Column 38 Deadlines

The countdown is on!  As of yesterday, the application deadline for 4/1 effective dates has passed.  Should someone want individual health insurance coverage in 2014, there are only 15 days left to apply, based on the current rules.  After 3/31/2014 you will only be allowed to buy individual health insurance plans if you have had a qualifying event, such as an involuntary loss of other qualifying coverage. 

I cannot stress enough how important it is to get started on the process ASAP as the resources are going to be taxed to the limit on the last few days.  Further, be sure to consider naming an agent or working with one.  You will want to have help after enrollment is complete as well.

Remember that during open enrollment you may not be turned down for coverage and pre-existing conditions are covered.  If you do not have ACA (Affordable Care Act) compliant coverage you will pay a penalty when you file your tax return for 2014. You may qualify for an Advance Premium Tax Credit (APTC) that will help subsidize your premium payment.

Note as of press deadline the insurance commissioner has not made any public comment about an option to extend existing non-compliant plans.

Here's a tip for enrolling unmarried couples living together with a child.   Since the system essentially defines household by the taxpayer status, if a couple is living together unmarried and one parent has qualifying group coverage, but the child and other parent do not, they may qualify for a subsidy. 

In a case I had this week, the father claims the child as his dependent for tax purposes. Since they are not married and his income qualifies, he can file taxes as head of household with the child as dependent and obtain a subsidy.   The trick in completing the application is when you get to the question of " Does the child have a parent not living in the household, deceased etc".  You must answer YES-because they file different tax returns and are not married, they are considered separate households. This is different for married or separated couples.  If they are living in different households but are not divorced, then filing head of household disqualifies them from a subsidy.

Are you interested in giving feedback on your health plan experience under Covered CA? There are two focus groups sessions that will collect information local for a research study funded by the CHCF (California HealthCare Foundation).  To participate, you must be over 18 and have used your health insurance for a doctors' visit, surgery or hospital visit.  If you are interested, contact Kay at 1-877-222-2909 x20 or This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .  It's possible that we may all benefit from the results of this study if we can get Covered CA to listen. Also you will be paid a $100 stipend for the two hours.   (Note if you mention my name, they say they will pay a $25 referral fee.  I will in turn give the money to the Ducky Derby!)

Since insurance is a highly regulated industry, we can't keep politics out of the discussion.  There are 273 bills pending in California that do have some Health Care issues related to the bill.  One in particular is a proposed initiative that is supposed to hit the ballot in November.  One place to start learning about the initiative is at The insurance industry is concerned that this proposed law will put entirely too much power in the hands of one politician who may have other aspirations than just insurance commissioner. From my perspective we are doing everything we can to comply with ever changing rules made by folks that have little understanding of the system.

There is little respect for agents from this commissioner or the director of Covered CA, yet it appears that we have enrolled 80% of applicants.  Millions of dollars have been spent on "outreach" and advertising, yet we can't even get printed materials to give our clients.  It makes absolutely no sense.  

Agents have continued to work in this morass for the simple reason that they care about their clients. Yes, we are in business to make money.  Most of us have yet to be paid for a lot of the business we have written and we continue to work for our clients.  Therefore, I am not inclined to support any legislation that concentrates power in one person, especially one who has already demonstrated a negative bias toward agents.  We are the ones who assist our clients not only with the initial purchase but with service afterward. 


*Information provided in this column is "to the best of my knowledge based on press deadline. Submit your questions to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it to be answered in the paper.