Column 19 Q and A

First of all the update as of my deadline Tuesday:  To date Anthem and Blue Shield have not received approval for the plans they are offering off the Exchange. I am not sure why the regulators would not at least approve the "mirrored plans" that are required to have the same rates and benefits as those On the Exchange.  At this point, it appears most brokers are assuming that these plans will be approved "as is".  Since the rates for the "mirror plans" must be the same on or off the Exchange we can use the On Exchange rates for quoting purposes.

However, we still don't have an application for the off Exchange plans for Anthem.  It makes no sense to me to disclose all the financial information required to purchase on the Exchange if you do not qualify for a subsidy.

Notices of 2014 rates are out to individual insureds and some are suffering from sticker shock.  Some are having their plans cancelled as we discussed in prior columns.  They want to know their options.  We are estimating rates based on those available, but we have nothing final yet.   So we continue to wait.  Is this the definition of "between a rock and hard place?

Q I am turning 26 and have to come off my parents plan in November.  What do I do?

Your first option is to take the COBRA extension that will be offered to you if your parents' plan is a group plan.  If theirs is an individual/family plan you should be offered an option to continue an individual plan at your own rate and zip code.  You can call the insurance company or your broker for a quote.

Another option would be to obtain a temporary insurance policy that will last until 1/1/2014 when you would be eligible for coverage under the new Guaranteed Issue rules. If your income is low enough you may qualify for a subsidy toward your premium if you purchase coverage on the Exchange.  In our state it's called Covered California. 

Since you are graduate student, your university may also have an option for coverage.  Note that many of the student plans do not meet the minimum value standards of the Affordable Care Act.  If this is the case, you could be facing a penalty for not having coverage that meets the standards.  However since your income is so low and you are living on loans, you may also qualify for the new expanded MediCal, likely at no cost to you.

I understand that you are concerned that your physician may not accept MediCal.  I suggest you call the office and ask if they will accept it because you are an existing patient.  I am unaware of any reason that you could not continue to see your Primary Care physician and simply pay cash if you were on MediCal, but expect no coverage for those services.  Then use MediCal for the more advanced services. 

Q. I have been terminated from my job and notified that my insurance is ending in November.  I am pending a workers compensation claim and collecting state disability, so my income is greatly reduced.  COBRA premiums are very high.  What do I do?

Depending on your current asset situation, you may qualify for MediCal.  But if not, you will likely need to take the COBRA to cover your ongoing claims.  You would not be insurable under today's rules.  But the good news is that you can apply now for coverage through the Exchange and likely receive a subsidy.  Just be careful.  If your income changes positively during the year, be sure to notify them so you do not end up with a big bill at the end of the year for a subsidy for which you were not eligible.

Fraud prevention update: Our friendly Certified Enrollment Counselors are receiving their badges.  They are required to wear this badge.  You may use your Smart Phone and scan the digital information and verify that the person is from Covered California.  Of course, you can also look them up on the Covered California website too!