The “glitch” is gone. Working Ventura County families who previously couldn’t get health insurance subsidies can now receive the aid to shrink their premiums.
The changes in Covered California, the state insurance marketplace now accepting coverage enrollments for 2023, impact spouses and children of employees insured through work.
In the past, family members were blocked out of the program's subsidies no matter how high premiums were in employer coverage. Affordability calculations were based on individual plans, not family coverage.
The limitation was dubbed the “family glitch.”
A new IRS rule finalized in October removes the barrier. People could be eligible for subsidies in 2023 coverage if family costs for work-based insurance consumes more than 9.12% of household income. Employees will still likely be required to keep work coverage for themselves but spouses and children can get insurance — and subsidies — through Covered California.
“We estimate there are more than 600,000 Californians who (were) in the glitch,” said Jessica Altman, Covered California’s executive director. She noted that while companies often pay for much of the coverage for their employees, family rates are usually far higher.
The amount of help available depends largely on income. CalMatters, the nonprofit news organization, cited analysis showing a family of four making $53,000 could save $4,340 in premiums a year through Covered California. People can assess their eligibility, and estimate the cost of premiums, by using the marketplaces' shop and compare tool.
Kaiser Family Foundation also offers an online calculator to determine whether people can save money through Covered California.
“People say ‘I probably make too much. It’s not worth the time,’” Altman said, noting that other changes mean more middle-income people qualify for subsidies. “Everyone, regardless of your income, should take that five minutes.”
Premiums in the program for 2023 are increasing an average of 5.6% across the state and 4.4% in the region that includes Ventura County. If people meet the subsidy levels, the aid can be significant. Altman said about two-thirds of the people insured through Covered California pay $10 or less a month.
The decade-old marketplace was created by the federal Affordable Care Act to provide coverage to the uninsured with subsidies from the federal government. Open enrollment for 2023 began in November and continues to Jan. 31. People who want coverage beginning Jan. 1 need to be enrolled by the end of the year.
In Ventura, Santa Barbara and San Luis Obispo counties, 77,620 people were insured through the program as of June. More than 90% of them qualified for subsidies. Different insurers provide coverage in regions across the state with Anthem Blue Cross, Blue Shield of California and Kaiser Permanente participating in the marketplace in Ventura County.
Altman credited Covered California for helping reduce the state's uninsured population from 17% in 2013 to 7% as of last year, but also pointed at people who face state tax fines for not having coverage as proof more education is needed.
“We have new data that shows there are over 1 million Californians going without coverage. We still have work to do,” Altman said. About half of the uninsured are eligible for Covered California subsidies and the other half likely qualify for Medi-Cal.
In Ventura County, about 39,000 people, or about 5% of the population, were uninsured in 2021, according to the California Health Interview Survey.
Tom Kisken covers health care and other news for the Ventura County Star. Reach him at email@example.com or 805-437-0255.
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This article originally appeared on Ventura County Star: Covered California expands coverage subsidies thanks to IRS rule