We are on the eve of Covered CA’s 2nd open enrollment period, consumers be ready. Here is a list of 5 lessons learned from the first open enrollment period that will help those that need to buy health insurance during the 2nd open enrollment:
1. Use an agent. You will need one. I realize that sounds like a shameless plug, but the facts from Covered CA’s first enrollment strongly back up the value of certified agents, so much so that Covered CA is redoing its marketing plan to notify consumers of agents available in their area, via storefront, internet or telephone.
A consumer has the option to enroll unassisted, enroll with a certified counselor (free of charge), or enroll with an agent (free of charge). Counselors are paid by Covered CA, and agents are paid by insurance carriers. Consumers that applied on their own experienced significantly higher errors than those using certified agents, both in trying to navigate Covered CA’s difficult website, and figuring out what they qualified for. The law is complicated. The website is difficult. Health insurance has a terminology all its own. Use any help available to make the experience quicker and easier, especially since it is free.
2. Do NOT establish an account with Covered CA until you have picked the plan you want. Last year, consumers had the tendency to log onto Covered CA and start applying before understanding any of their options. Confusing questions on the website lead to errors in everything from picking the wrong tax filing status to immigration issues, all of which left consumers stuck with an application that they could not complete and no clear understanding of what program or insurance plan was available to them.
Start by gathering what you need: information about insurance offered at work, most recent tax return, and immigration status. Get consultation about how each of those three determine your eligibility, decide where and what to apply for once you know what is available to you. Again, if you are using an agent, he or she can complete the application for you, making the process infinitely easier.
3. Keep a record of your monthly premium charges. The tax credits received in advance to pay premiums will be reconciled on the tax return of consumers that have taken the credit, the form is 8962. In January, consumers will receive a form 1095-A from Covered CA detailing the credits received. Expect errors. Record of payments made will help fill out the correct amounts on form 8962.
4. Do NOT report changes in income. Covered CA advises anyone that has a change in their income during the year to notify them so that their advanced premium tax credits can be adjusted accordingly. Unfortunately, too many people that have reported changes in income have had problems as a result. Insurance policies being terminated and erroneous Medi-Cal determinations are the two biggest headaches consumers have faced, and arguably the two most difficult errors to solve. Covered CA’s system of reporting changes just does not seem ready, so do not report changes. Instead, consult with a tax preparer to determine what the correct credit amount will be at year end, then adjust tax withholdings or make estimated tax payments accordingly.
5. A new doctor may not the end of the world. The new health plans, both on and off Covered CA’s exchange, have radically changed the network of doctors available to consumers. Many people are adamant about keeping their doctor, which limits the health plans available to them. There is a trusted relationship between a doctor and patient, but if you cannot articulate a specific medical reason why you must stay with the same doctor, perhaps a new doctor will be capable of delivering quality health care.
Buying a new health plan is a good time to re-evaluate your health care needs, make changes and try a different approach to your health. Above all, it is a time to educate yourself about what health care you are buying with that new health plan, and a time to become just as wise a consumer of health care as you are about your phone or cable plan.
