Losing Health Insurance from Work? Basics of Getting Health Insurance through Covered California. / HealthChoice

00:00

hi I'm Michael and welcome to California over last month or so Californians have been hit with a wave of shutdowns lock downs and force closures of non-essential businesses to help prevent the spread of the corona virus unfortunately these necessary measures have affected a huge part of the California workforce and we in California are seeing an unprecedented level of layoffs furloughs and forced times off has result the number of people applying for unemployment benefits have skyrocketed and they're even more to come so today we're gonna discuss what are your health insurance

00:30

options if you are no longer able to get health insurance through your work luckily here in California there's a lot of health insurance options for those of you trying to get health insurance coverage in these uncertain times especially when living life uncovered could put your economics your health and your family at massive risk not to mention that there's still a tax penalty of a minimum of six hundred and ninety five dollars for Californians who don't have health insurance coverage so whether you lost your health insurance through your work or still just haven't gotten coverage but need to this episode

01:00

it's gonna be for you so first let's talk about covered California covered California is a state-based health exchange that provides Californians with monthly assistance paying for their private health insurance plans it is not medica it is possible to apply for medical through covered California but covered California plans are private health insurance plans similar to the ones you may have gotten through your work like Blue Shield or Keizer or Melina or Health Net or most major health insurance companies but the difference with a covered California plan is that you can get an extra

01:32

premium assistance to help you pay for your monthly cost another great thing about cover California plans is that nobody can be denied because of pre-existing health conditions so whatever your health condition is you can still get coverage second covered California was specifically designed for people who lost their health insurance either temporarily or permanently by doesn't mean that plans can be enrolled anytime throughout the year whenever someone loses their health insurance additionally covered California plans can be cancelled at any time so for

02:02

example if you're losing your previous health insurance but are starting a new job your new jobs insurance doesn't start for 90 days then you can still enroll to a covered California plan for those 90 days and cancel whenever your new work insurance starts another example could be that because of temporary furlough or Dropper hours you may not be eligible for health insurance for the following quarter at your work in this case you can still enroll into a covered California plan for just those three months you need the coverage and cancel once you become eligible for your work insurance again

02:33

now this doesn't mean that covered California is only for temporary coverage these plans can be used as permanent insurance as well there is no time limit that you can have a covered California plan and they renew every single year so in that sense they are useful for temporary coverage or for permanent coverage so now let's talk about who's eligible for a covered California plan there's a lot of misnomers about who can and who cannot get insured through covered California but eligibility for covered California plans are based on a variety of things first in order to apply a person must be

03:05

a resident of California and have lawful presence in the United States so you got to live in California but if you do live in California but don't have lawful presence the United States you're still able to apply for some health insurance carriers directly but not recovered California and these direct plants are not eligible for monthly premium assistance so you will have to pay a hundred percent of those costs now if you're looking for insurance plans that do not require legal presence we will cover that in a future video so first you have to live in California second you have to have lawful presence the United States and third you must be

03:37

within 60 days of a life change that caused you to lose your health insurance these 60 days are called special enrollment period these life changes can be things like you had a baby or moved or lost coverage that your parents got married or the one most relevant today's video is you lost eligibility from your work insurance within these 60 days you have an opportunity to enroll a good plan but if you miss the enrollment window you have to wait till next year to enroll another one of the most important questions I get asked when helping somebody enroll is how much does

04:08

it cost and in fact it's really the main question that anybody wants to know and the answer is that it changes from person to person the cost of a plan through covered California are based on four main factors age income household size and zip and based on these factors everybody who has the same age has the same plan cost but what varies is a person's income household size and zip code these factors really can change the cost of plan for someone applying for CCA but generally the more you make the more you'll pay and the less you make the

04:39

less you pay so let's change perspective and look at a couple examples of CCA plans all right everybody hi so I wanted to get a chance to do a brief kind of overview of how subsidy interacts with plans through covered California and this is gonna be a simple example of a household a common household here in Southern California and how they could technically apply for covered California and get subsidy and how that apply their account so first this is a going to be like I said a household of four people

05:10

and their incomes can be $70,000 as you can see here they're located here in Southern California and the ages of the household members is 50 45 19 and 14 so like I said covered California bases a person's subsidy on age income household size and zip code so we've got all four of those things put into the calculator and so when we look at covered California there's a couple things that are really important we were looking at plans and again this is just a brief overview but it'll be a good opportunity

05:43

to kind of see how that subsidy works but basically cover telephony has four levels of plants and has a bronze a silver a gold and a platinum and you know the gold and platinum are really ideal for folks who have major health issues people who have a lot of expenses at their planet do or just want to have really really good coverage but they are usually pretty expensive and so the silver and the bronze are a little bit more basic plans the bronze is the most basic and also at least expensive and the silver is kind of the middle road of the cost as well as the middle road of

