Covered California: The COBRA Glitch

UPDATE: On May 15, 2014, Covered California announced a special two-month enrollment period for people on COBRA who want to switch to a Covered California plan.

"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.

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:

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:
She 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.