California health insurance - Covered California - 2017 Buyer's Guide

Your Covered California Buyer's Guide

Get Updated Guide to Open Enrollment Including Changes, Rates, Benefits, and a Plan of Attack HERE

We're not going to lie to you.

It's a lot to learn.

Health insurance is never fun but now they're throwing its less fun cousin..

Taxes!

There's a silver lining though.

If we do this right, it can mean $1000's in savings for you and your family.

That's not exaggeration. No infomercial.

We help people every day get these savings and we're going to spell out the key points here.

The Covered Ca Buyer's Guide.

Of course, you can always get personalized help at 800-320-6269 at no cost to you.

We're Certified Covered Ca agents who have each enrolled 1000's of Californians.

Personally!!

You can always quote the plans here with Tax Credits calculated but read below.

There are many pitfalls, traps, and mines to avoid! No kidding.

Roughly half of the self-enrolled people we "save" have errors in their applications that prevent them from getting a tax credit or result in some nasty April Tax Time paybacks.

So let's get started.

We'll break it into 5 important sections:

What is Covered Ca
The all important Tax Credit
Watch out for the Tax Penalty
Covered Ca plan basics
When and How to Enroll

First, the bird's eye view!

What is Covered California?

Covered Ca - It's a market, Silly!

We're going to speed round the overview of Covered Ca!

Covered California is our State's personalized version of Obamacare's "Exchange".

We wanted to build our own...so we did!

We even expanded some of the options beyond the original ACA (Affordable Care Act) law.

Covered Ca and a whole slew or rules started on Jan 1st 2014 and now rules the individual and family health insurance market.

Here's the key point...

Health plans available to individuals and families are now standardized.

We'll get into the basics below but here's the deal...

There are large tax credits available based on income through Covered Ca.

By law, the plans, rates, and networks must be the same off-Exchange or on (Covered Ca).

The tax credits are only available through Covered Ca!

The Tax Credit IS the real gist of Obamacare or ACA or Covered Ca (all the same thing!)

Let's start with the tax credit since it's so important!

If you have questions on off-Exchange or Covered Ca differences, call us at 800-320-6269.

The Covered Ca Tax Credit

The real deal behind the law is this...

You can get advanced tax credits to bring down the cost of coverage based on income.

There are some other considerations but income is basis now!

General income levels available upon request at help@calhealth.net

Some general pointers on the tax credit:

The tax credit is on a sliding scale
Below the minimum, you'll be eligible for Medi-cal
Above the maximium, the tax credit goes away complete
The tax credit is based on best estimate for current year's income
Household is defined as all those that file together on one 1040 tax form
The tax credit is deducted from your insurance premium monthly

That's right...you don't have to wait for April to claim it.

For example, if your insurance plan is $300/month and your tax credit is $200/month (not unheard of), you'll get a bill for $100/month from the carrier.

That's the whole point of Covered Ca.

They are keepers and administrators of the tax credit!

Now there are some other drivers that affect the tax credit.

Too many to get into here but we can walk through your situation at 800-320-6269. As Certified Covered Ca agents, our services are free to you.

Here are some big ones!

Married couples must file jointly
We may need to submit docs to backup income estimate. There's a quick easy way to do this. Call us and we'll explain!
The income estimate is roughly based on line 37 on the 1040 form.
Social Security, tax free interest, spousal support, foreign income are all included
Federal disability is not included. State is if it ended unemployment
Unemployment is included

Again, each person's income is tricky. That's where we see most of the issues.

You don't want to find out that you owe the IRS $3,000 in April because you answered one question wrong on the application.

It happens to 100's of thousands (maybe millions) of people each year.

That's our job as Certified Covered Ca agents - to help people correctly apply so they get the right amount of tax credit.

Oh...and our service is 100% free to you! Call 800-320-6269 and we'll get to work.

You can spend the estimated 45 minutes online just to fill app

That's the carrot. Let's look at the stick!

The Tax Penalty and Covered Ca

This is the IRS. Please kindly send us 2.5% of your Income. NOW

You don't want that reply when you file taxes.

Millions of Americans are getting them and it's a downer party.

Don't get invited. Here's the deal.

Part of the ACA law said that a person has to get ACA compliant coverage or pay a tax penalty.

Here's the amount:

Penalty for no insurance

2.5% of income is a big number. Let's say you make $40K per year.

That's $1000 tax penalty!

You could probably come up with better uses of $1000 than to subsidize OTHER people health insurance!

You're going to pay either way so why not get protected so health care costs don't wipe you out.

We know we know, you're the son of Jarel...Superman.

Never get sick. Don't see doctors. and your ACL is impervious to...ummm

Oh. ACL repair runs around $20K these days and that's they do it behind the Polo Loco.

If you combine the tax credit and the tax penalty, it just doesn't make sense to go uninsured.

A few key points on the tax penalty:

You're allowed 2-3 months uninsured in a year with a hardship waiver
The tax penalty is pro-rated. 5 months uninsured will be 5/12ths of the full penalty
The penalty is assessed at tax filing time the following year
There are other waivers based on affordability but they're tougher to qualify for
Plan must be ACA compliant - short term plans will not work

We can help you compare the cost of a qualified health plan with or without tax credit and the tax penalty.

