Open Enrollment Is Here!

Image

PRC_1819 Open Enrollment_22x21

This year’s health insurance enrollment cycle began on October 15, 2018, and ends on January 15, 2019. Enrolling is easy and may be done a number of ways:

Covered CA Basics

Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.

Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including outpatient care, hospitalization, prescription drugs, laboratory tests, mental health care, and emergency services. There are five health carriers who offer a variety of plans in the County of San Francisco: Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, and Oscar.

Sign Up and Renewal Dates

  • Sign up by December 15, 2018, for coverage starting January 1, 2019
  • Sign up by January 15, 2019, for coverage starting February 1, 2019 

Need Help Paying For Health Insurance Costs?

Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The AIDS Drug Assistance Program (ADAP)  and Office of AIDS Health Insurance Premium Payment Program (OA-HIPP)  help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.

Get Help

Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident who needs assistance in exploring your options and/or enrolling in healthcare you can contact PRC for additional help and information:  415-777-0333.

 

Advertisements

Employer-Based Health Insurance Premium Payment (EB-HIPP) Program for ADAP Clients

Featured

On May 15, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) announced the implementation of an employer-based health insurance premium payment (EB-HIPP) Program. New and existing ADAP clients who are enrolled in an employer-based health insurance plan are now eligible to receive premium assistance for their portion of their insurance premium.

EB-HIPP will pay medical and dental premiums, and it will also pay for vision premiums that are included in a medical or dental premium.  EB-HIPP It will also pay the even pays for medical out of pocket (MOOP) expenses!

Eligibility for EB-HIPP is based on the following requirements:

  • Be enrolled in ADAP
  • Be employed and enrolled in an employer-based insurance program
  • Employment verified with paystub dated within last three months
  • The employer must agree to participate in the EB-HIPP program

Medicare Part D Premium Payment Program (MDPP) Now Offers Medigap Premium Payment Program for ADAP Clients

Effective June 14, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) has also expanded their MDPP Program benefits to include payment of Medigap premiums. Medigap insurance is private insurance that helps pay for some of the health care costs that are not covered by traditional Medicare, such as copayments, coinsurance, and deductibles. New and existing MDPP clients will now be eligible to receive assistance with their Medigap insurance premiums, as well as medical out of pocket (MOOP) expenses for Medicare outpatient claims.

Note: EB-HIPP must pay the client’s portion of their premium in order for the client to receive MOOP benefits

It is tax time again.

Featured

2018With all the recent tax reform changes, many people have many questions. Intuit has created a nice article that explains how the changes affect 2017 taxes (taxes you actually file in 2018) and changes that take effect next year during the 2018-tax filing season (taxes you file in 2019).  Below are some highlights, important dates, and resources to help you file your taxes.

Tax Penalty for Not Having Health Insurance

Individuals without qualifying health coverage for all or part of 2017 may still have to pay a tax penalty for the tax year 2017. A tax preparer or tax prep software may assist in calculating any penalty for not having health insurance.

For the tax year 2017, the penalty is the greater of 1) 2.5% of total household adjusted gross income, OR 2) $695 per adult and $347.50 per child, up to a maximum of $2,085 per family. The penalty amounts have not been set for the 2018 tax year and beyond.

In limited situations, some individuals may be exempt from the tax penalty.

Medical Expenses

If you itemize deductions in 2017, you may be able to deduct qualifying medical expenses to the extent they exceed 7.5% of your Adjusted Gross Income. See the IRS Publication for a full list of qualified medical expenses.

Deadline to File 2017 Taxes is April 7, 2018

The deadline to file your personal tax return for the tax year 2017 is Tuesday, April 17, 2018. (Why the change? Because April 15 falls on a Sunday, and Monday is Emancipation Day, observed in Washington D.C., the home of the IRS.) If you are not ready to prepare and file your return by the deadline, you may request a six-month extension with the IRS.

