California health insurance - Top 10 Mistakes Covered California Open Enrollment
Top 10 Biggest Mistakes for Covered California Open Enrollment
Covered California Open Enrollment 2027: MUST Know Info - Watch on YouTube
We've helped tens of thousands of Californians navigate the fun times of Open Enrollment in California.
There are so many pitfalls, as many find out the hard way.
Roughly 50% of people we help who self-enrolled or renewed have issues in their accounts that can significantly affect their tax credit, their choice of plans, or even their ability to enroll.
We'll cover the 10 biggest issues we see below, but first, our credentials:
Here they are...the biggest mistakes:
- Wait too late
- Just auto-renew
- Don't update income
- Assume doctors are still in-network
- Don't reauthorize eligibility verification
- Assume income is from past year
- Don't update household changes
- Miss out on enhanced silver plans
- Be too close to Medi-Cal income ranges
- Go it alone!
Let's look at all of these.
Of course, there's zero cost for our assistance, and we can easily help with existing accounts to get you out of the danger zone or just save tons of time and headaches.
Steps to get help with existing Covered Ca account here:
- Login to Covered Ca here
- Click on "Question Mark" image up top; then "Local Help"; then "Agent"
- Search for last name "Jarvis" and "93923" zip. Select Goodacre Insurance Services
-
Answer questions and designate as agent! It takes seconds!
To enroll with a new application:
Okay... let's get started!
1. Wait too late
Open enrollment is officially Nov 1st through Jan 15th, but in order for our changes to go into effect for a Jan 1st effective date, we must finalize by Dec 15th!
Now, in past years, Covered California has extended this to later in December, but to be safe, try to make changes during November.
If you enroll or change plans after the December deadline, your effective date will be 2/1 unless you're losing other coverage (see when can I enroll in Covered Ca).
There's always a mad push for Dec 15th and Jan 15th, and the system can literally crash.
We can literally get you through the process and make all the changes in about 5-10 minutes over the phone.
Call 800-320-6269
Email:
help@calhealth.net
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2. Just auto-renew
Some people just don't want to look at it at all, or let's face it... everyone's terribly busy during the end of the year with holidays coming up.
If your plan is still available (not always the case), the system will auto-renew your current coverage for the next year if you don't do anything.
This isn't necessarily bad, but it's not always the best outcome.
Prices change. Networks change. Carriers or plans come and go each year.
Lately, the pricing and doctor networks have really changed each open enrollment, so it's important to take a look.
We can do the heavy lifting for you. For existing accounts, just delegate, let us know of any changes (especially income for the next year), and we'll run the numbers while highlighting potential savings.
3. Don't update income
Many people will sail into the next year at Open Enrollment and never think twice about income.
We need to reflect our income estimate for the next year during this time, and it has to be done in a certain way so it doesn't mess up our current year coverage and subsidy!
This gets a little more tricky, so reach out to us.
So... if we're at the end of 2024 and in Open Enrollment for 2025, we're trying to estimate our 2025 income, or the AGI we'll show on the 1040 tax form in April of 2026 filing.
That's a mouthful. Reach out to us. We can help, and there's zero cost for our assistance.
Then there's the joy of doctors.
4. Assume doctors are still in-network
Every open enrollment, we see changes in what doctors or hospitals participate with which carriers (or networks within carriers).
Year-end is typically when this shuffles, and you don't want to be on the wrong side of it if there are doctors or hospitals you want to stay with.
People usually learn this after open enrollment has shut down and they're trying to schedule an appointment with the doctors, and they're no longer in-network!
With our quoting system here, you can check doctor networks by plan of choice right through the quote!
5. Don't reauthorize eligibility verification
There's a little-known system in Covered Ca that requires you to authorize them access to check income via government systems such as the IRS.
There's usually a 1-5 year window you can authorize for, so every year, thousands of Californian accounts are exhausting this window.
If the verification option isn't extended, you'll suddenly see your subsidy disappear!
It's usually a nasty bill from the carrier for the full amount, and shock doesn't do it justice.
We can check your current status and extend for you to avoid any hiccups. It's not easy to find in the system for the average member.
- Login to Covered Ca here
- Click on "Question Mark" image up top; then "Local Help"; then "Agent"
- Search for last name "Jarvis" and "93923" zip. Select Goodacre Insurance Services
-
Answer questions and designate as agent! It takes seconds!
One more note on income.
6. Assume income is from past year
This isn't an issue of omission but just a quirk of how complicated the whole process is.
We're trying to estimate NEXT year's income during open enrollment. Many people just got a handle on what they made for the current year, so they use that number.
Income can swing quite a bit from year to year (self-employed, asset sales, etc.), so it's important to try to estimate as best you can for the following year.
This can be nearly impossible for many people, so reach out to us, and we can fine-tune it as well as explain what happens if we're over or under the estimate.
We'll take some of the fear out of the decision and help you avoid any surprises at tax time.
7. Don't update household changes
Same holds for changes to our household.
Their definition of household is everyone that files together on a 1040 tax form (even if not enrolling) for the year in question.
So, if we're planning on marrying next March, we want to strategize around this big change since it will affect the subsidies and options at that time.
This gets a little more complicated, but reach out to us and we'll find the best approach.
Same goes for expecting babies, divorces, moves, older children not being claimed on taxes, etc. Anything that affects our household and/or subsidy.
8. Miss out on enhanced silver plans
This is a big one.
There are very rich versions of the silver plan (73, 87, 94) available depending on our income estimate for the following year.
Reach out to us and we'll send you the income chart for the new year.
California expanded the enhanced silver plans so they have NO DEDUCTIBLE now!
Here's the deal. Let's say the income limit to get one of these plans is around $48K.
You're self-employed and your income estimate is from $45 - $55K. If you go in at $50K, you don't get the much richer plan!
This can mean $1000's out of pocket difference if you need health care for the exact same silver plan premium.
We can help you find these breakpoints and fine-tune your income to make sure we're looking at it correctly.
9. Be too close to Medi-Cal income ranges
Income can also swing the other way!
If our income estimate is too low, we OR our children (which have a higher income threshold) can get thrown into Medi-Cal.
The Medi-Cal threshold is updated each open enrollment and then again around March-April!
Usually, people are coasting along on their Covered Ca plan (probably a rich silver 94 plan), and then they find out it's canceled.
Medi-Cal can take 30-45 days to approve you if your old income is under the new updated levels.
Once you're in this limbo, it's a whole process to fix it, assuming you can. We always go through delegates of our clients and let them know if they're close or under the limit.
Again... don't just auto-renew with the same income! It can be a nightmare to fix this!
We can help and even help with kids that are thrown into Medi-Cal.
Speaking of which...
10. Go it alone!
Why??? There's zero cost for our assistance as certified Covered Ca agents, and our Google reviews above show what we try to do for our clients.
25+ years of experience and 1000's of Covered Ca enrollments and renewals.
We touched on only a smattering of the issues people run into with Open Enrollment each year, and it's SO much easier to catch these problems before the end of OE than after.
In fact, we may not be able to fix some of them after the window closes.
In 5-10 minutes, we can size up where you are, what needs to be done, and best yet... if you need changes or fixes throughout the year, just email us and we'll do it on this side!
You'll wonder why you were fighting the tide before. How can we help with new enrollment or renewals??