Dear Tom and Alan:
I just lost my job, so I signed up for an individual health plan. I called an insurance guy that a friend referred to me.
The scenario goes like this: I told him I lost my job and my medical insurance; I told him I wanted Anthem or Blue Cross; I told him my income was $1,600 per month (unemployment and a part-time job).
He came back with a high-deductible plan, $6,000 (maybe $8,000), I don’t really know, for a premium of $1 per month. Is this true?
Anyway, I received my Blue Shield card, and then a few days later got a letter (more like a short story) from Covered California asking for a bunch of information about my income and proof that I am a resident of California.
I am so confused. Am I covered by Covered California? Do I need to sign up with them? Can you untie this knot for me?
Naked and Afraid
Tom: OK, NAA, long story short, your agent did the right thing to sign you up through Covered California.
In order to get any subsidy you have to go through Covered California. They not only want all your information, they require that you keep them informed about any changes to your status.
Since you are enrolled with Blue Shield, you do not have to do any more signing up with Covered California, but you do need to verify income and residency. You can simply scan and upload your driver’s license and a copy of your pay stub. Or, of course, you can mail it in.
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Covered California calculates your net premium (gross premium minus subsidy) based on your annual income, not your monthly income.
Your total annual income is what you have made year to date, plus what you estimate you’re going to make for the remainder of the year.
I don’t want you to be surprised by a large bill from the government due to understated income and overpaid subsidy.
Al: Our reader first mentioned Anthem Blue Cross and then Blue Shield. Anthem left the individual and family plan market in 2018.
Anthem will be back in 2020, but only in certain regions in California (not Napa). Blue Shield has continued in the state, but the network of doctors seems to change frequently.
Covered California has announced the companies that will be offering plans for 2020: Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Oscar Health Plan of California, Sharp Health Plan, Valley Health Plan, and Western Health Advantage.
Of these, only Blue Shield, Kaiser, Health Net, and Western Health Advantage will be available in Napa.
By the way, California is one of the very few states offering its own (taxpayers) subsidies to residents.
Subsidies are available to those earning up to 600 percent of the Federal Poverty Level.