Free Tax Filing Assistance in San Francisco

Mission Economic Development Agency (MEDA)

Provides free tax services in English and Spanish. Call 2-1-1 (available 24/7 in 150 languages) to make an appointment.

Volunteer Income Tax Assistance (VITA)

Provides free tax return preparation for qualifying taxpayers. Visit the hyperlink above to locate a VITA or Tax Counseling for the Elderly (TCE) program near you.

Earn it! Keep it! Save it! A program of the United Way

Provides free tax services to qualifying taxpayers. Visit the hyperlink to find out about eligibility, what to bring to your meeting and the program sites near you.

AARP Foundation Tax-Aide

Offers free, individualized tax preparation for low to moderate-income taxpayers – especially those 50 and older – at more than 5,000 locations nationwide. Find a location near you by searching the link.

HEALTH CARE TIP: Adult Dental Benefits

Featured

Adult dental benefits were fully restored to Midi-Cal recipients effective January 1, 2018, as part of the 2017-2018 Budget Act. Now major services such as partial dentures, root canals on back teeth and gum treatment are covered. Along with an array of general maintenance services such as cleanings, x-rays and fillings and more, Western Center on Law & Poverty has a one-page fact sheet on the restored adult dental benefits.

Still, ongoing access to Denti-Cal services and providers is an issue in California. In 2015, the state appointed a State Dental Director to address Denti-Cal access. To access Denti-Cal and take advantage of these adult dental benefits enroll in Medi-Cal through Covered CA.

Reminder: Covered CA open enrollment ends Wednesday, January 31, 2018.

Importance of the First Premium Payment for 2018 Health Coverage

Featured

First, the deadline to enroll for 2018 health coverage is Wednesday, January 31, 2018, so enroll now.

Once signed up for a 2018 health plan through the marketplace, it is very important to pay the first month’s premium on time to activate coverage. If there are issues paying the first month’s premium payment in full, the Health Insurance Premium Payment Program may be able to provide financial assistance. Also, consider reaching out to the insurance company to understand payment options and/or grace periods. Once again, the first premium payment needs to be paid, or there is a chance of losing 2018 coverage.

If enrollment is not complete by January 31, 2018, there will not be another opportunity to enroll unless you qualify for a Special Enrollment Period. If you or someone you know is HIV+ and a San Francisco resident, PRC may be able to help with problems accessing health coverage.

OFFICE OF AIDS NOW PAYS FIRST MONTH’S HEALTH INSURANCE PREMIUM PAYMENT

By Chuan Teng, Esq.

Managing Legal Director

CA Office of AIDS’s Health Insurance Premium Payment program (OA-HIPP) now pays the first month’s premium (“binder payment”) for eligible health insurance plans (Management Memo 2016-18). Individuals must enroll in OA-HIPP within 48 hours of enrolling in a health insurance plan to access the binder payment benefit via OA-HIPP.

Individuals who miss the 48 hour deadline for binder payment may be eligible for limited special funding through AIDS Emergency Fund. See below.

HEALTH INSURANCE PLANS ELIGIBLE FOR OA-HIPP BINDER PAYMENT

The following health insurance plans sold through Covered CA are eligible for OA-HIPP binder payment.

  • Blue Shield
  • Kaiser
  • Anthem Blue Cross (non-Covered CA plans also eligible)
  • Health Net

HOW TO ENROLL (FOR NEW OA-HIPP ENROLLMENT)

New clients must enroll in OA-HIPP with a certified ADAP/OA-HIPP enrollment worker within 48 hours of enrolling in an eligible health insurance plan to access binder payment.

NEW CLIENTS: Immediately after health insurance plan enrollment, submit to an enrollment worker a Covered California Enrollment History or Current Enrollment summary page which includes the following information:

      • Premium amount
      • Health plan name and medal tier
      • Advanced Premium Tax Credit taken
      • Health plan billing address (if available)

(*A screenshot or screen-print(s) from the Covered California account is permissible.)

