Covered California: The COBRA Glitch

Screenshot from CoveredCA.com, the website of Covered California.

Screenshot from CoveredCA.com, the website of Covered California.

“Forgive me for intruding upon your personal email,” Jill Bond wrote me earlier this month.

Bond emailed that she had heard me on KQED’s “Forum” discussing Covered California, and then when a post from me popped up on our neighborhood listserv, she put two and two together and reached out for help. In the months since the Covered California marketplace opened, I have fielded a lot of inquiries from friends and colleagues. I emailed Bond back right away.

Even if you have COBRA now, the only way to enroll in a plan with a subsidy is to say you don’t.

Bond told me she had enrolled in a Covered California plan but didn’t understand where her subsidy was. When she had reviewed her options for Covered California, the “shop and compare” calculator indicated that she qualified for a subsidy — close to $300 — but when she actually enrolled, the subsidy was not applied.

And Bond definitely needs the coverage. In 2010, Bond was treated for non-Hodgkin lymphoma. While she’s cancer-free now, the aggressive chemotherapy damaged her immune system. She says she needs monthly infusions of antibodies to keep her healthy. The treatment is called IVIG, and it costs a small fortune — more than $8,000 a month, Bond said.

Bond outlined her personal situation, and I started running through the various possibilities that could explain where the problem was. She told me her income, and she fell within the range for a subsidy. I couldn’t come up with anything that explained why Bond’s subsidy was not reflected in her enrollment.

Then I realized one detail she had mentioned that I had overlooked. Bond had been insured through COBRA — insurance from her former job that she had been paying in full. I knew from Jon Brooks’ story on this blog that COBRA participation created a glitch for people trying to qualify for subsidies.

I asked Bond if she had put anywhere on her application that she had insurance via COBRA. Yes, she had. “There was a drop-down list,” Bond told me, “and I had to choose COBRA. There was no other choice that would have been appropriate.”

I asked Bond if she had indicated an end date for her COBRA coverage. She said there was no option for her to do so.

Here’s a screen grab from the “apply” section of the application:

Screenshot from Covered California online application.

Screenshot from Covered California online application.

Here’s the problem: People cannot be insured via COBRA and also get a Covered California plan with a subsidy. But that was not what Bond wanted to do. While she had not formally canceled her COBRA insurance, she knew it would cancel automatically when she did not pay her premium. Her intention was not to pay her January premium, which would have retroactively canceled her insurance back to midnight Dec. 31, 2013. Her new Covered California plan had taken effect on Jan. 1.

When Bond contacted me — on Jan. 11 — she had already paid her new Covered California premium in full, nearly $550. The amount of the premium has been hard on her financially. She had been so relieved when she thought she qualified for a subsidy. “It’s really disappointing for me to find out that I’m not actually getting (the subsidy) and then having to come up with the money to pay that premium … it’s killing me.”

I suggested that Bond call her COBRA provider and formally cancel her coverage — and then call Covered California to update her account to qualify for the premium. (As it turns out, it seems you cannot make this change online. Weeks ago, I created a Covered California account. I logged in so I could look at the screen in question. But this part of the application is no longer available for edits once you have finished creating your account. Consumers will need to call Covered California.)

Anne Gonzales, a spokeswoman for Covered California, confirmed the enrollment issue for people who have COBRA. She pointed out the challenges of blending one complex federal program — COBRA — with another, the Affordable Care Act. “It’s difficult to build a system to envision all specific scenarios,” Gonzales wrote in an email. “Consumers who have access to COBRA or are covered by COBRA would be wise to get help with enrollment, either in-person or through our Service Center, especially if they feel that they are missing out on qualifying for subsidies.”

Gonzales also said that Covered California is ”learning from the startup of our enrollment system, and listening to consumer feedback about what would help them through the process.”

Meanwhile, Bond canceled her COBRA policy and then called Covered California. Her subsidy is now applied to her plan and she will pay $256.45 per month. The tax credit saves her $288 monthly.

“This is AMAZING,” Bond emailed me (capitalization hers). “I am so relieved. That extra money will really help my family and I don’t have to worry about being canceled.” She’s glad to be able to get the transfusions she needs.

But as a final note, she says the Covered California representative she spoke to at the call center says “that on my enrollment application I should have checked NO to qualifying for health insurance, even COBRA. That doesn’t make sense to me, but I am not questioning it at this juncture.”

And Payment Problems, Too

My colleague Sarah Baughn enrolled in a Kaiser plan through Covered California. She had a heckuva time trying to pay her January premium. Turns out February is pretty tough, too. When she logged into her account to pay online, she got this error message:
2014-01-22_kaiser_payment copyShe continued to get that error message every day last week. The automatic phone system did not work. They had also not received a paper invoice.

On Monday, her husband spent 4.5 hours (that’s no typo) on hold before he was finally able to pay the February premium over the phone with a live human being.

Do you have a strange glitch you’re experiencing? Leave it in the comments below.

This post has been updated to clarify Anne Gonzales’ statements about the intersection of COBRA and the ACA.

Related
  • Mark Chekal-Bain

    I’d like to encourage your readers to consider contacting their state Senator or Assemblymember if they need assistance in making sure their premiums are paid or have another enrollment problems.

    • http://blogs.kqed.org/stateofhealth Lisa Aliferis, KQED

      I will include this information in future posts. Thank you.

  • Mary Ellen McMuldren

    So far, my son and I are enrolled in a plan for Jan, and I
    paid for January, and it’s frustrating because without the insurance id card providers now are being paid from my pocket and we will have to seek reimbursement later. I haven’t paid for February as I have no invoice. Claim forms are not available so I cannot seek reimbursement yet.

    However after I submitted that enrollment, my college
    student daughter joined our household and we re-did the application and then it
    came out so that my daughter and I were on a plan that I would buy (effective
    2/1/2014—same one my son and I are on now in Jan) and my son (8 year old) would be qualifying for Medi-Cal. The website stated that we would hear from a
    county worker. But we have heard nothing! So I cannot confirm that she is covered for February 2014.

    I really don’t know what to do next. None of these entities answers the phone. Not Covered Ca, not Blue Shield.

    I did call a county worker re Medi-Cal. She
    checked and found no record of my son in the system.

    It does appear that there is a streamlined way for
    applicants to end up in Medi-Cal through Covered Ca.

    Do you know anything about this? So much uncertainty!

    • http://blogs.kqed.org/stateofhealth Lisa Aliferis, KQED

      Can you please email me about your situation? laliferis@kqed.org

  • An observer

    I am trying to enroll with an insurer, but frankly, their customer service is so poor I am questioning why I am signing up? It seems I will only have problems and hassles if I do need care. Do people just put up with the lack of service by rules bound insurance companies?

  • jskdn

    I think this article is wrong and there isn’t a COBRA glitch. From looking a the text to the left of the drop down menu in the screen shot, it’s not being covered by COBRA that makes you ineligible for subsidies through the website application. It’s being covered by a COBRA policy that meets the ACA coverage requirement and costs no more than 9.5% of your income. She shouldn’t have checked the box because at her income, which I calculated to be $33,528, her COBRA coverage could cost no more than $265.43 a month to meet that test, which would be highly unlikely.

    • http://blogs.kqed.org/stateofhealth Lisa Aliferis, KQED

      If you have COBRA at present, but are planning to drop it for a Covered CA plan, there is no way to truthfully answer the “are you insured” question AND get a subsidized Covered California plan. The public information officer confirmed this is the case and said consumers with COBRA should answer “no” when asked if they have insurance in order to qualify for a subsidized plan. But consumers must be sure to time the cancellation of their COBRA plan carefully. We also point out that consumers cannot have both COBRA and a subsidized plan at the same time.

  • MST66

    The biggest problem with our plan right now is that few doctors, none of our regular ones, are accepting Anthem Blue Cross. They have said that Anthem is offering doctors approx. 30% less in reimbursents for patients covered by Covered California plans. When we signed up in December we paid for a gold plan that said it paid for chiropractic and mental health, they provided little detail on the plans and we also assumed they included medical and dental at $500 plus each, WRONG. That’s an extra $125 a month. Blue Cross has pulled a fast one and anyone who has tried to reach them or Covered California knows it takes hours, sometimes three or more to reach someone, they each blame each other. I have emailed the Governor and my federal and state representatives asking them to look into this. All the relief I felt about getting good coverage for my husband and I has evaporated, I just feel scammed now.

    • http://blogs.kqed.org/stateofhealth Lisa Aliferis, KQED

      Can you please email me — I’d like to talk to you about your situation. laliferis@kqed.org