This way, we can see what your REAL cost of insurance would be.

Call 800-320-6269 or run your instant quote here.

Carrot. check
Stick. check

What about the actual plans?

Let's check it out!

The Four Flavors of Covered Ca Health Plans!

This is probably the second biggest effect from the ACA law.

Plan design!

The law completely overhauled the plan designs since 2014.

Here are some of the basics:

There are 4 basic levels of coverage: Bronze, Silver, Gold, and Platinum
There can be richer versions of the Silver based on income
Preventative is covered at 100% in-network
You cannot be declined based on health
There are no lifetime or annual max benefits
There are no waiting periods or rate-ups for pre-existing conditions

By law, a plan must be within 2% of a benefits basis at each level.

Covered Ca goes a step further.

A bronze plan is a bronze plan. What's changing?

The carrier
The rate
The network
The accepted list of drugs

That really becomes the decision.

Since the benefits are standardized, it comes down to the doctors and hospitals you want access to!

And of course....rates!

You'll see that costs differ significantly across a given benefit level even though the benefits are the same!

Some of that is HMO versus PPO. Some carriers are higher for a given area and demographic make-up (age).

The main carriers that currently offer benefits in Covered California are:

There are some smaller carriers that specialize in certain areas.

You can quote the carriers in your area here with tax credit included.

The tax credit will apply the same to each plan option.

So how do we evaluate the four plan levels?

This is where our 20+ years experience comes into play but we'll give you a brief summary.

Everyone's healthcare needs and budget are different so it's best to go over your situation with a Certified Covered California agent at 800-320-6269.

Plan level summary:

Bronze: approx $5K deductible; 3 office copays; $6500 max out of pocket
Silver: Approx $2K deductible; office and RX copays; $6500 max
Gold: no deductible; richer office and RX copays; $6500 max
Platinum: no deductible; richest office and RX copays: $4500 max

Now, that's a broad sketch. There's a lot of fine tuning needed for each individual.

Here are some important take aways.

Enhanced Silver Plans

If you're offered a richer version of the Silver plan (Silver 73, Silver 87, or Silver 94), that's usually the best value.

Especially the Silver 87 or 94!

There's no reason to go any higher if you get this offer.

Max out of Pocket

You'll notice for the large bills, the three bottom plans all treat them about the same.

If you're expecting really big bills, you may want to look at the Bronze or Platinum.

We can explain why this works. It really depends on the premium difference for your age and area.

Premium difference

Otherwise, we go Old School!

The same calculation we've made 1000's of times with 1000's of clients.

Comparing premium difference versus benefit difference as we go up and down the levels.

We can help with this at 800-320-6269 or run your quote here:

Once we have the plan picked and we know our tax credit, how do we apply?

You have options there. Choose wisely!

The How and When of Covered California enrollment

First, we need to understand the rules for when we can apply.

There are two options:

Open Enrollment - Nov 1st - Jan 31st
Special Enrollment - rest of the year based on major life changes

That's it. We need one of the two to enroll in Covered Ca OR off Exchange.

We can get Short Term or Medi-cal anytime of the year!

Open Enrollment is pretty straight forward. What is the Special Enrollment?

Special Enrollment triggers

These are the most common triggers for Special Enrollment:

Loss of qualified coverage (usually employer sponsored)
Move to/within California if it affect health care options
Family make-up change (marriage, divorce, death, birth, etc)
Change in legal or immigration status

The life change needs to occur in the past 60 days to enroll.

There are some other less known triggers...call us at 800-320-6269 to see if you might be able to enroll.

Effective Date rules for Covered Ca

Of course, there are rules there.

Enroll 1st-15th of the month, effective date is following 1st of the month
Enroll 16th of the month or later; effective date is 1st of month following next 1st

Example of #2

You enroll May 17th. You will be eligible for overage July 1st.

These effective date rules apply to Open Enrollment as well.

One note...loss of qualified coverage allows us to enroll 1st of the month following application submission.

That's the when (enroll and effective).

What about the HOW??

That's our favorite part.

It's where we really HELP people.

We can enroll most people over the phone in 5 minutes at 800-320-6269.

No kidding.

People finish the process with us and they're literally stunned...especially if they know someone that self-enrolled.

We make it easy and there is absolutely no cost to you.

We're Certified Covered Ca agents who have enrolled 1000's of Californians in every possible set-up you can imagine.

Call us at 800-320-6269 to enroll, calculate tax credit, or pick plan. Hey, all three!

Again, we get many people who delegate us as their Covered Ca agent. They add us after the fact because they're running into problems with the online app.

We always go through and make sure everything looks correct.

That's where we find more than 1/2 have major issues that can prevent them from getting their full tax credit.

We have 20+ years experience
We have enroll 1000's of Covered Ca accounts
Our services are 100% free to you

We're also very nice. Seriously...that has to count for something in such a complicated system!

Call us at 800-320-6269 or run your quote: