Health Plan Open Enrollment Now Open

The health plan open enrollment for individuals under age 65 and not Medicare eligible began Nov. 1 and continues until Jan. 31, 2024. If you want coverage to be effective January 1, 2024, you must complete the process before 12/31/2023.

Your plan may have been “passively renewed” by Covered CA already. This means you will be automatically enrolled in your prior plan or the closest to it. But this does not mean you will pay the same premium you paid in 2023. According to Covered CA, the new state-enhanced cost-sharing program will increase the value of Silver 73 plans to approximate the Gold level of coverage and increasing Silver 87 plans to approximate the Platinum level plans. Over 650,000 enrollees will be eligible for these cost-sharing reduction benefits! This is for individuals and families that are at or below 250% of the Federal Poverty Level, ($75,000 for a family of 4).

Changes in the Federal programs will result in the loss of MediCal coverage for many. Covered CA implemented an auto-enrollment program to eliminate gaps in coverage and aid a seamless transition from Medi-Cal to a health plan offered by Covered California. However, this passive enrollment must be accepted by the individual and any premium paid, or the coverage is not effective. It’s critical that individuals pay attention to their status and take any actions necessary.
Do not wait until after the holidays to enroll. There are many changes coming and you will want to know your costs and benefits prior to 1/1. When enrolling and inputting income, you are projecting your income for 2024. This program looks forward, not backward for income projection.

A couple of 62 year olds in Shasta County with a combined income of $150,000 could qualify for a subsidy of $1434 monthly giving them a net premium of $376 to $468 for a Bronze High Deductible plan.

The same income shared between a couple of 40 year olds with children ages 8 and 10 could result in a premium of about $645 for the same level plan, including a $645 premium subsidy. Drop the family’s income to $85,000 and the premium for the Bronze plan is $19.00 monthly with a $1569 monthly subsidy.

The only way to qualify for any of the financial subsidies is to buy coverage through the Exchange, i.e. Covered CA. If you are currently purchasing coverage off the Exchange it may be worth it to see if you qualify for a subsidy. Go to www.coveredca.com and use the “Shop and Compare” feature. Then contact your agent and see if they can re-enroll you in coverage. Be very careful not to get directed to the online brokers websites. Just like any search these days, “sponsored” sites often come up first and they are not necessary the site you want to use. I have found that online brokers do not know our provider market and often misdirect or under-inform applicants.

Another option would be to contact Covered CA directly at 1-800-300-1506.

While there is currently no federal tax penalty for going without health insurance coverage, there continues to be a tax penalty from the State of California. Starting in 2024 the penalty is $850 per adult and $425 per dependent child under age 18 living in the household.

With all the financial help available to pay premiums, it doesn’t make sense to pay this penalty and go without this important coverage.

Covered CA also provides an additional pathway to Medi-CAL (the name for the state of CA Medicaid system). Regardless of assets, if income is low enough one might qualify for MediCAL. If you enroll in Covered CA and your income is below 138% of Federal Poverty Level (FPL) for Adults, your case will be referred to MediCAL and application re-processed. The limits are higher for Pregnant Women and kids.

Be careful when enrolling in Covered CA. At certain incomes you can become a “mixed household” with some members automatically enrolled in MediCAL due to these higher limits. Mixed households can be an administrative challenge at best!

If you have multiple jobs and/or sources of income, pay attention to the categories and enter them in the proper categories on the application. Update your status for consent for verification of income. This allows Covered CA to access tax records to verify income.

Subsidies are reconciled when your tax returns are filed, so if you misreported income for 2023, it will be reconciled with your 2023 tax return. You could be eligible for additional tax refunds or be required to pay more at this time, depending on the difference between what you estimated and what you ultimately reported.

If you need help, you can call Covered CA and submit the application on the phone at 1-800-300-1506. Following the call, set up your own access to your CoveredCA account, so you may update information as needed. If your income changes by 10% or your family size changes, you are expected to notify CoveredCA.

If you appreciate Margaret R. Beck’s informational columns, please consider a contribution to A News Cafe. Thank you.


Margaret R. Beck

Margaret Beck CLU, ChFC, CEBS started her insurance practice in Redding in 1978. She founded Affiliated Benefit Services.

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