More Issues With Covered California

Over the past year, consumers and agents alike have experienced many frustrating issues with Covered California (http://www.coveredca.com/). Consumer notification issues abounded, and enrollees continue to experience difficulty in navigating customer portals. Last, and certainly not least, errors with the site make accessing one’s information impossible as Covered California admins rush to solve problems with the sites infrastructure.

I work at a health insurance brokerage called SCI & Associates, in Stevenson Ranch, CA. While our primary focus is benefits, HR, and compliance for small to medium sized businesses, we also assist many individual clients with their health insurance needs. We’re happy to do this in fact. However, for clients who’s needs are best served by accessing coverage through Covered California, problems keep appearing like a bad game of “Whack-a-Mole”.

Covered California has recently been “refining” their process for auditing and evaluating income for all enrollees. Those who had not submitted this information were mailed a letter requesting the information, with a deadline of September 30th.

One major problem? Many, if not most, consumers, are finding the Covered California interface difficult to navigate. So difficult, in fact, that many are giving up, or spending, literally, hours on the phone with Covered California if they don’t have an agent to upload the verification for them.

The second problem that Covered California enrollees face deals with how income is being calculated. Quite simply, the methods for calculating an enrollee’s income are changing, with no notice being delivered to an enrollee. What does this mean? An individual who enrolled on 03/01/2014, and initially reported an Annual Gross Income of $16,000, could show in the system as $14,000, as the system can then calculate the income based on 10 months instead of 12. While this might not seem like a big deal, an enrollee could then fall below the “subsidy threshold”, and into the Medi-Cal category. Did I mention that Covered California will be transferring enrollees into Medi-Cal without notifying them in advance? Yes, this really happens.

While the above may or may not shock you, it is room for concern. Ultimately, if you or your client has coverage through Covered California, we advise that you keep a very watchful eye on any mail communication with a Covered California logo, and log into your account frequently. This is something we do for our clients on the agent portal to avoid issue. If you don’t have a broker, you can consider appointing one to avoid the burden of monitoring your own account exclusively.

-Nolan Waterfall

About the author: Nolan Waterfall
Nolan serves as a consultant, both to SCI, and within his own brokerage, Campfire Health, where he enjoys educating owners, C-level executives, and HR managers, on the in's and out's of all things compliance, technology, and benefits strategy. Nolan loves reading, anything outdoors, and spending time with his wife Joanna.

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