Cat Flag’s Health Insurance Misadventure, Part 3

Healthcare image from SocialInnovationMN

I honestly never thought I would have to do another one of these, yet here we are. This past month, I have had to deal, once again, with America’s health care system. So, once again, I am telling you about my experiences in the hope that in doing so, I will be able to help guide others who might wind up in similar situations. Besides, open enrollment for the so-called “Obamacare” health insurance marketplaces begins once again tomorrow, so now is as good a time as any to look at how the system works.

Quick Review: California and the U.S. Health Care System

The Flag of California

I’ve brought up before that California’s health care system is a bit different than the federal system. California has its own Department of Health Care Services to handle many health care matters. While California must follow federal health care laws, such as the Patient Protection and Affordable Care Act (better known as “Obamacare”), these laws are often flexible enough that the states can set up their own systems, so long as these comply with the federal law. So far, only 17 states and the District of Columbia have done so; all other Americans have to depend on the federal government and apply for health care through

Most Americans are still able to get health insurance for themselves and their families through their employers, and both the federal and Californian health care systems have set up exchanges for small businesses to get insurance to cover their employees. Americans over the age of 65 or who are disabled can still get health insurance coverage through Medicare, which is run by the federal government. Veterans of the U.S. military can also receive health care from the federal government through the Department of Veterans Affairs.

That leaves people who are not able to get health insurance from their employers – either because they are part-time workers, or because they are unemployed or self-employed – and do not qualify for Medicare or veterans benefits. I am a full-time MBA student and part-time worker, so I fall into this category. Under Obamacare, this means I have an individual mandate to buy health insurance or get fined. So, last year, I applied through California’s health insurance exchange system, known as “Covered California”. Both Covered California and are mainly interested in your income level, because that determines what type of insurance you can get.

Medicaid is a federal-state partnership to guarantee health care for Americans who are living in poverty. The government foots the bill for Medicaid patients’ health insurance, so they don’t have to pay a monthly fee or “premium”. California’s version of Medicaid is called “Medi-Cal”, and is managed by the state. If you apply for health coverage through Covered California, and your income is deemed to be low enough to qualify, they will send your case to Medi-Cal to be processed. This is what happened to me last time, and I got a Benefits Identification Card and a note saying I had been enrolled. Just keep that in mind for now.

If you do not qualify for Medicaid, you will have to buy insurance through government-run exchanges. In those states that have not set up their own exchanges, you will have to buy insurance from the federal exchange at, while we Californians will be buying insurance through Covered California. Either way, the federal government offers a special “tax benefit” for those whose income is not low enough for Medicaid but is still less than four times the federal poverty level. If you qualify, Uncle Sam will foot some of the bill for your health insurance. The government will pay the insurance company directly, so the amount you get billed for your insurance is much lower. If you make more than four times the federal poverty level, though, then get out your checkbook – you have to foot the whole bill yourself.

A Crash Course in Medi-Cal

Medical image from CDC and Ryan M Wallace

Now let’s go back in time a little bit, to when I first learned that I was approved for Medi-Cal. A few days after I got my approval notice in the mail, I got a packet of information in the mail from a private health insurance company called CenCal Health. I had always thought that Medi-Cal was run directly by the government, but I was wrong. The state government contracts with various private insurance companies to provide coverage for Medi-Cal patients from different areas. CenCal Health covers San Luis Obispo and Santa Barbara counties, billing the state government for the insurance plans it provides instead of the patients themselves. I was enrolled in CenCal Health’s insurance plan automatically when I was enrolled in Medi-Cal. I had no choice in the matter; there are no other insurance companies providing Medi-Cal coverage in my area and I couldn’t opt-out of Medi-Cal. I was legally obligated to get my insurance through them.

The next thing that CenCal Health sent me was a list of all the doctors in my area that accept Medi-Cal. It turns out that many doctors do not accept Medi-Cal, and many of those that did were not taking any new patients. This was a problem, since Medi-Cal is like an HMO: everyone has to have a primary care physician that he or she goes to see first, before being referred to a specialist for actual treatment. The good news was that there is a non-profit network of medical clinics in my area known as “Community Health Centers” or CHCs. These outfits were taking new patients, so I went in and signed up to get enrolled on their patient list.

