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Health Insurance Guys

Health Insurance Guys: Open or closed enrollment for all of us?

  • Updated
Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

Dear Tom and Alan: I was laid off work on March 13. I thought it would be just for a short period, but it turned out the whole business went out of business! Of course that means no Cobra (along with no income). My wife has been able to continue at her job so we’re not totally destitute. We’re estimating our total income will go from about $110,000 to about $44,000. First, do we have to wait until the next open enrollment? Second, would we get a subsidy because our income is way down? Third, what happens if I get a new job?

By the way, we’re 44 and 42, our daughters are 17 and 15.

Lem

Tom: You do not have to wait until the next open enrollment which probably will start in October or November for a Jan. 1, 2021 effective date. California started a new open enrollment, which ends June 30. If you start your application after June 15, your effective date through Covered California would be Aug. 1.

You would definitely be eligible for a subsidy with a family of four and a household income of $44,000 annually. Since your recent tax returns wouldn’t reflect your current income, you would have to fill out an Attestation Form to affirm your $44,000 instead of $110,000.

If you get a new job with benefits, you would just put your family on the employer’s plan and not worry about all this other stuff. However, it is extremely important that you contact Covered California regarding changes in income. They sometimes want that subsidy back!)

Al: Based on your information, we ran a quote on the Covered California Shop and Compare Tool. Your family qualifies for a subsidy of up to $960.53 per month. The absolute least expensive plan is the Kaiser Bronze 60 HMO (Health Maintenance Organization) at $2.00 per month (!). This particular plan has a family deductible of $12,600 per calendar year. You do get 3 doctor visits per year at $65. As you probably know, an HMO requires you to choose a primary care physician and everything goes through that doctor and that specific network.

The next metal tier up is the Kaiser Silver 87 HMO CSR (Cost Sharing Reduction) at $87.91 per month with the full $960.53 monthly subsidy. CSR is simply a way of giving additional benefits to those on a Silver Plan. For example, a $15 office visit and $5 prescriptions. The family deductible is $2,800 per year, or, $1,400 individual, with a maximum out-of-pocket of $5,400.

Finally, the first Preferred Provider Organization (PPO) plan is the Blue Shield Bronze 60 PPO at $200.60 per month. The deductible and just about everything else is going to be very similar to the Kaiser Bronze Plan. The difference, of course, is that the PPO Provider Network is usually larger than most HMO networks.

We can’t emphasize enough the importance of keeping in contact with Covered California. That $960.53 each month adds up quickly.

Submit questions to schrette@gmail.com or alancash@gmail.com.

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