Column 39 The countdown continues

The countdown continues.  There are only 8 more days to buy individual insurance, absent a qualifying event.  The deadline to purchase individual health insurance is 3/31/2014.  After that date, you may only purchase insurance if you have a qualifying event. (This assumes there is no extension of the deadline).  Qualifying events include:

  • Getting married
  • Having, adopting, or placement of a child
  • Permanently moving to a new area that offers different health plan options
  • Losing other health coverage (for example due to a job loss, divorce, loss of eligibility for Medi-Cal, expiration of COBRA coverage, or a health plan being decertified). Note: Voluntarily quitting other health coverage or being terminated for not paying your premiums is not considered loss of coverage. Losing coverage that is not minimum essential coverage is also not considered loss of coverage.
  • For people already enrolled in Covered California (also called the Exchange) , having a change in income or household status that affects eligibility for tax credits or cost-sharing reductions

Note that the concept of involuntary loss of coverage is important. There may be many reasons to continue your COBRA coverage, such as deductibles already met etc.  But that appears to mean that you will also be committed to that coverage until the earlier of the next open enrollment period or the expiration of that option. If income is such that the COBRA is unaffordable and one is now eligible for subsidy, that may be a separate qualifying event.

In the past you would call an agent to apply for insurance and you would be given a rate, with the qualification "subject to underwriting".  Now your agent will say, "I have a temporary plan for you that is likely not ACA (Affordable Care Act) compliant.  Otherwise, take two aspirin and apply for a bank loan to cover your catastrophic medical costs and call me in the fall."

Pediatric Dental benefits have created some issues.  The law states that 10 essential benefits must be included in all plans to be compliant with the ACA.  Most carriers have included that cost in the rate and spread it across all age bands.  Anthem decided to break that cost out and show it separately. The additional costs is about $5 monthly.  If you purchase the plan off the Exchange, you will see this cost broken out.  If you choose not to pay that portion, the entire plan will be cancelled (as we have been told).

For the last month or so, you may purchase coverage on the Exchange and not be subject to the additional charge, although you were subject to it for the first few months.  To date, we have been told that will be corrected, but nothing specific has come down.  The initial rules said there must be complete parity between the plans and the rates.  The law still requires this benefit be included.  But since the website now seems to have a problem allowing you to access those benefits, you may not be subject to the additional charge. Fixing the parity issue does not seem to be a priority and it may not even be done this year. 

Making changes to information on the Exchange is a real challenge.  Agents have been requesting a change form from Covered CA since last fall. In the meantime the process is as follows:

By clicking on the "Report a Change" button after logging on to your account, you can change your income, update your address, and notify Covered California if you have become eligible for other health insurance, such as such as employer insurance.

However, if your name, date of birth, or Social Security number is incorrect (or those of other members on the application) and you have already clicked the "Submit" button, you will need to withdraw your application and re-submit it with corrected information. Also, if you want to change health insurance companies or metal tiers, you will have to withdraw and re-submit your application.

The challenge with canceling and resubmitting is effective dates.  If you were looking for a 4/1 effective date and simply chose the wrong plan, you will now only be able to obtain a 5/1 date

Those wondering the status of MediCal applications can call 1-877-652-0731.  The sheer numbers of applicants and processing is impressive.  From 1/21/14 through 3/20/14 - 9784 referrals received from Covered CA for just Shasta County;  Processed - 6550 (67%)!


Some interesting Anthem facts:  They received 1 million calls on 1/1/2014. Hold time averages are 3 hours.  We hit a record in our office this week with 7 hours only to be disconnected!  Last year, Anthem wrote 160,000 new individuals for the year, but did 250,000 in the month of January- 78% were through the Exchange and the rest were off Exchange.

*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.