About Open Enrollment

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Open enrollment is the period of time during which individuals and families can enroll in or make changes to their health insurance coverage. In the United States, open enrollment typically takes place annually, although some states have their own open enrollment periods that differ from the federal timeline. Below is a bit more background on how open enrollment works in the Washington Health Plan Finder and Covered California systems.

The Washington Health Plan Finder is the state’s online health insurance marketplace, where individuals and families can compare and enroll in health insurance plans. Open enrollment in the Washington Health Plan Finder typically takes place from November 1st to December 15th each year. During this time, individuals and families can enroll in a new health insurance plan or make changes to their existing coverage. It is important to note that outside of open enrollment, individuals and families may only be able to make changes to their health insurance coverage if they experience a qualifying life event, such as getting married or having a baby.

Covered California is California’s online health insurance marketplace, where individuals and families can compare and enroll in health insurance plans. Open enrollment in Covered California typically takes place from November 1st to January 31st each year. Like in the Washington Health Plan Finder, during this time individuals and families can enroll in a new health insurance plan or make changes to their existing coverage. It is important to note that Covered California has a special enrollment period for individuals and families who experience a qualifying life event, such as losing their health insurance coverage or getting married.

If you are in Washington or California and are considering enrolling in health insurance coverage or making changes to your existing coverage, it is important to keep in mind the open enrollment period for the Washington Health Plan Finder or Covered California. These open enrollment periods provide a critical opportunity to enroll in or make changes to your health insurance coverage, and missing the deadline could mean having to wait until the next open enrollment period to make any changes. It is also important to carefully consider your health insurance needs and compare plans to find the coverage that best fits your needs and budget.

Washington Cascade Care OE 2021

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Starting Nov. 1, Washingtonians seeking health coverage have more options this year along with financial assistance. New for 2021 will be Cascade Care offerings that enable consumers to shop, choose, and save from more options in all counties.

“As more Washingtonians are impacted by the Coronavirus pandemic, having health coverage is crucial during these difficult times” said Exchange Chief Executive Officer, Pam MacEwan. “We encourage all Washingtonians who are seeking health coverage to shop during open enrollment and find plans for how they’re living.”

New this year, Cascade Care plans offer high value, standard benefits. Cascade Care is expanding access, choice, and value for Washingtonians at a time when they need it most. These plans offer deductibles that are on average $1,000 less than other plans, and cover more services prior to meeting a deductible, including primary care visits, mental health services, and generic drugs. Most customers will see that average premium costs and deductibles of Exchange plans are lower than previous years, including eight counties where a Cascade Care plans – either Cascade or Cascade Select – is the lowest-cost silver plan.

“With new plans available, we encourage customers to shop around for the best health plan that fits their needs,” adds MacEwan. “For example, many renewing customers can switch to the lowest cost plan in their same metal tier and save money, and many customers can save more than $50 a month by shopping.”

For those seeking coverage starting January 1, customers need to enroll in a plan by December 15. Those who enroll after that deadline and before January 15 will have a coverage start date of February 1. give us a call today to enroll.

Covered California Begins 2021 Renewal and Open Enrollment Period November 1, 2020

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With the start of Covered California’s open-enrollment period just a few weeks away, the exchange announced that the renewal process for a record number of enrollees is now underway — with more than 1.5 million Californians eligible to renew their coverage. In addition, the preliminary rate change that Covered California previously announced in August has been revised downward to a new all-time low of 0.5 percent for the 2021 plan year.

“Covered California heads into the upcoming open-enrollment period with more consumers than ever, and we will be doing so with the lowest rate change in our history,” said Peter V. Lee, executive director of Covered California. “California has built on and strengthened the Affordable Care Act, and right now this means that Californians facing a pandemic and recession are finding the security of having access to quality, affordable health care coverage.”

The latest data shows that Covered California had a record 1.5 million enrollees in June of 2020. When compared to historical data, Covered California’s highest enrollment total in October, which is when the renewal process begins, was 1.3 million in 2018. Current enrollees can begin renewing their coverage now, and they have until Dec. 15 to finalize their 2021 plan choice. People who do not actively select a plan for 2021, will be renewed in their current plan, so they do not suffer a gap in coverage.

“During a pandemic and recession, it is no surprise that Covered California is seeing record enrollment, because we are a safety net to help people get quality health care coverage,” Lee said.

