Dear Tom and Alan:
I’ve been on Covered California for two years now.
My plan is the Kaiser Silver HMO. Last year my rate increase was 6.9 percent.
I just got a letter saying my cost for 2018 is going to be 35.8 percent higher!
I did not get a raise this year, so my financial status has not changed, but, geez, this is unaffordable.
Why and how and what to do now?
By the way, the letter had both logos on it and said if I didn’t renew by Nov. 12 (really, last Sunday?) they would automatically renew me to the new plan. On page 2 they said I could change it to something else if I did it before Dec. 15.
Tom: OK, all the health plans that are compatible with the Affordable Care Act (ACA) are separated into tiers: bronze, silver, gold and platinum.
Through Covered California, you can choose any tier you can afford. For those individuals who earn less than $47,520, there may be subsidies available to help pay for monthly premiums.
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For the person earning less than $29,700, he/she might also be able to receive a benefit called Cost Sharing Reduction (CSR) that, when combined with a Silver plan, can offer even more help with deductibles, copays, etc. Note: the CSR is not the same as a subsidy, which is a tax credit based on income.
Through an executive order, the Trump administration has removed the federal funding for CSR. The people receiving the benefit are now facing a surcharge to pay for it.
Al: That explains part of the increase, but certainly not all. I’ve been working with a family of four whose plan is not through Covered California because they make “too much money.”
Their Blue Shield Bronze plan is going from $1,950 per month to $2,500 per month. They are not eligible for subsidies, nor CSR, yet their monthly payment is big and getting bigger. Keep in mind that a Bronze plan is the least expensive you can get.
Tom: Now, back to our reader’s question(s). If you have an agent, navigator, or just call the 800 number, you can go through the process of renewing for 2018.
It’s not always user-friendly, but you go through each of the different categories of your original application and make changes where necessary.
At the end of the process, you have the option to remove your existing plan and shop for a new one.
You will be astounded to discover that you will be able to get on a Gold plan for less than what the new rate was going to be on your Silver plan. If you are still eligible for subsidies, you will see rates as low as $1 for a Bronze plan and $75 for a Gold plan. The CSR is gone, but the rates are great.
The really important part is changing the plan and not getting stuck for another year at a higher rate.