How to Cope With Covered California Glitches

January 31, 2017

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Source: California Healthline

Frustrating. Irresponsible. Stressful. Crazy. Devastating. Asinine. The worst.

Those are some of the words three Californians used to describe their recent experiences enrolling in — and paying for — health coverage from Covered California.

The state insurance exchange is in the final days of its fourth annual open enrollment period, which ends Jan. 31, and it has been a burdensome one for many consumers.

Two Covered California errors have affected roughly 50,000 policy holders, leading to higher-than-expected premiums or the potential loss of their tax credits.

“My premium is almost doubled; my tax credit went down,” says Jennifer Sticht, 41, a Sacramento resident who was blindsided by higher rates because of one of the recent mistakes by the exchange.

“This has been an ongoing mess,” she adds.

Other consumers are grappling with bureaucratic headaches that have dogged the agency for years. For instance, many people believe they’re being incorrectly enrolled in Medi-Cal, the state’s health coverage for low-income residents. Fixing the error can be a drawn-out nightmare.

“It’s really stressful for consumers,” says Kevin Knauss, an insurance agent in the Sacramento region who fields frequent calls from people caught between Medi-Cal and Covered California.

“The concept sounds so simple and consumers wonder why it’s so difficult,” he says.

The exchange’s errors, and obstacles during open enrollment, come at an uncertain time for Obamacare. As I type, federal lawmakers are debating the fate of the health law, and on Inauguration Day, President Trump signed an executive order urging federal officials to take actions to that could weaken parts of the law.

But nothing has changed yet and probably won’t for a while. Covered California still exists. You still have coverage, and if you want to keep it, you need to pay your premiums and follow the rules.

Unfortunately, you may encounter more errors, obstacles and bureaucratic headaches along the way.

Today, I’m going to explain where to find help with Covered California challenges, especially if you were snagged by its recent errors.

Tax Credit Snafus

About 90 percent of Covered California enrollees qualify for federal tax credits, based on income, which reduce their monthly premiums. Both of the agency’s recent mistakes involved these credits:

  • Covered California discovered late last year that about 24,000 policy holders hadn’t provided consent for the agency to verify their income, even though the agency thought they had. Without that consent, thousands of consumers lost their 2017 tax credits, at least temporarily.
  • Covered California gave insurers wrong tax credit information for about 25,000 policy holders, resulting in inaccurate bills. In most cases the recalculated premiums are higher than consumers had initially anticipated.

“In this renewal period in particular, we’ve had a very small number of people, but real people have been really touched by some problems we’ve had,” acknowledged Peter Lee, Covered California’s executive director, at the most recent board meeting.

“These are systems issues that had never occurred before,” he added. “When you’re this big and this new, new things come up.”

Lee said the agency is aggressively reaching out to affected consumers to make things right.

But Sticht says she will drop her plan because her cost spiked from $340 to $680 per month, and she can’t afford it.

The mistake was the latest in a series of problems that have plagued her coverage since last year, including the cancellation of her policy without her consent for a short period of time, she says.

“It’s better for me to just go to the emergency room or pay cash to go to the doctor,” she says. “This is what the system has brought me to.”

Ronald Burnett, 41, of Huntington Beach learned in mid-January that his premiums will rise from $105 to about $175 as a result of the error. “It’s frustrating. I feel like I’m being taken advantage of,” he says. “Don’t make me pay for your mistake.”

Burnett opted to switch to a lower-priced plan as a result of the error.

You’re allowed to switch plans during open enrollment, which ends Jan. 31. But if you were affected by this mistake, you qualify for a special-enrollment period that lasts 60 days, beginning the day you received notice of the discrepancy, says Covered California spokeswoman Lizelda Lopez.

For instance, if you received an email on Jan. 4 from Covered California explaining the mistake, that’s your start date, she says.

To make changes to your plan, call Covered California’s customer service line (800-300-1506) or the hotline established specifically for these problems (844-623-2070).

I recommend you seek free, in-person help from a certified insurance agent or enrollment counselor. Find options near you on the Covered California website (www.coveredca.com) by clicking on “Free Local Help to Enroll” from the home page.

Also, if you believe your recalculated tax credits are wrong, you can file an appeal with Covered California, says Jen Flory, policy advocate for the Western Center on Law and Poverty.

Be warned that appeals take time, and they may not result in the decision you were hoping for. For more on appeals, click on “Filing an Appeal or a Complaint” under the “Members” tab of the Covered California home page.

Medi-Cal

Because income determines eligibility for Medi-Cal and Covered California tax credits, your eligibility can change if your income changes.As a result, some people move between the two, and as Obamacare debuted, state officials promised that the transition from one to the other would be “seamless.”It hasn’t been for many.

“The interface between Medi-Cal and Covered California continues to be very problematic,” says Dede Kennedy-Simington, vice president of the insurance agency Genesis Financial in Southern California.

“They have to find a way to hand consumers back and forth,” she says. “It’s creating a lot of concern and anger and frustration.”

Michael Connelly, 62, of Granite Bay, near Sacramento, got caught in Medi-Cal when he tried to sign up for Covered California for the first time. Connelly, who retired Oct. 1, mistakenly reported his income for the last three months of 2016 as zero when he applied for 2017 coverage, thinking it wasn’t pertinent to his application.

In doing so, he immediately got kicked into Medi-Cal, even though he really doesn’t qualify, and it took trips to county offices, an appeal with Covered California, endless hours on the phone and help from Knauss to fix the problem.

“After they have you, they won’t let you go,” Connelly says. “I’m telling them, ‘Do you want to see my bank account? I don’t need Medi-Cal.’”

How to Get Help

For help in these situations, call Covered California’s customer service line, or better yet, reach out to whomever helped you enroll. For problems with Medi-Cal, you’ll need to deal with your county eligibility worker, too.

Also try the Health Consumer Alliance, which can help you if you’re having trouble with Medi-Cal, Covered California or both. Find more information at healthconsumer.org or call 888‑804‑3536.

Covered California is setting up an “Office of the Ombudsman” to help resolve consumer complaints. Lopez said the agency will make a public announcement and post the Ombudsman’s phone number on the Covered California website when the new office is ready to start taking calls.

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