Friday, October 10, 2014

Understanding Covered California for 2015

By Richard L. Peatman, Pharm.D., Meadow Vista Pharmacy

It's that time of year again.  For those of you who have to purchase your own health insurance, you can look up your 2015 rates on Covered California now.  Go to  The good news is that the average price increase for the entire state is 4.2%.  Some areas, such as Region 3 (Sacramento, Placer Counties) had only a 1.8% increase.  The really big change this year is the addition of dental coverage.  Adult coverage will cost between $13 and $59 per month.  Children will be $9 to $34 per month.  Kaiser has partnered with Delta Dental for children's coverage.  Western Health Advantage has selected Premier Access and Anthem and Blue Shield have their own dental plans.  

Here are some things to keep in mind…

  • Sign up starts November 15, 2014 and ends February 15, 2105.  If you have a qualifying life event, you may receive Special Enrollment and become covered under a plan immediately.  Examples of these events are change in marital status, adoption of a child, moving to a new region in California, release from jail or prison or loss of Medi-Cal or health coverage from your job.  It is import to remember that you can also change or enroll in coverage if you have a change in income.
  • You can use a certified enrollment counselor to sign up or do it yourself on line or by phone at 1-800-300-1506.  Covered California's phone hours are Monday  Friday 8am to 6pm and Saturdays 8am to 5pm.
  • The price is the same whether you decide to sign up through Covered California or directly with an insurance company that offers an exchange plan.  
  • Your insurance agent may help you find Off Exchange Plans.  These are plans that are offered in California but not on the exchange.
  • Make sure to use your correct income when signing up.  Your premium assistance from the government is primarily based on income and if that has changed you want to make sure that you give the correct information when signing up for 2015.  The assistance can be significant.  A household with two adults and two children under 18 and a combined income of $70,000, would receive $600 a month on the lowest level plan.
  • Make sure to submit any required documentation promptly.  You can be denied or dropped from coverage if you fail to supply required information.
  • DOUBLE CHECK TO MAKE SURE THAT YOUR HEALTH CARE PROVIDERS ACCEPT THE PLAN YOU SELECT FOR 2015.  Hospitals and doctors are free to change the plans they accept.   Remember, that in most cases, you can keep your 2014 plan for 2015, just keep paying for it.    Consider whether you want to add dental coverage.  And finally, check your Covered California account to confirm your coverage.  Don't assume it's right.

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