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Covered California Announces New Plan Selection Options

by Wendy Barnett

Member Level Plan Selection for APTC Eligible Households

Covered California Family Plan SelectionA recently announced feature on the Covered CA application significantly affects the plan selection process by adding much needed versatility. Covered California now gives families who are eligible for Advanced Premium Tax Credits (APTC) the option to choose different plans for different members in their household. Therefore, if one member needs richer benefits or a certain doctor network that other members don’t need, plans can be chosen based on those specific requirements.

Before this feature was available, all the members of a household had to choose the same plan level and the same insurance carrier. The Covered California system couldn’t handle itemizing out the tax credits to different insurance companies or plans.

Covered California made updates to their CalHEERS online application(version 16.7) on August 1, 2016 and said “The tax credits will be automatically disbursed across the selected individual plans or custom grouped plans.” The optional custom grouping option will make selecting plans easier, especially for larger families. Members who are not eligible for tax credits cannot be grouped with members who are eligible for tax credits.

Important To Know:

  • Family Deductibles / Out-of-Pocket Maximums

Enrolling family members on different plans brings separate deductibles and out-of-pocket maximums. This means co-pays and co-insurance are not combined into one family deductible or family out-of-pocket maximum when everyone is enrolled on the same plan. This could mean higher out of pocket expenses overall. It’s important to do the math when you are considering choosing different plans as lower premiums may not equal lower health care costs.

The improved plan selection process also simplifies applications for members with AI/AN status allowing them to choose an AI/AN specific plan with cost sharing reductions with or without other members in their household.

Members who are eligible for Medi-Cal will remain separate from members who are eligible for Covered CA subsidies. Although they will apply on the same application, they may not be grouped on a Covered CA plan with other members of the same household who qualify for a tax credit.

If you’re thinking about choosing separate plans within your household and need some guidance, give us a call at 1-877-752-4737.