Covered California Special Enrollment for American Rescue Plan’s Increased Premium Assistance
President Biden’s American Rescue Plan increases premium assistance in the Exchanges (Covered California). It eliminates premium payments for individuals at the lower end (i.e. incomes below 150% of the Federal Poverty Level), and it increases federal premium assistance for those with incomes between 150 and 400% of FPL, and it adds premium assistance for those with incomes above 400% of FPL.
It is now open for new enrollees as of April 12, 2021. If you are already in Covered California, your premiums will be automatically recalculated and should be reduced this month (May). If you are not on Covered California and are either uninsured or unemployed or buying private individual insurance outside Covered California, you should check out the plans, the coverage and the prices at https://www.healthforcalifornia.com/covered-california/plans?https://www.healthforcalifornia.com/individual-and-family-quote&gclid=Cj0KCQjwytOEBhD5ARIsANnRjVidJmV1E_mYrtyl6B4h-MRs2AQ17lM9b0uY9L7mrCzcnnUBwaVDqzsaArE3EALw_wcB.
It is unclear how long the new Open Enrollment period will last. Typically, it’s three months. I did see one article saying this open enrollment in California would be open until or through December 2021 although that surprised me; other states in the federal Exchanges have Open Enrollment until the middle of April. https://californiahealthline.org/news/article/covered-california-says-health-insurance-just-got-too-cheap-to-ignore/
What are the new income limits as compared to the older ones? Now if you are an individual with income under $19,140 or a family of four with income under $39,300, you pay zero premiums. Now if you are an individual with income above $51,400 or a family of four with income above $104,800, you are eligible for premium assistance if your premiums exceed 8.5% of your income – in other words, the increment above 8.5% of income is paid by premium assistance. https://www.healthforcalifornia.com/covered-california/income-limits?gclid=cj0kcqjwytoebhd5arisannrjvi8te4dt_atxqgdqdg4hz9q86gywwsc5f5zyivbtkknoxfejs0ho-uaai-0ealw_wcb In between, your shares of the monthly premium will go down and the federal premium assistance will go up.
The increased federal premium assistance under the American Relief Plan is available by law through the end of 2022. https://www.kff.org/health-reform/issue-brief/how-the-american-rescue-plan-act-affects-subsidies-for-marketplace-shoppers-and-people-who-are-uninsured/ Biden’s proposed American Family Plan would make the increased federal premium assistance permanent. https://www.whitehouse.gov/briefing-room/statements-releases/2021/04/28/fact-sheet-the-american-families-plan/
The participating plans in California include the large statewide insurers like Blue Shield, Kaiser, Health Net and Blue Cross as well as the regional insurers like Sharp, Molina, LA Care, Balance, Valley Health Plan and Western Health Advantage and also a new innovator, Oscar. https://www.coveredca.com/get-started/ The plans vary widely by price, so shop carefully. In general, premium assistance is tied to the second lowest cost health plan with silver coverage in your region; if you buy a more expensive plan, you pay the incremental difference and if you buy a less costly plan, you get the savings. For people with incomes less than 250% of FPL ($31,900 for an individual), cost sharing assistance is also available to reduce your deductibles, copays and co-insurance when you see a doctor or are hospitalized or get a prescription filled, but to get that extra assistance you need to choose a silver plan.
MediCal coverage is available for individuals with incomes of less than $17,775 or families of four with incomes of less than $36,570. These limits are a good bit higher for pregnant women and for children. The advantage of MediCal for consumers is no copays, no deductibles and no premiums. You will have a choice of providers participating in the local MediCal managed care plans in your county.
If you are undocumented, you cannot qualify for Covered California. Within the MediCal incomes limits, the undocumented can qualify for limited benefits (emergency care and maternal health), and those under the ages of 26 may qualify for traditional full scope coverage.
MediCal can be retroactive for three months prior to your application. Covered California is prospective – i.e. you apply, you pay your share of premiums and you get your coverage.
Prepared by: Lucien Wulsin
Dated: 5/7/21