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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.

Switch to a "Normal" Individual Policy?

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Question: Husband on Medicare. Wife on CovCA. Income forecasts show we will be over the CovCA limit. Want to drop the Blue Shield plan (via Cov CA) and purchase new independent individual plan as wife's employer does not provide insurance. Can we do this? How? When? I assume deductibles won't be carried over (except for another Blue Shield plan maybe?)

Answer: Your question highlights a couple of common misconceptions about Covered California coverage. The fact is that you can keep your Blue Shield coverage through Covered California even though you are no longer eligible for premium assistance. Just change your income with CC so that your subsidy gets turned off. During open enrollment, November 1, 2015 through January 30, 2016, you can drop your CC coverage and apply directly with an insurance carrier, like Blue Shield. However, there is no real benefit in doing so, as the rates and plans are the same when you go directly to the carrier. Additionally, should your income drop again, you would have to reapply with Covered California to get subsidized.


You are asking “us” a question that can only be answered by CoveredCA. “We” are not them. You should contact CoveredCA and make your complaint known to them. We have no control over how they operate or what information they do or don’t make known.

In reality, finding the cost of the “second lowest” silver plan is not at all difficult if you have the list of premiums. There are regional variations in premiums due to local costs. But it can also vary depending on the age of the insureds — a husband’s premium will be different than his wife’s if there is any age difference between the two. Throw in one-to-three children under age 21, and any over 21, and it can become somewhat complicated.

Why do you make it so difficult to find 2nd lowest cost silver plan for my taxes?

“there is no real benefit in doing so, as the rates and plans are the same when you go directly to the carrier.”

In general, the information in the full response above is accurate. However, the statement quoted here only has to do with the same plan and the same insurance company. A Silver HMO from Blue Shield will cost the same on or off the exchange, but may be more or less than a Silver HMO plan from Anthem or HealthNet or Kaiser. Open enrollment is an opportunity to change insurance companies as well as plans.

But a CoveredCA provider network can be different than the insurer’s off-exchange network for the “same plan”. And, obviously, the networks for each insurer’s plans are different. A Kaiser physician will not be found in any other network, and a Blue Shield physician might be found in Anthem or HealthNet networks or both or neither.

Using an agent to help make a plan selection is advisable for most folks. We (most of us) will check provider directories to make sure your physician is in the network you are thinking of selecting, and we check drug formularies to let you know if your current medications are covered and to what extent. We also understand the nuances that differentiate some plans, such as deductibles and copays or coinsurance that may be important to know.

It costs a person nothing to be assisted by an agent, and can save thousands in out of pocket expenses to be recommended the most appropriate plan for a person’s/family’s needs.

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