance he thinks he is locked in.

If he is losing sleep over the fact someone is coming for asset recovery, all he needs to do is not step into any hospital/doctor’s office, and wear a bracelet that he is “SELF PAY — DON’T BILL INSURANCE”.. problem solved.

Some people just seem to have a pathological aversion to the system where something is required of everyone for everyone’s good.

Walt, you can purchase private health insurance for you and your spouse in lieu of MediCal, but it will cost you at least $1,200 per month for a Silver Plan. Your premiums for the next 2 years will add up to $28,800. Add to that average out-of -pocket medical expenses of $2000 per year per person on top of the premiums and your total projected cost is $36,800. That’s a fixed expense, even if you stay relatively healthy for the next 2 years. Why would you do that? You would be reducing your retirement nest egg by $40,000 on the off chance that your estate might be charged back after you are both dead. How does that make sense?

Asset Recovery is mandated under federal law for all institutional (nursing home) health care benefits paid regardless of age, and all health care benefits provided to persons over age 55. Essentially, these dollars are a no-interest loan, and following the death of a beneficiary, the state must attempt recovery of up to 100% of the expenditures. A person’s home is the #1 asset against which a lien is established.

If a spouse or minor child continues to reside in the home, asset recovery is postponed.

If your income is below the 138% of federal poverty level, you cannot enroll in a health care plan and receive premium tax credits. But this does not mean you can’t enroll in a traditional health plan.

It sounds to me, Walt, like you need to file an appeal with DHCS asking to be terminated from Medi-Cal and allowed to pay the full cost of a health plan of your choice. When Covered California receives a copy of the appeal notice, they will likely give you permission to do so. I have done this for one of my clients.

But if you stay on Medi-Cal for the next couple of years until you reach Medicare age (65), any health care expenses you incur will be recorded on the meter. You, or your heirs, have the right to repay the state at any time prior to enforcement of asset recovery.

I was unaware of the Medi-Cal Asset Recovery Program for California until 4-1-14 when I received a yellow notice advising me of it, 4 months after I applied through CC. I am 63 & I do not want to have my estate hit with a claim when I die. I have written 2 letters & attached it to the form twice already but the Dept. of Health Care Services keeps sending another form asking me to sign it & choose a plan. Just received another 1 today. I was told also to write a letter & request to be removed from this program which I did but obviously I am still being asked to pick a plan. I have been drawing a line through the form with a note to see the attached letter. Called 1-800-430-4263 & was told they can not help get me off this treadmill. I would just like to have regular medi-cal as a safety net but not have a charge of $568.00/mo. or something like it that my estate would have to pay, especially if I never use it. Can you help? Sent the letter to District 08 in LA, Ca.

The question you should be asking (yourself) is when can you get on to another plan. No one is holding you back to the exchange plan. You can stop paying premium and you are out. You can call them up and get off immediately. I believe the website also has the terminal plan option — although the cut off may happen on some specific times of the month. yes, there is a penalty, however modest. But that is your choice.

Covered CA indicated, during its last Board meeting on May 22, 2014, that the next open enrollment period will be from November 15, 2014 to February 15, 2015. I have no reason to believe otherwise.

“November 15, 2014 – February 15, 2015” These are the dates announced by HHS for the Healthcare.gov website only, and has been determined to be a political maneuver by the Obama administration.

There is nothing official concerning CoveredCA that I have been able to find.

I believe the next Open Enrollment Period is November 15, 2014 – February 15, 2015.

I have found nothing on any of the CoveredCA websites or in their news releases that states when 2015 open enrollment takes place. Independently, the California Coverage & Health Initiatives website has posted its own press release dated April 1 that states open enrollment will be from November 1, 2014 to February 28, 2015. (http://cchi4families.org/open-enrollment-for-covered-california-has-ended-but-multiple-health-coverage-enrollment-options-for-children-and-families-still-exist/)

This is just par for the course when it comes to CoveredCA — choosing to make its own rules separately from those of the federal government.

Did you know that Anthem changed it’s policy 2 weeks ago to state that if a client signed up without an agent, then that client can NEVER have an agent. Can you believe that? So, if you signed up for Anthem, realized you have the wrong plan and decide to call an agent to help you (happens all the time), Anthem will not allow a change under any circumstances.

Further, since this was just 2 weeks ago, that means people who signed up didn’t even know they were making an irrevocable decision to never have an agent. Shouldn’t this be disclosed somewhere?

Is this common place? Blue Shield doesn’t do this!

Here’s something even more crazy, they also switched their policy to say that if you do have an agent, a client can change that at any time. They used to require the writing agent’s signature, but not anymore. Now it’s easy to change agents. This one seems more fair to me because if someone is really unhappy with their agent, they shouldn’t have to ask that agent for permission to fire him/her.

Member services told me all of this and then I followed up with my sales rep who tried to give me false info until I told her to research it and get back to me with a definitive answer. She confirmed all of the above.

So, I’m not sure if this is a big deal to you and other agents, but if it is, you can get the word out via twitter and whatever else and maybe we can put some pressure on these guys. How on earth can you have a policy that says someone can never have an agent!! The LA Times will probably be interested in this story.

Max. The 2014-2015 open enrollment period has been rescheduled. It starts Nov 15 and ends Jan 15, 2014 so as not to interfere with the mid-term election on Nov 4th.

Actually, Open Enrollment for CoveredCA will begin on October 15 and end on December 7 — 45 days — coincident with the Medicare Advantage Annual Enrollment Period.

Krish wrote: “when can you get on to another plan” and “You can stop paying premium and you are out. You can call them up and get off immediately” and, finally, “there is a penalty, however modest”

I’m not sure what he was trying to indicate, but once enrolled, you cannot “get off immediately” — a termination date must be at least 14 days down the road from an online request to terminate.

And terminating (or lapsing by failing to pay premiums for) a CoveredCA plan in mid-year does not permit you to enroll in an off-exchange plan in mid-year. In order to do that, one must have experienced a Qualifying Life Event (“QLE”).

Of course, anyone may stop paying premiums at any time a premium is due, and give up their health insurance to face the IRS “Shared Responsibility Payment” of up to 1% of household income (apportioned for each month without being enrolled in a Qualified Health Plan).

Under the PPACA, contrary to popular belief, a person cannot obtain health insurance “whenever they choose to do so.”

The question you should be asking (yourself) is when can you get on to another plan.

No one is holding you back to the exchange plan. You can stop paying premium and you are out. You can call them up and get off immediately. I believe the website also has the terminal plan option — although the cut off may happen on some specific times of the month.

yes, there is a penalty, however modest. But that is your choice.

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