Another in a series of Q&A columns answering consumers’ questions about the Affordable Care Act.
Calling all procrastinators: There’s still time! Granted, I wagged my figurative finger at you in previous columns, warning you that Dec. 15 was the deadline to sign up for health insurance from Covered California or the open market if you want it to kick in Jan. 1.
But things have changed. You now have until Monday, Dec. 23 to enroll for Jan. 1.
For the extreme procrastinators among you, that isn’t even the final deadline. This year — and this year only — the open-enrollment period lasts through March 2014. Please note, however, that the later you sign up, the later your health coverage begins.
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Q: I need to buy a health plan but make too much money to qualify for tax credits from Covered California. Should I still shop for a plan from Covered California or take my chances on the private market? What’s the difference?
I’ve wondered the same thing.
Let’s start with this important baseline fact: Here in California, insurers are required to offer the same plans with the same benefits, both on our health insurance exchange, Covered California, and on the open market. And at the same price.
Assuming that you don’t qualify for tax credits (which can only be applied to plans purchased through Covered California), that means you’d be paying the same, full-cost price inside or outside Covered California for the same plan.
But you may have other options.
Some insurers may sell additional plans outside Covered California, says Charles Bacchi, executive vice president of the California Association of Health Plans.
Those plans still have to meet Affordable Care Act coverage requirements, he says, but they may offer different benefits, such as other cost-sharing arrangements (lower or higher co-pays, out-of-pocket maximums and the like). Or some may offer more doctors/hospitals to choose from (the networks for some Covered California plans are limited). Such choices may affect plan prices.
“Some regions might have different options than other regions,” Bacchi says.
If you need help figuring out what’s available on the private market, call the health plans directly. Or you may consider seeking the advice of an insurance agent who is certified and trained by Covered California. A certified agent can help you enroll in the exchange or the open market, and you won’t pay extra for the help.
One of those agents is Tom Freker of Fountain Valley. For his clients who don’t qualify for tax credits, Freker says he prefers the ease and speed of the private market.
“The difference is you can be done with the application in 10 minutes,” he says. “Not Covered California.”
For example, he mailed some health insurance applications to Covered California on Oct. 18. He says they finally appeared in the system on Dec. 5. Covered California says it has been experiencing overwhelming demand and is working to keep up.
Freker also notes that some insurers that aren’t participating in Covered California are nonetheless selling individual and family plans on the private market. In Orange County, he points to Cigna as an example.
To find certified agents near you, visit CoveredCA.com.
Q: My daughter, 30, is unemployed and lives with us. She has no income but is looking for work. Should she apply for Medi-Cal or a plan from the health insurance exchange? The Covered California application asks for household income, which would disqualify her from tax credits, based on my income.
Judging from the number of questions I receive from parents like Steve in Azusa, many adult children are back at home with Mom and Dad — out of necessity.
As I’ve mentioned before, the Affordable Care Act relies heavily on our tax data to determine program eligibility and financial assistance. That’s where Steve’s question comes in.
As he notes, the amount of tax credits you’re eligible for rests on your household income.
So, what’s household income?
In the case of an adult child living at home, it can be more complicated than you think. If you claim your child as a tax dependent, your income will count toward hers, even if she’s unemployed and even if she’s just applying for herself.
“If (Steve’s daughter) is claimed as a dependent, then her income is the income of that tax filing,” says Covered California’s Anne Gonzales. “If she is not claimed as a dependent, then it’s her own income.”
The same is true of Medi-Cal, which is public health insurance for low-income Californians. Starting Jan. 1, Medi-Cal will broaden its eligibility requirements, raising the income threshold and opening the program to those who were previously ineligible, such as childless adults.
Again, if you claim your adult child as a tax dependent, your income will count toward your child’s income for Medi-Cal eligibility purposes, says Tony Cava of the state Department of Health Care Services.
So what options are you left with? Perhaps not the ones you were hoping for: You could pay out of pocket for a plan. There’s also a catastrophic plan from Covered California for people under 30 (which your daughter may be too old for).
Please also check with your tax preparer.
Fingers crossed, your daughter will find work, and her employer will offer coverage.
Q: I am one of those million people that got their current insurance plan canceled. I am self-employed and had a Blue Cross policy. The new plan that was going to replace our current plan was twice as expensive and double the deductible. Please help us.
Under the Affordable Care Act, some Californians will see a huge benefit. They may get health insurance for the first time, save hundreds of dollars per month on premiums or qualify for free Medi-Cal.
But we might as well just come out and say it (accepting it is another matter): Some Californians are going to take a financial hit — perhaps a big one — because they have to pay more for a plan that needs to be “upgraded” to meet Obamacare requirements.
Howard from Sacramento may be among them.
Howard, if you or others have received a cancellation notice from your insurer, don’t assume that you’re definitely going to have to pay more for a new plan, and don’t automatically go with the replacement plan your insurer offers.
Instead, do your homework. Depending on your income, you may qualify for tax credits from Covered California. (Covered California’s number is 800-300-1506.) Or you may be able to find a more reasonably priced plan on the open market.
There may be other options I’m not thinking of, so take advantage of the new hotline that Covered California created just for people whose plans have been canceled: 855-857-0445.
You may end up being one of the winners.