06:14

the benefits it's also the most popular plan so when we're looking at the plans that just came up here we'll look at the silver level plan and silver level plans our silver level plans then cover California and by that I mean that the benefits are exactly the same regardless of which plan someone looks at so whether it's health net or Molina or Blue Shield or Kaiser or sharp or whomever it is the benefits are exactly the same that does not change now the cost is going to change because the cost of the plan is actually more expensive or less expensive but the benefits don't change

06:44

and the subsidies doesn't change so in this case we can see here of a person who household of four who are 50 and 45 and 19 and 14 and their income is 70,000 they live here in Southern California the amount of subsidy that they're eligible for is nine hundred and forty-five dollars and seventy five cents and that is a combination of both federal and state subsidies and that subsidy is applied to Rio whichever plan somebody would want to choose so whether they choose a Health Net plan or a Blue Shield plan or the other plans it applies to all the different plans

07:15

equally so that's not gonna change the only thing that would change that is someone's demographic information so your household size your income and the important thing with income is that it is dollar for a dollar so if your income goes up like five dollars or $10 or $1000 it's going to have an effect on how much subsidy you are eligible to hear eligible to get so in this example if we look at Health Net the actual cost the plan is one thousand three hundred and eighty seven dollars and twenty seven twenty cents and so that would be the same as if you went to Health Net

07:47

and said I want this plan and get that plan exactly the same plan but the difference is that the federal government is gonna kick in nine hundred and seven dollars and twenty three cents for this family and the state government's gonna kick in twenty eight dollars $38.52 bringing that total down to four hundred forty-one dollars and forty-five cents so this is the amount that they are actually going to have to pay every month this is the actual total cost and then these are the subsidies that are eligible because of their income in their household and those

08:18

kinds of things and like I said these subsidies are exactly the same so they don't change from plan to plan it's just that the actual cost of plan differs so if we looked at a Blue Shield PPO plan you can see here that the actual cost the plan is [Music] is 2,175 dollars and 73 cents the subsidy stays the same because that again is based off their age income household size and location so that's not going to change but it means that if

08:53

they choose this plan it's still silver-level plants the benefits are the same but the actual cost the plan is much higher and so even though the same amount of subsidies added the total costs the plan is still going to be much higher than if they had chose the house map and the other thing that's important is that these plan benefits they change every year the cost change every year so not every year is BlueShield the most expensive or HealthNet the least expensive or million in the middle or sharp or whatever those things will change every year and that's why it's very important to look every year at

09:23

what those plan costs are and make sure that they fit what your budget is as well is what your needs are and so there are other plans as gold is bronze there's also platinum we'll go over those in a future video but this example is just really meant to show how that subsidy interplays with the actual cost of a plan and give you an example of what a household an average household looks like and what that cost could be so with that let's get back to the video all right so lastly let's talk about income so cover California basis how much monthly premium assistance you can get on the four factors I mentioned earlier one of

09:55

the biggest factors of the four is income and this can be a bit tricky because everyone's income situations are different also I want to preface this section by saying that I am NOT a tax preparer I'm not a CPA I'm not really that good with numbers so if you have any specific questions about your income and Magi please reach out to your tax professional and they give you better guidance for your specific situation so that being said covered California uses something called a modified adjusted gross income to calculate your subsidy or Magi this uses your taxable income as well as

10:26

things that are not included on your taxes but all include for the purposes of eligibility for premium assistance some of these things that are counted are hourly earnings and bonuses unemployment benefits SSDI Social Security and a variety of other things that may not be on your taxes but should be included for the purposes of calculating you're covered California subsidy so here's a handy form that we use put out by it UC Berkeley that gives an overview of what should or should not be included in Magi income the important thing to

10:56

remember here is that covered California is asking you to make an estimation of your income for the year 2020 that's this year that means if your income is going to be different this year from last year 2019 you'll need to make an estimation of what you think your income will be for 2020 that includes any money you've already made so far plus any unemployment benefits and any income from spouses or children or dependents or anyone who beyond your taxes even if those household members are not applying for insurance they're all your tax then

11:28

we generally want to include their income and again this is just a brief overview of income but we will save the in-depth income requirements for future videos so I hope that you got some of your questions about getting health insurance answered Bay in this video I know that the whole process can be confusing and frustrating and sometimes just just plain hard especially a couple with all the other things that may be going on your life right now that is why we here at California are here to help we are certified covered County enrollment entities and we can assist you think all the steps the process of

11:58

enrollment in addition to getting you enrolled we're available year-round to help you submit documents make up is the existing covered California accounts get tax forms like 1095 days and help you renew your plans when it comes time so if you need to enroll or have general questions feel free to reach out to us and we can make some of your videos or post answers to your general questions but if you want more specific help you can always contact us like the information on the screen and we can walk you through the whole process of enrollment in English or in Spanish so please don't forget to Like and

12:28

subscribe to get updates when our newest and most informative videos become available so for California this is Michael wishing you a happy healthy day

Losing Health Insurance from Work? Basics of Getting Health Insurance through Covered California.

Table of Contents

More in Lectorium

SMALL BUSINESS

SENIOR PRESCRIPTION COVERAGE

DENTAL COVERAGE

SENIOR VISION COVERAGE