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

Posted on

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

Posted on
 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.

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

Posted on

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.

Unemployment Compensation, The CARES Act, and Your Eligibility for Marketplace Subsidy in CA and WA

Posted on

Unemployment Compensation

In the CARES Act, Congress authorized a new federal Pandemic Unemployment Compensation program, which provides an additional $600 in federal benefits per week of weeks of unemployment ending on or before July 31, 2020.

If you had a change in income, you may be eligible or free, or lower cost health insurance. Give Core Columbia Insurance a call in California at 619-259-6905, or in Washington at 206-258-6820. We are always here to provide straight answers, process all necessary changes to your account on your behalf, and ensure you are able to obtain the health coverage you need at the lowest price available.

This type of unemployment income is excluded for purposes of calculating Medicaid eligibility, but included for purposes of determining tax credit eligibility in the Covered California and Washington Health Plan Finder Systems.

  • New and existing clients should not include the additional $600 per week when reporting their unemployment benefit income.
    • This includes households with tax credit enrolled members only.
    • New and existing clients already receiving MediCaid should not report income changes in their application during the COVID-19 emergency.
    • Families who have members on MediCaid, and members receiving tax credits or qualified health plan coverage should continue to report changes in income to see if they qualify for no cost or lower cost care.
  • The Exchanges in CA and WA are working on system updates (planned by end of June) that would allow new and existing clients receiving both tax credits and the additional $600 per week to correctly account for it. More information is forthcoming as additional regulatory options are also explored. 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 in California at 619-259-6905, or in Washington at 206-258-6820.

A Message From Core Columbia About Coronavirus COVID-19

Posted on

There’s a lot in the news lately about coronavirus COVID-19. Here’s what you need to know to help you understand what it is and how you can protect yourself and the people you care about. 

Core Columbia Insurance is closely monitoring COVID-19 developments and what it means for our customers. Our clinical team is actively monitoring external queries and reports from the Centers for Disease Control and Prevention to help us determine what, if any, action is necessary on our part.

We’re sharing information today to help explain what COVID-19 is all about, how to protect yourself and what to do if you think you might be infected. We also help to answer questions customers are asking about COVID-19 and how it impacts us all.

Employers and members will receive the following message shortly. Please contact Core Columbia Insurance a call in California at 619-259-6905, or in Washington at 206-258-6820 with questions.. We are always here to provide straight answers, and to help you gain access to care. 

About coronavirus COVID-19

What is coronavirus and COVID-19?

Coronavirus is a type of virus that causes mild respiratory illness – an infection of the airways and lungs. COVID-19 is a new strain of coronavirus. It’s part of the same family of coronaviruses that includes the common cold.

What are the symptoms?

The most common early symptoms appear between 2 and 14 days after infection. Symptoms can be mild to severe. They include fever, cough, and shortness of breath.

How does the virus spread?

Like many other viruses, COVID-19 seems to spread from person-to-person through a cough, sneeze, or kiss.

What is the risk?

As of today, the Centers for Disease Control and Prevention (CDC) states that the risk in the U.S. is still low. They will update the status regularly on the CDC website.

Prevention and treatment

How to protect yourself

Frequent handwashing is the most effective way to protect yourself from infection. Other good habits to practice include covering your mouth and nose with a tissue when you cough and sneeze, and cleaning frequently touched items such as phones, keyboards, and doorknobs to help remove germs. Visit the CDC website for more on prevention and treatment.

What to do if you have symptoms

Call your doctor if you develop a fever, have a cough, or have difficulty breathing. And let them know if you’ve been in close contact with a person known to have COVID-19, or if you live in or have recently traveled to an area where the virus has spread. You can also check to see if your plan offers telehealth benefits to see a doctor online. If you think you’re infected, using telehealth helps to prevent spreading a virus.