New Record-Low Rate Change

Covered California also announced that after the reviews by the California Department of Managed Health Care and the California Department of Insurance, the statewide weighted average rate change was revised downward from 0.6 percent to a new record-low of 0.5 percent.

The lower rate change is the result of reduced rates for Health Net’s EPO and PPO products, which are subject to review the California Department of Insurance, in Contra Costa, El Dorado, Los Angeles, Marin, Mariposa, Merced, Monterey, Napa, Orange, Placer, Riverside, Sacramento, San Benito, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Cruz, Solano, Sonoma, Stanislaus, Tulare and Yolo counties (see Table 1: California Individual Market Rate Changes for 2021 by Rating Region).

Consumers both on and off the exchange benefit from Covered California’s competitive marketplace, which allows them to shop for the best value and benefit from lower increases. In addition, many consumers can save more by shopping and switching to a lower-cost health plan. With the reduction in the statewide average rate change, the average rate change for unsubsidized consumers who shop and switch to the lowest-cost plan in the same metal tier is now -7.4 percent, which means many Californians can get a lower gross premium if they shop and switch. The average rate change varies by region and by an individual’s personal situation.

Nearly nine out of every 10 consumers who enroll through Covered California receive financial help — in the form of federal tax credits, state subsidies, or both — which help make health care more affordable. California’s state-specific enhanced subsidies, which were introduced for the first time in 2020, are benefiting about 590,000 enrollees in Covered California and are available again for both new and renewing members in 2021. 

“The bold policy choices made in California to build on and strengthen the Affordable Care Act have led to a very competitive market that is full of choice for consumers,” Lee said. “Covered California continues to provide stability and lower costs in the face of national uncertainty in health care.”

In 2021, all 11 carriers will continue offering products across the state, and two companies will expand their coverage areas, providing increased competition and consumer choice. Nearly all Californians (99.8 percent) will have two or more choices and over three-quarter of Californians (77 percent) will have four or more choices.

Open enrollment for the upcoming year will begin Nov. 1, 2020, and run through Jan. 31. Open enrollment is the one time of the year where eligible consumers cannot be turned away from coverage for any reason. Covered California will be launching a new ad campaign on Nov. 9 and has budgeted $157 million for marketing, sales and outreach during the current fiscal year — an increase of more than $30 million from last year.

In addition, consumers who need coverage earlier may be eligible for the special-enrollment period that is currently underway. Consumers who experience a qualifying life event, such as: losing their health care coverage, losing their job, suffering a loss of income, moving or being a wildfire victim, could be eligible to sign up for coverage that begins in November or December.

California Marketplace Domestic Abuse QLE Details and Enrollment Instructions

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 As of October 5, 2020, “Victim of domestic abuse or spousal abandonment” is available as a distinct Qualifying Life Event (QLE) selection on the special enrollment period (SEP) dropdown menu in the CalHEERS application.  However, the consumer would need to have prior knowledge of these options and manually enter the reason using the “Other” QLE option on the dropdown menu. If you have any questions, or have trouble with your application, Core Columbia is here to provide free assistance.                

Starting October 5, 2020, consumers can select the “Victims of domestic abuse or spousal abandonment” QLE to:Apply for coverage (for new members).Remove self and/or dependents and begin a new case and enrollment (if enrolled on an existing case).·A QLE is NOT needed for coverage terminations, but the authority of the consumer depends on the consumer’s role in the case. If the consumer is the Primary Contact or authorized representative of the Primary Contact, the consumer may remove the abuser and/or dependents from the case.If the consumer is the spouse or registered domestic partner of the Primary Contact, the consumer may remove self and/or dependents from the case. If the consumer is NOT the spouse or registered domestic partner of the Primary Contact, the consumer may remove self from the case but not dependents.The only exception is if the consumer is a dependent or unmarried victim of domestic abuse within the same household as the Primary Contact. In that event, they may remove self and/or their dependents from their abuser’s case and plan and then enroll in a new plan under their own case using this QLE.The Primary Contact will receive notification of the change to their household plan.The consumer can apply using the single or head of household tax filing status on their new application without penalty of misrepresenting marital status or tax filing status.Consumer will need to consult a certified public accountant or a tax specialist about the marital and tax filing statuses they must report on their tax returns.After selecting the QLE and completing the application, coverage will be effective according to the 15-day rule.
New vs. Existing Consumers For New ConsumersMarital Status:  Enter the status as stated by the consumer (single, married, divorced, etc.).Note: If consumer states “married,” spousal information is required. Consumers using the “Victim of domestic abuse or spousal abandonment” QLE may choose to declare a different marital status despite being married to avoid the requirement to enter spousal information.Tax Filing Status:  Enter “head of household” if the consumer claims a dependent child (natural child, stepchild, or foster child) on their tax return, or “single” if not. Do NOT enter “married filing jointly” or “married filing separately.”Do not enter partner’s income.For married individuals who receive federal tax credit and/or state subsidy and will not file taxes as “Married Filing Jointly,” alert the consumer that he or she may need to check the exception box at the top of page 1, IRS Form 8962 and Form FTB 3849, as applicable. Consumers in this situation should talk to a tax advisor about their specific situation.  For Current Covered California Consumers (no Medi-Cal)To remove an abuser and/or dependent(s) from a case (if Primary Contact or spouse, registered domestic partner or authorized representative of the Primary Contact:“Remove a Member” using the Report a Change process.If Open Enrollment (OE), complete application for a new case as usual.If not OE, select the “Victim of domestic abuse or spousal abandonment” QLE and follow steps above to begin a new case.

