California Individual & Family Exchange Similar to

I recently ran across an article comparing the purchase of individual & family health insurance coverage through the California Health Benefits Exchange to shopping online at Amazon, Travelocity, or Expedia. Sure sounds easy enough. Just pick the health plan you want and click on a button to buy it from the Exchange, just like you get your airline tickets or new book by your favorite author shopping online today. And with no medical underwriting it should be even easier than it is today. And it will provide a tax subsidy for the cost of premiums for those who qualify. What could be simpler?

Well, no, the Amazon example that has been bandied around is a very poor example of how you will buy health insurance coverage in the Exchange in California. Unless, of course, Amazon and Expedia initiate new requirements to provide a bit more of your personal and financial information that just a credit card number to purchase the ticket or the book.

California individuals & families purchasing health insurance under the reform law in California from the Exchange will fall into one of four "buckets".

*Medi-Cal& Healthy Families full coverage levels (no share of cost)
*Medi-Cal at exchange subsidy levels with potential Healthy Families kids
*Those above Medi-Cal threshold entitled to some exchange subsidy
*Those above 400% FPL who will receive no subsidy from the exchange

All applicants seeking to purchase Exchange coverage for themselves and/or their families through the California Health Exchange will have to be financially 'vetted' to determine level of subsidy qualification (if any) before they can purchase an Exchange plan. Specifically the Exchange wants to ensure those qualifying for no-cost or cost-share Medi-Cal and Healthy Families are addressed appropriately and not enrolled incorrectly.

In discussing this with a carrier rep, we were trying to figure out if there is a method to determine what information may be required by the California Health Benefits Exchange to purchase and enroll in an exchange subsidy product. Because those currently covered by Medi-Cal and Healthy Families must certify their financial eligibility every year, we realized that the current Medi-Cal application is likely an accurate framework for the information that will need to be provided to the Exchange (and IRS) to purchase subsidy coverage.

Below I have linked to the current California Medi-Cal Application and and Medi-Cal Instruction brochure. I suggest those considering Exchange coverage take a look at the questions and information required on this application to better understand what information the CA HBEX will require to properly assess subsidy level and qualifications to purchase from the Exchange. It's a bit more 'personal' than Amazon and Expedia.

California Medi-Cal Application Form

California Medi-Cal Application Instructions


As always, for specific health insurance information, use the link above to go to my web site.

FPL - Federal Poverty Level
HBEX - Health Benefits Exchange
Healthy Families - A low cost health plan for children
Medi-Cal - California's Medicaid program


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