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We’ll post information here from time to time to advise you of deadlines, new developments, changes in the law that may affect your insurance, and the like. Let us know if there’s a topic you’d like to know more about.

What Was New in 2023 for Covered California

This information appeared on our health insurance page a year ago, but we’re archiving it here as we update that page for 2024.

New carrier: Aetna

Aetna is entering the individual marketplace with an HMO product. It is competitively priced, but in our service area their provider network is not robust. The biggest impact of Aetna’s entry will be in eastern El Dorado County, where there will now be three carriers instead of two. Since the Affordable Care Act bases premium tax credits on the cost of the second cheapest silver plan in a given zip code, and because there is a wide gap between Aetna and Anthem’s prices, which are similar, and Blue Shield’s PPO, which is much higher, Blue Shield PPO subscribers in eastern El Dorado County are going to see significant cost increases in 2023. Switching to Aetna or Anthem will alleviate the price increase, but you may need to travel west for your medical care, except in an emergency situation where you are allowed to use out of network providers.

Changes to silver plans: higher deductibles and copayments

This table shows some of the substantial increases in deductible and copayments for silver plans in 2023. Costs shown are per-person, per visit, and in-network.

Hospital Deductible$3,700$4,750
Out of Pocket Maximum$8,200$8,750
Primary Care Visit$35$45
Specialist Visit$70$85

Some relief for the family glitch: Dependents will now be eligible for premium tax credits if your employer doesn’t subsidize the cost of their insurance, making it unaffordable

Prior to 2023, if an employer offered health coverage to an employee, the additional cost to cover the employee’s dependents was not considered when determining whether or not the employer’s coverage was affordable. This family glitch prevented many families from getting subsidies for dependent coverage from Covered California. For example, if an employer paid for an employee’s health insurance but charged $1,000/month to cover the spouse, the spouse’s coverage was considered affordable.

In 2023, the cost of covering the entire family is considered; if the family cost (employee plus dependents) exceeds 9.12% of the household’s income, then the dependents are eligible to receive premium tax credits for coverage through Covered California. Note that the cost of an employee’s coverage is still considered separately from the family cost; employees whose employee-only coverage costs less than 9.12% of household income cannot get premium tax credits for themselves, even if their dependents can. This means that the family glitch isn’t completely fixed. For example, if a married couple both work and each spouse’s cost for coverage through their respective employer costs 9% of the household’s income (total cost: 18% of household income), neither spouse would be eligible for premium tax credits.

The reason the glitch wasn’t fully fixed is because the wording of the Affordable Care Act as to whether or not an employee’s coverage is affordable is flawed, testing each employee’s affordability of coverage as a percentage of the entire household’s income. The Internal Revenue Service was able to add a regulation as to the affordability of coverage for dependents who aren’t employed by an employer who offers them health coverage, but it couldn’t work around the wording of the law with respect to a family member whose employer does offer them coverage. Completely fixing the family glitch will require Congress to amend the law, which has so far been impossible due to partisan politics.

Note that Covered California does not perform any of these tests; it is up to the applicant to correctly answer the is this coverage affordable question in the Covered California application. Let us sign you up and we’ll do the math for you!

COVID-19 Public Health Emergency Ending

Update: Covered California announced on that they will allow the public health emergency qualifying life event to be used through , giving people until the end of the month to still sign up or make changes to their health coverage.

On the federal government declared the COVID-19 pandemic to be a public health emergency. That emergency declaration is ending on , resulting in big changes that affect Medi-Cal enrollees and people wanting to obtain health insurance. These changes aren’t really new—we’re just going back to how things worked before COVID—but we’ve been operating under emergency measures for so long that it’s important to remind everyone how the normal rules work.

The Affordable Care Act guarantees coverage to people regardless of any preexisting health conditions, but that poses a problem: With coverage guaranteed, people could save money by not getting insurance until they get sick. Insurance works by having a broad pool of people, healthy and sick, all paying premiums. If only sick people bought insurance, the premiums would have to be much higher, because there’d be far fewer people paying premiums to cover the same amount of claims. To avoid this adverse selection problem, the ACA does the same thing that employer-sponsored group health plans, which also have no preexisting condition limitations, do: Enrollments are limited to a brief annual open enrollment period, plus a small window when people can sign up after a qualifying life event like having a child or getting married. Additionally, coverage doesn’t begin immediately after you sign up. For Covered California, the annual enrollment period is November 1 to January 31, the qualifying life event enrollment window is 60 days from the QLE, and coverage doesn't begin until the following month (or January 1 during open enrollment, if later).

