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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.


September 2014 Archives


Split Coverage and Subsidy?

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Question: If a spouse wants to stay on COBRA while the other spouse applies for Covered California during open enrollment, will the "household income" calculation still apply to both spouses' total income even though the coverage is for one?

Answer: Yes. The combined income of both spouses is used in the subsidy calculation even though only one spouse will require coverage through Covered California. Of course, the subsidy will be less for the one spouse enrolled than it would have been if both enrolled.


Medi-Cal Excess Charges?

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Question: I recently scheduled an appointment with a doctor for a physical. This was a new doctor under Medi-Cal Anthem Blue-Cross that I had never seen before. The doctor had me sign something saying that no matter what my insurance was I had to pay extra to the doctor for whatever the insurance didn't cover. I was surprised they had a medi-cal patient do this as I thought the doctors agreed to accept what medi-cal paid. Now I am afraid to go back as I know I will not be able to pay anything out of my own pocket. Is this even legal? BTW I waited 3 weeks to see the doctor and was given the doctors PA to talk to. Never even saw the doctor at all.

Answer: Since you are enrolled in a Medi-Cal Managed Care Plan through Anthem Blue Cross, you need not worry about the "excess billing" language in the standard Doctor/Patient Agreement. If your doctor orders a test or procedure that is not covered by Medi-Cal, he will tell you in advance. If you feel you have been taken advantage of, you can file a grievance against the physician with Anthem.


Waiting for Medi-Cal?

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Question: I called to cancel my Anthem plan because I lost my job and applied for Medi-Cal. I haven't heard much back from MediCal yet and Anthem is bugging me to pay the premiums. What do I do?

Answer: At this point, Medi-Cal still has a backlog of about 300,000 applications to process. Let's say your application is in that pile. Medi-Cal will cover you retroactively to the date of your application. So if you let your individual policy lapse and have unavoidable medical expenses in the coverage gap, you can eventually be reimbursed for some of the money you had to put out. But it won't be easy.


STILL RECEIVING BILLS?

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Question: WHY AM I NOW RECEIVING BILLS FROM COVERED CALIFORNIA? TODAY IS SEPT. 21ST 2014. I WAS APPROVED JANUARY 2014 AND TURNED 65 MAY 18TH I PAYED MY MONTHLY DUES NOW I AM BEING BILLED FOR SERVICES FROM MARCH 2014. I WAS ON HEALTH NET COVERED CALIFORNIA FOR THREE MONTHS UNTIL I WAS ELIGABLE FOR MEDICARE WHEN 65, NOW I AM GETTING ALL THESE BILLS ADDING TO OVER $1,0000 FROM COVERED CALIFORNIA. I AM SOOO VERY UPSET I COULD SCREAM!!! I HAVE HAD NOTHING BUT PROBLEMS FROM THE COVERED CALIFORNIA PLAN RIGHT FROM THE BEGINNING WHEN TRYING TO SIGN UP.. PLEASE-PLEASE HELP ME. THERE IS NO WAY I CAN AFFORD TO PAY THIS BILL!!!!!! THANK-YOU, DIANE

Answer: Diane, your caps lock key is stuck. Health Net needs to know you are now on Medicare. Call them and tell them. The number is on your insurance card. You will not have to pay premiums after May 1st.


Individual vs Agency Rights?

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Question: This question comes up quite a bit especially when there are several agents working under an agency, Can a certified covered ca agent write business under another certified agent log on, using their id and password and pin? Is is ok for the entity business owner to demand an agent to write under to log in so commission's are paid to the Entity? What liable affect can this have on the agent who is write's under the other agent? Especially when all agents signed a contract direct with coveredca?

Answer: If your employer has any sense at all, she told you before you accepted the job that you would not be paid commissions directly from the insurers, but according to some internal compensation plan for your agency. The issue of logging into another agent's Covered California account is not against any Covered California rules that I know of so in my opinion it can be done until someone tests it formally or perhaps legally. The contract you signed with Covered California is not a factor unless you enroll CC applicants through your own broker account.


Estimating Income for Part of a Year?

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Question: Currently enrolled in CoveredCA with a subsidy. When I turn 65 in August of 2015 I will change my plan to medicare, will my subsidy for the first 7 months of 2015 be calculated on my income from Jan 1 - Aug 31 of 2015 of will my subsidy for the first 7 months of 2015 be calculated on my income for the entire year of 2015?

Answer: This seems tricky, but it's not. Your subsidy for the first 7 months of 2015, should be based on your estimated monthly income from Jan 1 to Aug 31 of 2015. The Covered California application software will convert this monthly average to an annual income number from which your subsidy is computed. This may seem to overestimate your subsidy eligibility, but since you will only drawing 8 months of the subsidy before moving to Medicare, you will not be drawing too much, or more importantly, leading to any unpleasant surprises on your tax return.


Question: What can agents who are dissatisfied with Covered California service do to be heard by the people who run the agency?

Answer: Max Her replies, "If you, like I, are dissatisfied with the performance of CoveredCA, the Call Center (FOUR hours on hold today pursuant to the notification that four of my clients' documents were not in order and that they are in jeopardy of losing their coverage -- none of which is accurate), $58 payments for Medi-Cal enrollments that have never materialized, and so on, please email me (max.herr@verizon.net) with your complaints and concerns."

"I have decided to fly to Sacramento for the September 18 CoveredCA Board Meeting and will try to find a way to air our grievances with the Board in public session. We are, I believe, not being given the credit we deserve for effecting a significant percentage of both Medi-Cal and QHP enrollments for 2014, nor are we being asked for our input on how to make the system more efficient and accountable, and I believe it's high time to hold Peter V. Lee and the Board accountable to us for a change."

I look forward to hearing from you. I will print your emails and deliver them personally to the Board at the meeting. Ideally, it will be a large stack of paper.

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