Covered California clarified

BY: JOHN BOGNA

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The enrollment deadline for California’s version of the Affordable Care Act (aka Obamacare) is March 31st, and a lot of Californians are still waiting to sign up. Our collective hesitation likely has to do with the program’s hour-long phone wait times, crashing websites and inaccurate physician’s listings. Not too long ago, the online marketplace specifically for small businesses and their employees, dubbed SHOP, was taken down for repair.

Covered California is also afflicted by a woefully unprepared outreach program.

When I attended a seminar near where I live in the Antelope Valley area (about 60 miles north of Los Angeles), I was still confused by the end. The speaker, employed by the Los Angeles County Department of Education, was not well-prepared and did not seem to know the answers to a lot of the questions being asked. Roughly a book’s worth of worksheets and printouts were given to everyone in attendance, but they were full of redundant information.

Nevertheless, most of the information I am about to share I gleaned by reading through the handouts myself at home, after the presentation ended.

The program divides coverage by county, separating the state into four different county areas: Sacramento, Los Angeles, San Francisco and San Diego counties.  Different providers are assigned to each area, so LA county will have some, but not all, of the same providers as San Diego county (for example).

There are 12 total providers listed as being a part of Covered California:

Alameda Alliance

Anthem

Blue Shield

Chinese Community Health Plan

Contra Costa Health Plan

Health Net

Kaiser

LA Care

Molina

SHARP

Valley Health Care

Western Care Advantage

Including Medi Cal, there are five levels of coverage. From the most basic to the most bells and whistles, the monthly premium options are Bonze, Silver, Gold and Platinum. You are given the choice between these “tiers” of coverage after entering your information.

Depending on which plan you pick, the provider will pay between 60-90% of your insurance costs, respectively. There are also PPO (Preferred Provider Organization) and EPO (Exclusive Provider Organization) versions of plans offered by the same provider. EPO plans offer payment assistance in the form of subsidies, but do not appear to offer any coverage when you go out of their network. PPOs offer a more extensive coverage network, but no subsidies.

Copays for doctor visits, ER visits, and the like vary from plan to plan. The Bronze plan has the lowest monthly premium but the highest out-of-pocket cost. The Silver plan was recommended at the seminar, because it has a monthly premium in the affordable range, and you don’t pay for regular doctor visits. Each plan has to cover what the speaker called the “ten essentials” which include things like doctor visits, brand name meds, screenings, flu shots and so on. Each plan also lists an out-of-pocket maximum that once you reach you cannot go over; the provider has to pay the rest of your costs for that year.

If you’ve got health insurance through your job, you can keep it. However, if you find that you’d be paying less through a CoveredCA plan you have the opportunity to enroll.

You can get help paying for your insurance monthly, when you actually have to pay for care, or both, depending (again) on income level. If you make below 15k for a single person and around 32k for families of 4, you qualify for Medi Cal

As I mentioned earlier, physician listings are confused in some areas to the point where neither some doctors nor the insurance companies they’re contracted with know what network they are a part of.

In short, some weapons-grade kinks still need to be ironed out of this system.

Despite the shortfalls, more than 650,000 people are enrolled. Further changes may be made or deadlines pushed back before all is said and done. It remains to be seen whether the plans will actually provide the sterling level of coverage they claim.

The big question is whether the system will be working well enough for people to avoid the penalty fee ($95 or 1% of your income, whichever is greater) and apply by the deadline.

Covered California is currently in open enrollment, and the deadline is March 31st, which is the very last date you can turn in your application for the program. If you submit by the March deadline, payment for your first month of insurance needs to be received by April 25. Coverage will begin on May 1. Open enrollment is every year from October to December, with Medi Cal available for enrollment year-round.