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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.

Children Forced into Medi-Cal?

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Question: Why am I only being given the option for Medi-Cal for my children (age 5) on our CoveredCa application? We want them on our chosen plan (a Blue Shield PPO) but Covered Ca is not allowing that option. Our income is far above the Medi-cal limits for a family of 4.

Answer: For a 3-person household, your income would have to be $50,000 or more for the children to be eligible for subsidized private insurance while it only has to be $20,000 or more for the adults to be eligible. Why is that? It's a lot cheaper to cover people on Medi-Cal than to subsidize them with private insurance. Ultimately, it costs the taxpayers less and reduces the overall cost of healthcare.


Stephen …

You don’t provide enough details of your/your daughter’s situation to be able to respond effectively. Please write to me personally with more specific details of what transpired and I may be able to evaluate whether you have any recourse.

Since last May, for some reason my daughter was forced to be covered under medi-cal and subscribe Healthy family plan while my family of 4 are covered by a blue shield bronze plan throught covered CA. Now I receive bills for $78 (6 months of premium) wanting me to pay for my daughter’s healthy family plan which we don’t need. I called medi-cal in August to request to cancel but didn’t get anywhere. So I’m paying double insurance for my daughter. What can I do except paying the $78?

The “numbers” stated above are not quite accurate. A household of 3 would require income in excess of $52,641 for the child under age 19 to be ineligible for Medi-Cal (>266% FPL). That same household of 3 requires income in excess of $29,684 for all adults age 19 and older to be ineligible for Medi-Cal.

You are not required to enroll your children in Medi-Cal. But it requires checking the box “NO” this person does not want health insurance, and paying the full cost of the insurance for your child(ren) off the exchange, which, for ages 0-20, would be about $105 for a 2015 Blue Shield Bronze PPO in Los Angeles County, each higher metal tier adds about $20-$22 per month to that premium. There are other plans available with lower and higher monthly premiums for off-exchange/unsubsidized plans. At age 21, the cost per month would rise $60-$100 or more depending on the plan.

The reason for the big increase at age 21 is a natural effect of the PPACA, which prohibits health insurance companies from charging more than 3 times the premium for persons age 64 compared to what they charge persons age 21. So if a Blue Shield Platinum PPO is $270 per month for a 21 year old, it can be as high as $810 per month for a 64 year old.

Say thank you to those members of Congress who voted to pass the legislation without understanding what exactly they were voting for at the moment.

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