August 27, 2014

FAQs

F.A.Q’S

1. Can I choose my own doctor?

Answer:  Yes, thousands of doctors accept insurances that participate in the CoveredCA market place , as well as, all of the major hospital providers in San Diego. Doctors availability will vary based on the insurance provider.

2. Which Insurance Companies are available?

Answer: The available Insurance companies vary from region to region. In San Diego all of the largest insurance providers participate in the exchange.

3. How do you get paid?

Answer: We are compensated either by the state directly, or by the Insurance provider. There is ABSOLUTLY NO COST  to the insured.  This allows us to be able to continuously help with any Insurance issues that our clients have year round, not just during open enrollment.

4. Can I change my current CoveredCA plan through your services?

Answer: Yes, if you would like to make a change in metal level, plan provider, or have a household change we can assist you to make the appropriate changes.

5. What information do I need to bring ?

Answer:

  • Government Issued ID
  • Address
  • Date of Birth for all Household Members
  • Last Year’s Tax Information or Current paycheck stub
  • Social Security Card for all household members applying for health insurance
  • If already covered through CoveredCA- Have Current Plan information (application #, Case #, Policy number)

6. Which Doctors accept CoveredCA?

Answer: Doctors networks through CoveredCA and outside of Covered CA are mandated by Federal law to be exactly the same. A doctor who is accepting new patients through any of the marketplace providers must except plans on and off the exchange equally.

7. How do I get help with my CoveredCA account outside of  November- February?

Answer: Outside of November-February Individuals will need to have a life changing event that will qualify them for Special Enrollment. These events consist of: substantial change in income, household size change, location change or loss of current benefits.

8. What is the difference between Open enrollment and special enrollment?

Answer: Open Enrollment is a time period when Individuals can make changes without pre-requisits. This means that they are able to change plans, metal levels, or companies without having to have a “life changing event” to qualify them. Special Enrollment allows the individual to make the same changes but requires a “life changing event” to happen before somebody can change there plan.

9. Who qualifies for Subsidies  CoveredCA?

Answer: In general, Subsidies are available for individuals who are residence of California, are legally present, and meet the income guidelines for subsidy.

10. What if I make too much for Subsidy?

Answer:  Individuals who make above 400 % of the Federal Poverty Level are still eligible to enroll in a health plan through CoveredCA but they will not be eligible for Subsidy. At the end of the year if their income is below the 400% FPL then any amount of subsidy that should have been received will be paid back on the year’s tax return.

11. What are subsidies based on ?

Answer: In general Subsides are base on four criteria : Age, Income, Location and Household size. The subsidies are qualified based on a sliding scale that varies based on the previous four attributes.

12.  Do I have to be a citizen to qualify?

Answer: In general, A person does not have to be a citizen, but they will have to be lawfully present in California.

13. Where can I go to get Health care?

Answer: All of the major healthcare providers in San Diego Accept one or more of the plans available on the CoveredCA exchange.

14. What if I my income is not steady?

Answer: If you income is not steady, you should still apply for CoveredCA, because it will be adjusted automatically to the correct amount of subsidy based on your end of the year tax filing.

15. Can self employed individual apply?

Answer: Yes, Self employed individuals should apply.

16. What are the penalties if I don’t get health insurance?

Answer: Last year the penalties for not having insurance was 1% of the household income. This year it will be increased to 2%.

17.  Is CoveredCA Full coverage?

Answer: The plans that are available through CoveredCA are full coverage. They cover general, preventative, and emergency care.

19. What information do I need to apply ?

Answer: To apply you will need to have a valid form of Identification and your basic personal information: Address, Name, Date of birth, and socieal security number ( or alternat citizenship documents).

20. What do you charge for your service ?

Answer: There is no charge for our service.

21. When will my coverage start?

Answer: For new enrollees the insurance coverage will begin January 1 2015

22. Can I get coverage, even if I have coverage offered through my spouses work?

Answer: If you are offered “affordable” coverage through either your work or your spouses work, you will not be able to qualify for Subsidies.

23. How long can my children stay on plan?

Answer: Your children can stay on your health plan until the age of 26 regardless of there student status, but they must be claimed on  your taxes as dependents.

24.  Can I be declined for health reasons?

Answer: NO, the Affordable Care Act disallows insurance companies to decline coverage based on previous, current or potential health problems.

25. What happens if I overestimate or underestimate my Income?

Answer : If you overestimate your income and receive less Subsidy than you should have your will receive the remaining amount of subsidy on your tax return. If you underestimate your Income and receive too much subsidy throughout the year you may be asked for a portion of it to be paid back on your taxes.