ACA Application with covered CA

[teej1985]

DW is on ACA with the same plan: Blue Shield Bronze 60 HDHP PPO. Our household income is $30K. We check the Shop and Compare tool. It shows her premium about $400/m. But, the CoveredCA agent on the phone who signed up for her, says it is $0. So we signed up with the plan with $0 premium. I do not know how that works and it is still $0 for next year.

So, I can only suggest to call CoveredCA to sign up for you, and ask what premium will be.

That doesnt' make any sense at all. Are you sure it's the same plan?

 

[Alex The Great]

Do you have a special reason, like an ongoing medical condition that requires your current docs?

Yes unfortunately this is a case. But hope it will be resolved in 1-2 years in one way or other so I can sign up for Kaiser if everything is OK.

 

[Alex The Great]

DW is on ACA with the same plan: Blue Shield Bronze 60 HDHP PPO. Our household income is $30K. We check the Shop and Compare tool. It shows her premium about $400/m. But, the CoveredCA agent on the phone who signed up for her, says it is $0. So we signed up with the plan with $0 premium. I do not know how that works and it is still $0 for next year.

So, I can only suggest to call CoveredCA to sign up for you, and ask what premium will be.

It sound strange to me. I talked to CoveredCA and the price they offered was exactly the price on their web site for my situation. It seem to me something really tricky is going on around these plans.
As regarding the last year, I remember it was somewhere around $312/mo and more doctors accepted it. This year, I see those doctors are out. I suspect this plan will be out of exchange next year as they clearly have some issues.

 

[Alex The Great]

See this post from TFB: https://thefinancebuff.com/aca-insurance-not-include-doctor.html

Thanks, this is exactly the situation. But in my case, I still get a massive premium subsidy.
Right now, Kaiser is definitely not a solution for me. I'll see about the next year. But the problem with Kaiser is to get a descent PCP. This is hard because so many people signing up for Kaiser in this area and not that many descent PCPs. Also Kaiser is good if you are healthy. Otherwise, they may have a poor handling of some condition especially if you have something not common.

 

[fh2000]

That doesnt' make any sense at all. Are you sure it's the same plan?

We received a letter from CoveredCA on 12/1/23 confirming our eligibility. I am on Medicare.

DW's Plan Summary is below:

Plan: Blue Shield - Bronze 60 HDHP PPO
Monthly Premium: $1,133.89
Financial Help: -$1,133.89
Amount you pay: $0.00

Is this the same plan as OP?

 

[Alex The Great]

We received a letter from CoveredCA on 12/1/23 confirming our eligibility. I am on Medicare.

DW's Plan Summary is below:

Plan: Blue Shield - Bronze 60 HDHP PPO
Monthly Premium: $1,133.89
Financial Help: -$1,133.89
Amount you pay: $0.00

Is this the same plan as OP?

Yes it is the same plan.
The problem is in my zip code. Subsidy may vary greatly between zip codes or even more between counties. Mine is 95118, Santa Clara county.
In fact, I just checked it on their web site: 94080 (San Mateo County), 1 person 56 y.o. w/$23K projected income, Blue Shield Bronze 60 HDHP PPO $60.41/mo.

 

[cathy63]

We received a letter from CoveredCA on 12/1/23 confirming our eligibility. I am on Medicare.

DW's Plan Summary is below:

Plan: Blue Shield - Bronze 60 HDHP PPO
Monthly Premium: $1,133.89
Financial Help: -$1,133.89
Amount you pay: $0.00

Is this the same plan as OP?

I don't know how they're coming up with that much of a subsidy unless they changed your income estimate somewhere along the line. But if you aren't entitled to that big a credit, you will just have to pay back part of it when you file your taxes in 2025. Since you're under 200% of the FPL, your repayment is limited. I don't think the limit for the 2024 tax year is known yet (though it might have been posted in the Federal Register at some point), but it should be around $750.

 

[cathy63]

Yes it is the same plan.
The problem is in my zip code. Subsidy may vary greatly between zip codes or even more between counties. Mine is 95118, Santa Clara county.
In fact, I just checked it on their web site: 94080 (San Mateo County), 1 person 56 y.o. w/$23K projected income, Blue Shield Bronze 60 HDHP PPO $60.41/mo.

The subsidy is based on the second lowest cost silver plan that's available to you (this is what we mean by "benchmark"). At your income level, the subsidy will be enough so that specific plan will cost you about $5/mo. Once that amount is calculated, you can use it on any plan you want and you will just pay the difference.

What's making your subsidy lower than San Mateo's is that you have two cheap insurance options available to you in Santa Clara while San Mateo only has one. In Santa Clara, Valley Health is the lowest cost silver plan and Kaiser is the second lowest so that's the one your subsidy is based on. But Valley Health doesn't do business in San Mateo County, so there Kaiser is the lowest cost plan and Blue Shield is the second lowest. That Blue Shield plan in San Mateo is over $300 more expensive than the Kaiser plan in Santa Clara, so the subsidy in San Mateo is also over $300 higher.

Since you are looking at an HSA eligible plan, have you figured the HSA contribution deduction into your income calculations? Your actual income should be about $27150 if you plan to contribute the max.

 

[Alex The Great]

The subsidy is based on the second lowest cost silver plan that's available to you (this is what we mean by "benchmark"). At your income level, the subsidy will be enough so that specific plan will cost you about $5/mo. Once that amount is calculated, you can use it on any plan you want and you will just pay the difference.

What's making your subsidy lower than San Mateo's is that you have two cheap insurance options available to you in Santa Clara while San Mateo only has one. In Santa Clara, Valley Health is the lowest cost silver plan and Kaiser is the second lowest so that's the one your subsidy is based on. But Valley Health doesn't do business in San Mateo County, so there Kaiser is the lowest cost plan and Blue Shield is the second lowest. That Blue Shield plan in San Mateo is over $300 more expensive than the Kaiser plan in Santa Clara, so the subsidy in San Mateo is also over $300 higher.

Since you are looking at an HSA eligible plan, have you figured the HSA contribution deduction into your income calculations? Your actual income should be about $27150 if you plan to contribute the max.

Cathy, thank you so much for explanation! Your reason sound logical.
Yes indeed the number I provided for CoveredCA is not my gross income but a projected MAGI. One deduction I included is HSA contribution. I also count on capital loss carryover $3K from the previous year, which is also included.