Covered CA – Consumer Income Reconciliation Notice

Covered California will be sending a notice next week to health plan enrollees that received APTC, or “premium assistance,” encouraging them to report any changes in income or household size since enrolling in a Covered California health plan.

Enrollees who received premium assistance this year will need to file taxes for 2014. When they file, the IRS will check to see if the amount of income they reported to Covered California is the same as the amount of income they actually made. The IRS will also check to see if their family size is the same as when they applied. The IRS will compare, or “reconcile,” the amount of premium assistance they qualify for based on their actual income and family size reported on their tax return with the premium assistance they received during the taxable year.

Enrollees who experienced a change in income or household size but have not reported this information to Covered California are at risk of having to pay more at tax time. If needed, Covered California can work with these enrollees to reduce their current premium assistance to minimize this consequence.

Covered CA Notice sent to (some) Clients

From COVERED CA:

Notices with Incorrect Open Enrollment Dates

In the past two weeks, about 11,000 Denial of Coverage notices were generated and sent to consumers with the incorrect Open Enrollment dates for the Individual Marketplace. These notices were sent to consumers that applied outside of Covered California’s Open Enrollment period.  Although the dates indicated were correct at the time the notices were sent, a change in the law resulted in a change to the Open Enrollment period indicated.

The incorrect dates on the notice were October 15, 2014 through December 7, 2014. The 2015 Open Enrollment period is November 15, 2014 to February 15, 2015.

Please [be aware if you were] affected by this notice [and take note of] the new Open Enrollment dates. Be sure to also check whether [you] qualify for Covered California’s Special Enrollment Period.

If eligible, you can call [today for questions about enrolling in this special enrollment period].

[If you] are not eligible for Covered California’s Special Enrollment Period, [you] can apply during Open Enrollment this fall for coverage beginning January 1, 2015.

Qualifying Life Events

Now that Open Enrollment has ended, you must have a “Qualifying Event” to make any changes or enroll in a new plan outside of Open Enrollment.  As of today’s regulations (always subject to change), the next Open Enrollment period will begin on Nov. 15th, 2014.

Examples of Qualifying Life Events:

In all state-based, federal and partnership exchanges, individuals may also enroll outside of the open enrollment window if they have a qualifying life event. The consumer and the agent should contact each specific exchange directly for their qualifying life event procedures. For your reference, qualifying life events include:

  • Marriage
  • Having a baby
  • Adopting a child or placing a child for adoption or foster care
  • Moving outside your insurer’s coverage area
  • Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
  • Gaining citizenship
  • Leaving incarceration
  • Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
  • For people already enrolled in marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions

Apply by Monday 3-31-14, Open Enrollment will be OVER

 
Enrollees Who Want to Beat March 31 Deadline Rush Should Sign Up Now
 
SACRAMENTO, Calif. — Covered California™ today confirmed its March 31 deadline for open enrollment in an exchange health insurance plan and announced its policies for completing an application for health care coverage.
 
With five days left to enroll in a Covered California health insurance plan, the exchange is urging consumers to sign up before the deadline if they want to get affordable health care coverage and avoid a tax penalty.
 
“If you haven’t applied yet, do it now,” said Covered California Executive Director Peter V. Lee. “We are concerned that high numbers of people will come to our doors at the last minute and won’t be able to get enrolled in time. If that happens, consumers face a penalty for not getting insurance, and they may miss out on the peace of mind that comes with coverage.”
 
Covered California also clarified the process for completing applications for health coverage in 2014.
 
“Covered California is not extending its deadline for applying for a health plan,” Lee said. “However, we’re committed to helping all those who started an online application to cross the finish line.”
 
Individuals who start an online application by 11:59 p.m. on March 31, 2014, will have until 11:59 p.m. on April 15, 2014, to complete their application and select a plan. To start an application, the consumer must take at least the following steps:
 
  • Create an online account.
  • Fill out all required information on the “Apply for Benefits” page and click “Continue.” The page contains two required fields (see application screen images online athttp://news.coveredca.com/p/blog-page_26.html).
  • After clicking on “Continue,” individuals will be taken to the “Consent for Verification” page, where they need to click on “Save & Exit” or “Continue.”
  • They must return to their online account no later than April 15 to complete the application and select a plan. 
Covered California reminds consumers that they must make their first premium payment to the health insurance company by the due date to avoid the tax penalty.
 