Reporting Your Lost Wage Assistance FEMA Payment in Washington

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Beginning September 21st, Employment Security Department will begin processing payments of an additional $300 per week to the state base weekly unemployment benefit approved under the Lost Wages Assistance FEMA payment.

Federal Emergency Management Assistance (FEMA) has approved five weeks of payments, for weeks August 1st – September 5th*. The duration of the benefit is undefined (contingent on weekly federal approval) and recipients receive the payments retroactively for eligible weeks. 

*As of September 14th, 2020, the payments were approved on a weekly basis for that time.

The Lost Wages Assistance FEMA payments is not countable for Washington Apple Health (Medicaid) eligibility but is countable for tax credit and cost-sharing reductions. You should not include the $300 Lost Wages Assistance FEMA payment in your weekly unemployment income amount reported to the Washington Healthplanfinder application.

You may choose to adjust your Qualified Health Plan tax credits by adjusting the amount of tax credits applied to your premium in Washington Healthplanfinder.

If you require assistance, or have any questions, give us a call at 206-258-6820.

2021 California Health Insurance Rate Changes Announced

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Covered California announced today that the average rate change for the 2021 individual market will be 0.6 percent. This marks a record-low for the second consecutive year and follows California’s efforts to build on, and go beyond, the Affordable Care Act!

The rate change was driven lower by California’s affordability initiatives, the state subsidy program and state individual mandate penalty, which were designed to improve affordability and encourage enrollment.

All 11 of Covered California’s health plans will be returning for 2021, and two plans will be expanding their coverage areas. As a result, 88 percent of Californians will be able to choose from three carriers or more and 99.8 percent of consumers will have two or more choices.

As always, if you have questions, give us a call at (619) 259-6905. We are here to help.

Tips on Reporting Self-employment Income to the WA Exchange

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Are you self-employed? It is best practice to estimate your self-employment income and expenses for the year based on past earned income, expenses, industry standards and other information. If you filed a federal tax return last year, you could use the Adjusted Gross Income you reported, deduct self-employment expenses, then add or subtract based on how you think your income may change for the current year. 

As always, if you have any questions, do not hesitate to give us a call at 206-258-6820. We are always here for you with free assistance.  

If you are trying to report self-employment income based on prior year taxes:

Adjusted Gross Income – Expenses from Prior Year +/- Anticipated Changes = Current Year Self Employment Income

You should update your estimated annual net income when your business circumstances change. If your earnings are lower, you may be eligible for higher tax credits and Cost Sharing reductions. If your earnings are higher than you reported on your Washington Healthplanfinder application, you could have to pay back some or all of the tax credits you took during the year.

You may report that you are self-employed, and may or may not receive a “wage” or pay stub. Only do this if you do not receive a paycheck from your business (income from a corporation is reported as “earned income”.) Additionally, if you receive dividends from your corporation, this would be considered “other” income.

When you are truly self-employed, follow the guidelines below for how income should be reported. You can report all earned income (through your business), collected from your most current tax return, profit and loss statements, or other income ledgers. Individuals should report their net income, taking into account any allowable business expenses (sometimes called “profit”).

