1. Assets do not count, only income when calculating subsidy reimbursement. That would include any income that contributes to your adjusted gross income (AGI), like income from real estate or securities. Focus on your modified adjusted gross income (MAGI).
2. You can buy your health insurance plan through Covered California even if you do not qualify for subsidized premiums due to your higher income. (Of those Californians currently insured by individual health insurance plans, almost 50% or about half a million individuals will not qualify for subsidies.) The health exchange hopes to sign you up and offers a compelling reason to do so: a marketplace to compare coverage from all the participating insurance carriers. On the other hand, your current carrier will make it incredibly easy to essentially roll-over your current coverage into an exchange-approved plan. So if you are like many people who don’t particularly want to spend any time at all shopping for health insurance, your current health plan issuer will offer the path of least resistance.
3. Covered California will not collect premium payments in the individual exchange. The consumer will pay the health plan issuer. For example, if you select a Kaiser qualified health health plan in the exchange, Kaiser will bill you directly and you will send your payment to them. If you are receiving a premium subsidy, that portion will go directly from the federal government to Kaiser and you will only be billed for the remaining portion of the total premium.
4. Covered California will have special enrollments throughout the year for individuals and families who become eligible for coverage in the marketplace because of a “qualifying event in their lives. Here are some qualifying events.
A .Change of income. (We do not have the specific percentage of income change at this time)
B. Change in legal marital status, including marriage, death of a spouse, divorce, legal separation and annulment.
C. Change in the number of dependents, including birth, death, adoption, and placement for adoption.
D. Change in employment status of the employee, or the employee’s or retiree’s spouse or dependent, including termination or commencement of employment.A dependent ceasing to satisfy eligibility requirements for coverage due to attainment of age.
Special enrollment periods cover 60 days from the qualifying event to enrollment to allow enough time to make the transition
5. Covered California is a marketplace that offers coverage underwritten by private insurance companies. Providers - doctors, hospitals, etc. - will continue to be contracted with the insurance companies, not directly with Covered California. For example, if a doctor is now part of Blue Shield’s network, in all probability they will continue in Shield’s network within the exchange.
6. The subsidy amount is based on the premium for a Silver level plan, but the consumer may use their subsidy to select a plan from any other level. For example, the let’s say the consumer cost is $200 and the federal subsidy is $400 for a Silver plan. An individual or family who wants a more expensive or higher tier plan, gold or platinum, must pay the difference above the $400 subsidy for the plan they choose. Likewise, an individual of family that wants to save money can use their $400 subsidy to purchase a Bronze level plan and cut their cost. HSA plans will be available at both the silver and Bronze level.
7. The “grandfather” option is available for all plans in existence on March 23, 2010, that have continuously covered someone since that date, and have not taken any restricted actions under the regulations. The major benefit to grandfathering a health plan is that grandfathered plans have the ability to avoid several mandates and thus avoid the increases in healthcare costs associated with those mandates. Non-grandfathered plans will cease to exist, so yes you will have to select a conforming qualified health plan in 2014 if you are not covered by a grandfathered plan. The rates for the conforming QHPs will be higher than current rates, but grandfathered plans will face increases as well, so what the difference may be is anybody’s guess at this point. We can expect the see the rates for QHPs in late May or June 2013.
8. Tax credits (aka premium subsidies) are only available through Covered California. These premium tax credits are immediately applied at the time you are purchasing insurance. You do not have to wait until you have filed your tax return to be reimbursed. When you buy health insurance in the Exchange, your tax credit will be sent directly to the insurance company from which you are purchasing your insurance. You will be responsible for the remaining balance after the subsidy is credited. Tax credits are available even if you have no tax liability.
9. If you earn less than $31,810 for a family of four, you will be eligible for free public insurance coverage under Medi-Cal. Otherwise, you will be able to buy the same high- quality health insurance from Covered California that is available on the private market today. You will not be forced to choose an HMO type plan (Covered California Copay Plan) if you prefer a Coinsurance Plan. Covered California is the only place where you can use tax credits or cost-sharing subsidies from government assistance programs to lower your health care costs. If you are not eligible for free public insurance or federally subsidized health insurance in Covered California, you can purchase the health insurance of your choice in the non-exchange marketplace.
10. Only your current modified adjusted gross income (MAGI) and not your assets will be taken into account in determining your eligibility for coverage in Covered California. If you are eligible for Medi-Cal you cannot also be eligible for a premium subsidy in the Marketplace. However, you may opt out of Medi-Cal and purchase unsubsidized coverage either in Covered California or in the market outside the exchange.
11. A 2009 Congressional Budget Office (CBO) report suggested an increase of between 10% and 30% beyond what they would have been without the ACA. But higher premiums for people who purchase coverage in the individual market will be offset by federal subsidies for low and middle-income families. The increases on the individual market are because of ACA provisions that: (1) Require plans to cover a broader scope of items — including maternity care and mental health treatment; (2) Mandate that premiums for older beneficiaries be no more than three times higher than what younger people pay; (3) Bar insurers from rejecting people with pre-existing conditions; and (4) Limit deductibles.
12. The affordability standard, according to the ACA, is when the employee’s contribution to coverage cannot exceed 9.5 percent of the household annual income. Last week the IRS further clarified affordability as being based on what the employee contributes for self-coverage only, not family-coverage. In other words, the affordability of coverage will not take into consideration the portion of the annual premium the employee must pay for family coverage. Also, uninsured children will be ineligible for premium subsidies in the exchange.
13. PCIP (Preexisting Conditions Insurance Plan) insureds will be free to select a health plan from Covered California or directly from a health insurance company. Since your preexisting conditions will no longer matter as far as purchasing health insurance is concerned, the need for the PCIP will cease to exist. The PCIP will have served the purpose for which it was created and it will phase out in 2014.
Additional Covered California information will be presented consistently for both our benefit and obviously to keep the consumer informed. Just call us toll free at 888-504-6171 for additional information or vist the above link to send us an email.