Effect on Covered California

Covered California has been allowing people to use the public health emergency as their qualifying life event, effectively letting people sign up and make changes to their coverage year-round. After the public health emergency ends on , people can only sign up or change plans if another qualifying life event applies. If you’ve held off on buying health insurance and are more than 60 days from a qualifying life event, you only have until to do so; after that you’ll have to wait until open enrollment to buy coverage that starts next year. Call us before time runs out, and keep in mind that, due to a major system upgrade, Covered California’s system will be down from until , during which time we cannot sign people up nor make any changes.

Effect on Medi-Cal

During the COVID-19 public health emergency, states were prohibited from dropping people from the Medicaid program (called Medi-Cal in California), even if they no longer met the qualifications for the program. That prohibition ended on , so Medi-Cal has resumed sending annual renewal questionnaires and will begin dropping people who do not respond or no longer qualify. Questionnaire due dates coincide with the anniversary of being enrolled into Medi-Cal. The first Medi-Cal non-renewals will be effective on . Medi-Cal recipients should go to https://KeepMediCalCoverage.org for information on how to update their information with Medi-Cal and on what to do if they get a letter saying they will be dropped from the program.

If you are dropped from Medi-Cal, you will automatically be transitioned into the lowest cost silver plan available to you through Covered California. You will have one month after your Medi-Cal coverage ends to accept the new plan or choose another one, and make the first month’s premium payment, if any; otherwise the Covered California coverage will not take effect and you will not have health coverage. If you do not obtain coverage within 60 days of being dropped from Medi-Cal, you will have to wait until open enrollment to sign up for coverage that takes effect the following year. Call us and we can help you pick a plan and make a payment so that you can retain health coverage for you and your family.

Our First Blog Post: 2022 Recap

In the waning days of 2022, I’m excited to unveil our revamped web site, which features this blog page, expanded content, and a site search capability. The new content won’t show up in the site search until Bing’s robot next indexes our site, which could be a few days or weeks from now. I dusted off my computer science degree and coded all of this myself in HTML, CSS, Javascript and PHP. It was fun to get geeky again and catch up on modern day web technology!

The reason I had the time to do this was the sale of our property and casualty insurance division to O’Donnell Insurance Services on . Our focus is now exclusively on health, life, and disability insurance, which has left me with more time for family and hobbies (and programming this web site😊). My former employees have all found work with other insurance agencies. We’re now open Monday through Friday from 9AM to 5PM, with office hours by appointment only, as I’ve rented out the office to eXp Realty and use their conference room to meet clients. Please call O’Donnell for service on an existing P&C policy that we wrote or for quotes on new P&C business.

2022 was a busy year on the legal and regulatory front, with several changes affecting our industry:

  • Since , we’ve needed to record all phone calls that involve Medicare Advantage and prescription drug plan products. We also need to print a disclaimer on our web site and other Medicare-related communications and read it out loud on the phone calls we must record. A new California law will also require emails we send starting January 1st to include our insurance license numbers. My emails have always contained my license number, but now it will have to appear on a different line of my email signature; I’m sure you’re as thrilled as I am about this dramatic improvement. Seriously though, most regulations come about due to a few bad apples whose misdeeds we all end up paying for through increased oversight. At some point, the regulatory overhead sucks the joy out of the job; that was a major reason why I stopped selling investment products in 2018. Medicare oversight is heading in that direction, but hopefully the call recording regulations will be enough to weed out the bad apples.

  • The American Rescue Plan Act of 2021 eliminated the Affordable Care Act’s subsidy cliff for people earning over 400% of the federal poverty level, but only for 2021 and 2022. The Inflation Reduction Act extended this through the end of 2025. Since Congress usually looks at a bill’s cost over ten years and this is a very costly benefit, in all likelihood it will keep deferring the subsidy cliff for a few years at a time instead of applying a permanent fix.

    The Inflation Adjustment Act also made substantial changes to Medicare drug plan coverage, but to keep the ten-year cost of the bill down these changes are being phased in over the next few years. The only change for 2023 is that the cost of insulin will be capped at $35 for a one month supply.

  • The ARPA prohibited states from removing people from Medicaid (called Medi-Cal in California) during the federal COVID emergency. This has led to wasteful absurdities: a person who got laid off from a high-paying job could apply for and get Medi-Cal, and then keep it after getting a new high-paying job. The 2023 omnibus spending bill, which was just signed into law, allows states to resume income-testing Medi-Cal recipients and disenrolling them, starting in April of 2023.

Finally, I’m pleased to announce that my wife Nancy obtained her health and life insurance license last month. Just as I advise my clients to hope for the best and plan for the worst through life insurance and estate planning, getting Nancy licensed was key to our own estate plans, to prevent a forced sale of the agency if I were to suddenly die. I will acquaint her with the agency’s operations over time so that she could eventually step in if I needed help. It’s a great comfort having plans in place to take care of the people you love! Call us if we can help you with your own contingency plans using disability and life insurance products.

Best wishes for 2023.

signature of Robert