  • If self-employment income is higher than business expenses, report as net income

If business expenses are higher than income, report a net loss

California Extends Special-Enrollment Deadline to Give Consumers More Time to Sign Up for Health Care Coverage During COVID-19 Pandemic

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Covered California announced on Tuesday that it would be giving consumers more time to sign up for health care coverage during the COVID-19 pandemic by extending the current special-enrollment deadline through the end of July. 
If you would like to enroll, or have any questions about your options, give Core Columbia a call at 619-259-6905.

“Covered California is committed to helping people get access to the health care they need, and while California is reopening parts of the state, there is still a lot of uncertainty out there due to the pandemic,” said Peter V. Lee, executive director of Covered California. “We want to make sure that people have a path to coverage, whether it is through Covered California or Medi-Cal, and giving people more time to sign up is the right thing to do.”

Every year, Covered California provides eligible consumers the opportunity to sign up for health care coverage outside of the traditional open-enrollment period if they experience a qualifying life event. These can include events like losing your health insurance, moving, getting married or having a baby.  

 People who sign up will have access to private health insurance plans with monthly premiums that may be lowered due to federal and new state financial help that became effective in 2020. After selecting a plan, their coverage would begin on the first day of the following month — meaning individuals losing job-based coverage would not face a gap in coverage.

The latest data from California’s Employment Development Department shows that 6.3 million unemployment claims have been processed in the state since the pandemic started.

“We know that when people lose their jobs, they often lose the health care coverage that was protecting them and their families,” Lee said. “While Californians who lose coverage can always sign up outside of open enrollment, we want to make sure even those who have lost work and did not have insurance have access to the health care in the middle of a pandemic.”

Medi-Cal and Off-Exchange Coverage

In addition, consumers who sign up may find out that they are eligible for no-cost or low-cost coverage through Medi-Cal, which they can enroll in online. Those eligible for Medi-Cal can have coverage that is immediately effective.

California has suspended Medi-Cal renewal reviews through the end of the public health emergency, ensuring that those already enrolled can continue their coverage and freeing up resources to quickly process new enrollments. The Department of Health Care Services (DHCS) also received expanded authority to expedite enrollment for seniors and other vulnerable populations, expand the use of telehealth and take other steps to make it easier to access care.

If you would like to enroll, or have any questions about your options, give Core Columbia a call at 619-259-6905.

Washington Health Plan Finder Unemployment Income Reminder and CSR Information

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As a reminder, the Federal Pandemic Unemployment is countable income for Qualified health plans with tax credits and is not countable income for Washington Apple Health (Medicaid). If you have any questions or need to update your income, Core Columbia Insurance is always here to provide straightforward, up to date answers to all of your questions – give us a call at 206-258-6820.

Cost Sharing Reduction (CSR) Tiers

Changes to income can change eligibility. Much of the recommended Qualified Health Plan shopping are based on eligibility of Cost-Sharing Reduction (CSR) tier per household members seeking coverage. The CSR tiers drives the system to make recommendations for different “Groups”.

What are Cost Sharing Reduction (CSR) Tiers?

Cost Sharing Reductions (CSR) reduce the copay, deductible, and other out-of-pocket costs for individuals and families that are eligible based on many different factors including eligibility for tax credits. These out-of-pocket savings apply only to silver-level Qualified Health Plans. There are no CSRs for platinum, gold, bronze, or catastrophic health plans, and they are not available for Qualified Dental Plans. American Indian/Alaskan Native (AI/AN) customers may be eligible for CSRs on additional Qualified Health Plan types.

Washington Income Reporting and Your CARES Act Federal Stimulus Payments

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In response to the COVID-19 public health crisis, Congress passed the CARES Act which includes a federal stimulus payment. The amount most individuals will receive is a one-time payment of $1200 individual/$2400 joint filer/$500 per child. Core Columbia Insurance is here to answer any questions you may have about how this benefit impacts your eligibility for Healthplanfinder coverage.

The one-time federal stimulus payment (also referred to as the “Recovery Rebate” by the media or “Economic Impact Payment” by the IRS) is not considered income for purposes of Apple Health or APTC/CSR eligibility. At this time, Core Columbia and the Exchange advise clients to not report this as income in their application.

The federal stimulus payment (referred to as the Recovery Rebate or Economic Impact Payment) is not income for purposes of applying for health and dental coverage through Washington Healthplanfinder. You do not need to report any check or payment amount you receive from the federal government in your application.

Core Columbia Insurance is always here for you, working remotely, to provide straightforward, up to date answers to all of your questions – give us a call at 206-258-6820.