We have been preparing for the next Open Enrollment period for purchasing individual and family medical insurance plans, which begins on November 15, 2014 and ends on February 15, 2015.
One thing I’ve discovered is that the insurance companies, California State government and the Federal government all have different names for insurance plans offered through Covered CA, the state-run exchange for buying health insurance.
Here’s a list of all the different names I’ve come across in CA that essentially all refer to the same plans, the Covered CA plans.
- Covered CA plans
- Obamacare plans
- Exchange plans
- CA State Exchange plans
- Marketplace plans
- HBEX (Health Benefit Exchange) plans
- HIX (Health Insurance Exchange) plans
- Health Care Reform plans
- PPACA (Patient Protection & Affordability Act) plans
- ACA (Affordable Care Act) plans
- Federal Healthcare.gov plans
- On-Exchange plans
These names are confusing and misleading, as many of you discovered last year. The solution is to simply remember that there are 2 markets: On-Exchange and Off-Exchange.
1) If you do not qualify for a subsidy you do not have to buy from the Covered CA website. You can buy Off-Exchange plans with no Govt. subsidy. You can avoid the technical problems and onerous information requirements of the Covered CA website by applying for a plan through our website www.health-insurance.com, or calling us at 925-284-2000. There are no fees for our services and the premium for your plan is the same whether or not you use an agent.
2) If you qualify for a subsidy due to your income, you can use our expertise as your certified agent to apply to Covered CA, and to receive ongoing assistance from us. These are called On-Exchange Plans. In fact, it is advisable to use a certified agent to apply to Covered California plans because they have up-to-date information on changing plan designs, provider networks, drug formularies, and a dedicated broker support team at Covered California for support. Certified insurance agents enrolled between 40% and 80% of individuals, inside and outside of Covered California.
Applying for a subsidy (also known as the Advance Premium Tax Credit APTC) by applying to Covered CA may require you to submit documentation to verify information such as income, immigration status and employment. The information you provide is subject to verification by the IRS, Dept. of Homeland Security, Dept. of Labor, etc. either at the time of application or at a later date.
Here’s a simple chart to help you figure out which type of medical insurance plan you may qualify for in 2015:
| The 2 Markets for Individual Health Plans | |
| ON Exchange |
OFF Exchange |
| Possible Tax Subsidy based on income |
No Tax Subsidy |
| Marketplace | OFF-Marketplace |
| Covered CA | NON-Covered CA |
| Government Exchange | NON-Government Exchange |
| Limited number of insurance plans | Broader number of insurance plans |
Please keep these terms handy when reading about or shopping for health insurance. When in doubt, call us at 925-284-2000.
The 2 markets for Individual Health Plans:
(1) On Exchange: Tax Subsidy based on income, Marketplace, Govt. Exchange, Limited insurance plans.
(2) Off-Exchange: NO Tax Subsidy, NON-Covered CA, NON-Government Exchange, Broader number of insurance plans.
As always, for our assistance, please call 925-284-2000 or go to www.Health-Insurance.com.
Phil Lee
Lee Health Insurance Services
About Phil Lee