Another in a series of Q&A columns answering consumers’ questions about the Affordable Care Act.
You’ve jumped through all of Covered California’s hoops. You figured out what makes a bronze plan different from a silver one. You made your best guess at how much money you’ll earn next year. You paid your first month’s premium.
Now you have health insurance.
Or do you?
Today, I’m explaining yet another Covered California computer glitch that has left an untold number of consumers confused about what kind of coverage, if any, they qualify for.
So much for jumping through hoops.
Q: I received 18 notices from Covered California in one day. Fourteen say we’re covered and four say we’re not. Which one should I believe?
A: Los Angeles writer Juniper Ekman applied for family coverage from Covered California during the Affordable Care Act’s first open-enrollment period.
Her 2-year-old daughter qualified for Medi-Cal, and she and her husband qualified for a Covered California plan, subsidized by some hefty tax credits to reduce the cost of their monthly premium. (As I have previously reported, it is indeed possible for children and adults in the same family to qualify for different programs because kids are eligible for Medi-Cal at a higher income level than adults.)
A few months after the family’s coverage kicked in last year, batches of letters began arriving from Covered California.
Some said Ekman and her husband didn’t qualify for tax credits. Some said they did. The ones that did offered differing amounts of credits they were entitled to.
The letters came five or eight at a time. Then, in September, a whopping 18 notices landed in one day.
“Think of the sheer amount of postage they’re wasting. Put that money into the health care system,” Ekman suggests.
In all, Ekman estimates she received about 50 notices last year, with the last bunch coming in November. Unflustered, she didn’t call Covered California each time the missives arrived, like I probably would have done.
Instead, she consulted her insurance company directly from time to time to make sure her coverage was still active. It was.
“It was mostly just irritating,” she says. “I worked for the government at one time. It is not an institution that encourages competence.”
In November, health consumer advocates complained to the Covered California board about the confusing, multiple and inaccurate notices.
In their complaint, the advocates cite many cringe-worthy examples, including one Bay Area consumer who received 40 notices in less than a month.
In another case, four people in the same household received four different eligibility decisions in the same notice.
“People have the legal right to know what they were determined eligible for, what that was based on and what they can do if they disagree,” says Elizabeth Landsberg with the Western Center on Law & Poverty. “If we can’t even tell people correctly what they’re eligible for, they can’t get service or care.”
Dana Howard of Covered California says the agency became aware of the problem in late summer and determined it was — once again — caused by programming issues with its computer system.
This is the same system that has cost nearly half a billion dollars so far. While it has helped multitudes apply for health insurance, it also is responsible for countless glitches and widespread consumer misery.
Essentially, Howard says, the computer system was having trouble communicating with the Medi-Cal enrollment system that counties use. Counties determine eligibility for Medi-Cal, which is publicly funded health insurance for low-income residents.
“People were getting multiple notices because of the misalignment between the two,” he says.
There are no firm numbers, but people whose families have a mix of Covered California and Medi-Cal recipients, like Ekman’s, probably were disproportionately affected, Howard says.
As of December, the problem has been fixed, he says. “The multiple and duplicate notices have ceased,” he says.
I hope he’s right.
If you already have received multiple notices and aren’t sure what to do, Howard urges you contact the person who helped you enroll in the first place, whether an insurance agent, certified enrollment counselor or even a Covered California phone rep. (If you call Covered California’s customer service number at 800-300-1506, be prepared for a wait.)
If you signed up on your own online, you can, and probably should, seek one-on-one help anyway.
You can find references to free, local help at the Covered California website: www.coveredca.com.
If you think you may be eligible for Medi-Cal, even if one (or more) of your many notices says you’re not, call your county directly to confirm, Landsberg suggests.
You can find a list of county Medi-Cal offices at the state Department of Health Care Services website: www.dhcs.ca.gov.
Should none of those work, call the Health Consumer Alliance (healthconsumer.org and 888-804-3536), which offers programs to aid consumers across the state.
Questions for Emily: AskEmily@usc.edu