Paper applications must be postmarked by March 31, 2014, to meet the open-enrollment deadline for 2014 Covered California plans. To guarantee coverage beginning May 1, 2014, however, consumers are encouraged to enroll online.
 
After the end of open enrollment on March 31, consumers may be eligible for Covered California’s special enrollment period, which can be triggered by one of several “qualifying life events,” as defined under the Affordable Care Act. Some of those qualifying events are:
 
  • Getting married.
  • Having a baby or adopting a child.
  • Permanently moving to a new area that has different health plan options.
  •  Losing other health care coverage that is considered minimum essential coverage.
  • A change in income that would affect an enrollee’s eligibility for financial assistance.
 
Low-cost or no-cost coverage through Medi-Cal is also available to consumers year-round, and they can check their eligibility and sign up on the Covered California website, through its Service Center or with the help of assisters.
 
Covered California also operates its Small Business Health Options Program (SHOP) year-round for businesses with 50 employees or fewer.
 
Covered California’s next open enrollment, for 2015 coverage, will begin in fall 2014, likely mid-November.

Enrollment Tips for the Consumer

A summary of an article in Benefits Pro had some excellent suggestions:

There’s still time to shop for coverage before open enrollment closes March 31. But this year — with Obamacare — there’s more to know and understand than ever.

Ehealth released a list of top five health insurance tips for consumers who are shopping for 2014 coverage during the remainder of the open enrollment period.

1. Know your deadlines. PPACA creates specific deadlines that affect you when it comes to enrolling in coverage and avoiding a tax penalty at the end of the year. Carriers might have their own enrollment deadlines and rules to determine the date on which your coverage becomes effective.

•March 31 — This is the last day of the nationwide open enrollment period for 2014. You need to enroll in health insurance coverage by this date in order to avoid possibly having to pay a tax penalty on your 2014 federal tax return.

You should know that enrolling in coverage in the second half of the month generally means coverage likely will take effect on the first day of the month, two months in the future. So, for example, enrolling by Feb. 15 means that your coverage may start as early as March 1, but enrolling on Feb. 16 means that your coverage won’t begin until April 1.

2.  Shop outside of public exchanges to explore all your coverage options. Government exchange websites are designed to provide subsidy-eligible consumers with access to plans specially qualified for purchase with a subsidy. Not all plans are. Some major carriers have opted not to sell plans through the exchanges. Consumers who want to choose from the broadest selection of plans and find the best match for their needs and budget also should consider plans available off the exchange through licensed agents. These plans will still meet the coverage requirements of the law and keep you from having to pay a tax penalty, so long as you maintain your coverage during the year without a gap of more than three consecutive months.

3. Understand the true cost of any health plan you’re considering. The true cost of any health insurance plan is about more than your monthly premiums. It’s also about how costs are shared when you actually receive medical care. Look at your annual deductible, copayments, and coinsurance — and your annual out-of-pocket maximum. Understand how different forms of cost-sharing may apply to different kinds of medical care. Read the fine print, and talk to a licensed agent for personal help understanding your coverage details.

4. Make sure that government subsidies will work for you. PPACA allows some people earning less than 400 percent of the federal poverty level (about $46,000 per year for a single person or $94,000 for a family of four) to receive subsidies to help with their monthly premiums, depending on the cost of coverage for the benchmark plans in their area. Be aware that your eligibility is based on your projected earnings for 2014 rather than your past earnings, and only the government can make the final determination on your subsidy eligibility. If your income fluctuates or changes during the year, your eligibility for a subsidy may also change. If you earn more than expected in 2014, you may have to repay all or a part of any subsidy you received when you complete your 2014 federal tax return.

5. Pay attention to doctor and hospital networks. People who already had self-purchased coverage in 2013 might find that their list of network providers is different in 2014. Just because your favorite doctor accepts a specific insurance company doesn’t mean that he or she is a preferred provider for all plans sold by that insurer. Provider networks may have changed on January 1, and some plans limit your access to providers to help keep costs in check. Make sure that the doctors or hospitals you like best — or the ones close to your home—are preferred providers under your new health plan in 2014.