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Covered California: Insurance Details You Should Know About

If you have an individual health insurance policy, chances are your plan will go away and be exchanged into a comparable plan soon. This week President Obama proposed a fix in the law to allow policyholders to keep their plans for up to a year but whether this fix can be done without legislative delays remains unclear. The bottom line is that sooner or later you will be faced with two options: accept the new insurance plan they exchange yours to, or shop for another plan either in the private marketplace or through Covered California. If you are not up to speed on what Covered California is about, I suggest you read my previous post here: A New Era for Health Insurance - Covered California.

Whether you would benefit from purchasing a new plan through Covered California depends on your Modified Adjusted Gross Income (MAGI) from tax year 2012. If you make too much income to qualify for any tax credits, you are better off either accepting the new plan they exchange you to or shop for another one in the private marketplace.

Here are some details that you should keep in mind if you decide to get your new insurance plan through Covered California.

Ensure No Gap in Your Coverage

Complete the application as soon as you can. Although Covered California is not on the hot seat like the Federal Exchange Program for technological issues, it is nonetheless overwhelmed with the increasing number of applications. You want to make sure your application is processed in time so that there will be no policy gap for your health coverage starting 2014.

Deadlines

If you want your coverage to start January 1, 2014, you need to enroll before December 15, 2013 and pay your January premium before January. If you miss the December 15th deadline, the open enrollment does not end until March 31st, 2014. Just make sure you submit a completed application, receive an eligibility determination and make a plan selection by the 15th of each month (from January-March, 2014), you will receive coverage starting first day of the following month.

Premium Payments

Currently there is no electronic payment option for premiums; you will receive paper bills and you will need to send payments by check. There is talk in the future to set up an electronic payment option for the sake of convenience but no promises have been made yet.

Dental & Vision

If you are an adult and have separate dental and vision plans - keep them! Covered California only offers dental and vision benefits for children at the moment. There may be “supplemental plans” for adults through Covered California in the future but there will not be any federal premium assistance for these benefits.

Check the Network

Be aware that even though Covered California plans are offered by household names - such as Blue Shield and Blue Cross - they may have a different network than the typical Blue Shield plans in the private marketplace. The best way to verify whether your doctor is in the network is to contact the insurance company or a trusted broker and ask them to research it for you.

Travel Out of State or Overseas

Check your benefits; some plans cover only emergency assistance if you are outside California. As far as we know, no Covered California plans have overseas health coverage. So if you are traveling overseas, you might want to look into getting additional coverage.

Renewal of Insurance

When you fill out the application, there is an option to authorize Covered California to use computer resources, such as the IRS, to check your income for previous years. If the sources show you are still eligible, your coverage can be renewed for another 12 months without additional paperwork. If you decline this option, you will have to complete the application packet every 12 months.

Student Health Plans

If you or your dependent has student health plans through school, verify the plans meet the minimal essential coverage requirements. Otherwise, you may need to get an additional plan as required by law.