What your Health Insurance benefits will cover

Your health plan, if ACA compliant, should cover the care you get if you’re diagnosed as having COVID-19, based on your plan’s benefits. It should also cover testing for COVID-19. You’ll likely pay any out-of-pocket expenses your plan requires, unless otherwise determined by state law or regulation. For clarification on your specific plan, give Core Columbia Insurance a call in California at 619-259-6905, or in Washington at 206-258-6820. We are always here to provide straight answers, and to help you gain access to care. 

Sources:

  • Centers for Disease Control and Prevention: About Coronavirus Disease 2019 (COVID-19) (accessed March 2020): cdc.gov/coronavirus/2019-ncov/about/index.html.
  • Centers for Disease Control and Prevention: Frequently Asked Questions and Answers (accessed March 2020): cdc.gov/coronavirus/2019-ncov/faq.html.

Navigating Your Options re: Qualifying Life Events and COBRA

Posted on

Are you losing your employer sponsored coverage, turning 26 and becoming ineligible to remain on your parents’ insurance, or losing your existing coverage in a divorce? These situations are all qualifying life events, which entitle you to a special enrollment period to select a new health insurance option. You will have many different options, from COBRA, to a subsidized or unsubsidized plan through your state’s health insurance marketplace, to no cost coverage through your state’s MediCaid expansion, depending on your situation. While there are no right or wrong answers on which choice to make going forward, a number of different variables can change what is likely to be the lowest cost option to suit your needs. The one constant is the importance of consulting an expert to discuss your unique situation, and the deadlines involved.  There are many deadlines and restrictions to be aware of, for example, there is a 60 day period after a qualifying event in which you are permitted to enroll in a marketplace or a COBRA plan, and you will become ineligible for a subsidized marketplace plan for a certain amount of time post COBRA enrollment. If you or a family member has recently lost, or is set to lose, health insurance coverage, give us a call at 619-259-6950, or send a quick email to us at info@corecolumbia.com. There are never fees to you (the consumer) for our services. We are always here with free expert advice, to listen to your unique situation and your needs, and enable you to weigh the pros and cons of every available option before making an informed decision in a timely manner.

MediCaid and Covered California: Program Eligibility and Reporting Income Changes

Posted on

I have been hearing a lot of questions and concerns lately about MediCal and Covered
California income updates, so wanted to provide everyone with a brief overview of what some of
your obligations regarding income are when enrolled in either of these programs.
No matter what type of program or plan you are enrolled in, if the information listed in your
application changes, you are expected to report a change. Knowing when to report the change,
and which changes prompt or necessitate a change in health plan eligibility, is where it gets
tricky.

Your duties to report a change differ from program to program, and from one type of change to
the next. Address, family size, and Income updates are two types of changes I see often that
require immediate attention, and that often cause changes to plan type or program eligibility. If
you are enrolled in MediCal, it is your duty to report changes of this nature to the county within
10 days of the change. If you are enrolled in a Covered California plan, you are still required to
report the changes, but the deadline extends to within 30 days of the change. If you are
updating your income, and it moves you into a different income bracket based on household
size and income (calculated as %FPL, or percentage of the Federal Poverty Level), eligibility will
be determined based on the new information, and you will be forced to change plans or
programs. If you have moved below 138% FPL, you will be eligible for the MediCal program. If
you have moved above 138%FPL, you will be eligible for a subsidized Covered California plan.
MediCal does not have enrollment deadlines, or a special enrollment period like Covered
California does. If the change reported makes you MediCal eligible, the county may request
additional information. If your change makes you ineligible for MediCal, but eligible for a
Covered California plan, you will have what is referred to as a qualifying life event, as well as
specific deadline to enroll in a health plan. Working with an agent at Core Columbia Insurance is
always the best way to make sure you have met all of your obligations to the state and county,
and are receiving a plan that suits your individual needs, at the lowest price available.

As always, if you have questions or concerns, or would like to discuss a hypothetical situation,
or how any of this information pertains to your case, do not hesitate to reach out! We are here
year round to provide free assistance with these sorts of questions and concerns – give us a call
at 619-259-6905, or shoot us an email at info@corecolumbia.com.