Real Life Experiences in Covered California

CoveredCAAnnouncementConsumers, agents, and certified enrollment counselors are reporting various challenges with Covered California health plan enrollment. CECs and agents want Covered California to offer a refresher-training course to address real-life scenarios and complex cases. Agents also want their own dedicated help line as the CECs have, according a report by the California HealthCare Foundation. For the report, PerryUndem conducted interviews with a diverse group of users.

Consumers want Covered California to reduce call center wait times, let Californians know that in-person enrollment help is available, and translate the Covered California online application into other languages. They also want the Medi-Cal processing time to be shortened, clearer guidance on what enrollment documentation is required, and a clear explanation of the Medi-Cal enrollment process. Consumers also want Covered California to improve the online chat function, update the provider search function, and offer clearer guidance on how to calculate their incomes.

Those applying online through Covered California were surprised they could not complete the application online. Many were unsure of their next steps or how they would be contacted about their eligibility. Most had long waits to hear back from Medi-Cal — some more than four weeks. Most did not know how to track the progress of their application and did not know whom to call.

Some consumers say that the process did not fully prepare them to make a coverage choice. The physician search tool did not work well for some and others felt overwhelmed by too many plan choices.

Faced with the enormous task of  implementing a new system, California has made significant improvements to the enrollment process. However, broader issues remain significant, according to the report.

Even after completing the process, many participants are not clear about the relationship among Obamacare, Covered California, and Medi-Cal. Many did not know that they could get in-person assistance to enroll. Many did not know Medi-Cal had been expanded and that they may be eligible. Some did not know about the premium tax credits; and most are unaware they might have to pay back some of the financial assistance if they inaccurately reported their income or if their income changed. Some are not familiar with how insurance works. The enrollment process did not answer many of these questions for consumers.

Those with fluctuating income and those who are paid in cash had a hard time figuring out future earnings or averaging their incomes. Some just guessed when applying.
Language and cultural barriers were an issue for many consumers. Latinos want Covered California to address their specific enrollment concerns. Some Latino consumers heard rumors that Medi-Cal could take their home if they enrolled in the program. The detailed questions about family members — even those not applying for coverage — unsettled some Latino consumers.
Many Vietnamese- and Mandarin-speaking consumers could not enroll online in their primary language. They had to rely instead on English-proficient family members or apply in-person with a CEC or agent who spoke their language. Mandarin-speaking and Vietnamese-speaking consumers suggested that Covered California go deeper into their communities with outreach.

CECs did not feel well trained, saying they had limited ability to help Medi-Cal applicants. Many were on their own to figure out complex enrollment problems. Many also said that, with had limited experience with Medi-Cal, they could do little to help clients apply for that program. However, a new phone line for CECs is helping.

The most challenging task for consumers weighing premiums, deductibles, copays, and total out-of-pocket costs. Many chose a plan based primarily on the premium. The amount of documentation required to enroll surprised consumers who thought it would be an entirely electronic process. Medi-Cal applicants had the heaviest burden; they are often instructed to supply proof of income, proof of residence, immigration information, and more. Consumers who called Covered California’s call center complained of long waits and not being able to get through to a person. Many waited 45 minutes or longer for help. Most had to call multiple times. However, once they got through, many said the customer service representative was helpful.

Many who have been identified as likely to be eligible for Medi-Cal through Covered California had not yet received a final eligibility determination from county social services at the time of the study. In fact, many of these consumers did not set out to apply for Medi-Cal. Rather, it is through the Covered California enrollment process that they discovered they are likely to be Medi- Cal-eligible. For more information, visit www.chcf.org.

Last Updated 10/14/2020

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