ENROLLMENT WORKERS: Submit enrollment documentation through the A.J. Boggs portal by creating an Update Form using the People Picker tool and inform your ADAP Advisor of a new pending OA-HIPP application within 48 hours of the client’s health insurance enrollment.


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

    • STEP 1: Create an Update Form by using the People Picker tool to upload the enrollment documentation in the “most recent Covered California medical plan billing statement[2] field under the “Insurance Assistance” tab in the A.J. Boggs portal.
    • STEP 2: Enter the Covered California enrollment confirmation number located in the top left corner of all summaries into the “Member or Subscriber ID” field.
    • STEP 3: Promptly notify ADAP Advisor that a new OA-HIPP application has been submitted and requires initial payment so the application is prioritized for review/approval.
    • STEP 4 (Follow-Up Steps Required AFTER Enrollment): Upload client’s billing statement with the client’s health plan member ID/policy number to the A.J. Boggs portal by creating an Update Form. The client will receive a health plan billing statement from his/her health plan once initial payment is made by OA-HIPP.

If the client misses the 48-hour deadline to enroll in OA-HIPP for binder payment, the client will need to make the initial premium payment out-of-pocket to secure health insurance. See below for special funding.

LIMITED SPECIAL FUNDING FROM AIDS EMERGENCY FUND

Limited special funding through AIDS Emergency Fund is available for individuals who miss the 48-hour deadline to enroll in OA-HIPP to access a binder payment. HIV-positive San Francisco residents may be eligible for special funding. For more information, contact AIDS Emergency Fund (415-558-6999 x 228).


[1] Existing OA-HIPP clients must update their health insurance information in the A.J. Boggs portal as soon as possible to ensure ongoing premium payments.

[2] A billing statement is not required at the initial OA-HIPP enrollment. However, a billing statement must be uploaded in the A.J. Boggs portal after the binder payment is made and the health plan issues a billing statement to the client. See Step 4.

OPEN ENROLLMENT IS STILL IN PROGRESS!

Image

By Adrienne Mendle, Esq.

ATTENTION ALL HEALTH CONSUMERS!

OPEN ENROLLMENT IS STILL IN PROGRESS! 

From now until January 31, 2017, eligible Californians can sign up for health insurance on Covered CA AND may be able to receive subsidies to help pay for monthly premiums!

 You’ve probably heard about rising premiums on the healthcare exchanges. Although this is true, don’t despair – premium subsidies are also increasing! In addition, California offers significant financial support for HIV+ individuals eligible to purchase health plans on Covered CA.

 California’s Office of AIDS offers two programs to help pay for health care: ADAP and OA-HIPP. The Aids Drug Assistance Program (ADAP) pays for costs and co-pays associated with HIV-related prescription medication for qualifying individuals making less than 500% of the federal poverty level ($59,400 per year for a household of one). The Office of AIDS Health Insurance Premium Payment (OA-HIPP) program pays for monthly health insurance premiums and has recently begun paying co-pays for outpatient out-of-pocket medical costs, like doctor’s visits and labs. To qualify for this program, you must be enrolled in a private health plan (not through your employer) and be enrolled in ADAP.

 Starting this year, OA-HIPP is also making “Binder Payments” (AKA the first month’s premium) for new Covered CA enrollees! If you sign up for OA-HIPP within 48 hours of enrolling in a Covered CA health plan, OA-HIPP will initiate a Binder Payment on your behalf, activating your new health coverage.

 If you would like coverage starting on January 1, 2017, you will need to sign up for a health plan by December 15, 2016. Open Enrollment ends January 31, 2017; after that, you will need a Special Enrollment Period to sign up for a Covered CA health plan.

 PRC’s Equal Access to Healthcare Program is here to help you through Open Enrollment! Do you need to enroll in a health plan for 2017? Do you need to renew your health plan for 2017? Curious as to whether you are eligible for ADAP and OA-HIPP? Need assistance with something else? Give us a call at 415-777-0333! Our dedicated team of attorneys and advocates would love to talk to you about your healthcare needs.