A few days later, I got a call asking me to come down and get a check-up, so they would have a base-line idea about my health if I had to come in. They assigned me a primary care physician, a really friendly guy, and we chatted a bit while he did all the usual procedures (check my pulse, look in my ears, check my breathing with the stethoscope, and so on). It was all pretty routine. A few days after that, I got a call from CenCal Health asking me about my primary care physician. It turned out, they didn’t know I had signed up to be a patient at the CHC! Oops. At least it was an easy fix, and soon I got an insurance card in the mail stating who my primary care physician was.

Then, for several months, I didn’t think about health care or health insurance at all. I was healthy, I didn’t have a big bill to pay every month, everything was good. Or so I thought.

The Big Twist: I’m a Welfare Queen?

"Mama mia, Mama mia, Let me go!"

“Mama mia, Mama mia, Let me go!”

Then, just last month, I got a note in the mail from Covered California. It said, and I’m quoting here, “Based on the change you reported: You qualify for health insurance through Covered California.” To which I said, “What?”

I hadn’t changed anything! My first thought was that there was some fraud or identity theft going on, so I called Covered California’s customer service hotline to sort it out. That’s when I got the bad news.

Apparently, Covered California had done an audit of their applications for 2014, and found that my application was one of many that had been misfiled or mishandled. I had not qualified for Medi-Cal after all! I had been enrolled by mistake! I was supposed to have been in Covered California’s program all along.

This was a big problem, because now I had only two days to select and apply for health insurance through Covered California or else I would be without health insurance when November arrived, and subject to a fine. As you can imagine, I was not happy about any of this. But I had no real choice in the matter, so I logged on to Covered California and looked at their insurance plans.

What insurance options are there?

Signing form image from Florida A&M

I looked at the available list of insurance plans I could choose from. All of them were PPOs, meaning I could see any doctor on the plan I wanted and would not need to go through a primary care physician first. There were only two companies offering insurance plans to pick from – Anthem Blue Cross and Blue Shield of California. It turns out that next year there will be more insurance companies available to choose from, but for now, there’s just the two.

The plans that were offered, for the most part, fell into four “Coverage Levels”: Bronze, Silver, Gold, and Platinum. Bronze is the cheapest, but forces you to pay more out-of-pocket for your medical care. Silver covers more of your medical bills, but is more expensive. The pattern repeats up the chain, until you get to the Platinum plans, that cover almost all of your medical expenses but make you pay the heftiest premiums. Again, the actual amount you would pay for each plan would vary based on your income.

Interestingly, I noticed that the plans at each tier were exactly identical – both companies’ Bronze plans offered exactly the same coverage, both Silver plans offered exactly the same coverage, and so on. The only difference between the two plans was the cost. Anthem’s plans were more expensive than the Blue Shield plans. Well, shoot, I thought, why would I pick Anthem, then?

There was one more interesting option that I discovered while shopping and comparing insurance plans. I learned that California offers a special tier of insurance coverage for certain, income-eligible individuals, known as an “Enhanced Silver Plan”. These are plans that offer coverage equivalent to a Gold or Platinum plan, but Uncle Sam pays most of the bill, and the price the patient is left with is about the same as that of a Silver plan. Not everyone will qualify for these plans, but for those that do, it sounds like a pretty sweet deal to me.

Once I made my selection and applied through Covered California, they contacted the insurance company, and in turn, the insurance company sent me a letter saying that all I had left to do to enroll was pay my first bill. Then, I would be enrolled on November 1.

The problem was that I didn’t get that letter in the mail until October 30. Ack! I couldn’t pay by mail, so I tried to pay online. Wouldn’t you know it, just as I clicked “Pay Bill”, their website crashed. I had to wait until morning, when I could finally pay by phone, just hours before the deadline. Disaster averted!

With that finally out of the way, I got confirmation of my enrollment via e-mail and snail mail. Now, I’m just waiting for the stack of paperwork associated with my new insurance coverage listing all the rules and all the doctors I can see. Meanwhile, open enrollment for next year’s Obamacare exchanges starts tomorrow, and if I want to get coverage by January 1, 2015, and I do, then I will have to apply through Covered California again by December 15.

Ripping hair out image from Vempyre