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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Terminating CC for Medicare?

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Question: My wife and I have Covered California coverage for 2017. I am listed as “primary subscriber” with Blue Shield. I will turn 65 in Feb 2017 and will be on Medicare, My wife however needs to remain on our CC plan for 2017. What is the best way to terminate my account with CC/Blue Shield since I will start Medicare but not change my wife’s continuation with Covered California, and then list her as primary subscriber after February?

Answer: Login to your Covered California online account and use the “report a change” feature. Under the “Personal Data” tab, go directly to the healthcare section and select “Yes” to receiving medicare benefits under the recipient’s name. The Covered California system will automatically terminate coverage for that subscriber without removing the required household details. The subsidy will automatically adjust for remaining subscribers.

Married Filing Separately?

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Question: I am married but file separately for taxes. My spouse does not wish to apply for Covered CA for since they are covered by their University's coverage. Do I include them in current monthly household income? We have separate bank accounts. Also, I do not currently work. I am full-time in grad school and only have student loans/grants. Do I include these loans/grants in my monthly household income?

Answer: If you file taxes as "Married Filing Separately", you are not eligible for premium assistance (subsidy). Your grant and student loan income are not taxed as income, so your taxable income appears to be $0, making you eligible for Medi-Cal. If you choose not to enroll in Medi-Cal, you can purchase individual health insurance directly from any insurance company licensed in California.

Question: My 21 year old son was added to our #CoveredCalifornia account with a start date of 9/1/16. He made $12,000 during the last 4 months of 2016. We are having issues with him stating that he is going to claim himself. Which do you think would be the harder hit, taking the $12,000 overage on our income for the year or covering him for 4 months and not claiming him.

Answer: My original answer to this question was wrong. This is the corrected answer. Explain this to your son. If he claims himself, his taxable income will be $12,000 minus his standard deduction of $6,300 minus the personal exemption of $4,050 for a net taxable income of $1,650 resulting in a $165 tax liability. If you claim him as a dependent, he loses the exemption so his taxable income will be $12,000 minus his standard deduction of $6,300 for a net taxable income of $5,700 resulting in a $570 tax liability. So basically, your son will lose $405 if you claim him. However, the tax benefit to you, the parents, will probably be more than $405 because you are probably in a higher tax bracket. I am unable to compute the financial consequences in your 2016 Covered California account without more demographic info. Send another question with your email address, zipcode, ages of family members and income by member and I will be more specific. In 2017, you should no longer claim your son as a dependent. Thank you Ernest for providing this answer.

Question: I wanted to shop for new coverage for 2017, but didn’t get around to it yet. Meanwhile, Covered Cal;ifornia automatically renewed my current policy. Can I still make a change?

Answer: Yes. If you pick a new plan by January 15, coverage under the new plan will take effect on February 1. If you pick a new plan between January 16 and January 31, coverage under the new plan will take effect March 1. In order to avoid a gap in coverage, you will have to pay the premium for your current policy until your new coverage takes effect.

Can I Lose Birth Control Coverage?

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Question: My Facebook friends are urging me to get an IUD before coverage for birth control disappears. Will I lose really lose that benefit?

Answer: In the days immediately after the election, there was panic about birth control. Women were Urging each Other to “Get IUDs Now, Before It’s Too Late,” and “a Trump presidency will threaten women’s reproductive rights.”

For the past six years under Covered California, women have had access to free birth control through their insurance plans because of a provision requiring coverage for preventive health benefits. Trump hasn’t addressed this issue, but fears have been stoked because he became more clearly opposed to abortion as the campaign went on. And Vice President-elect Mike Pence is a strong social conservative who opposes abortion in almost all circumstances.

Technically speaking, Trump might not even have to rely on Congress to get rid of these benefits. HHS could redefine what types of services must be included among the preventive care the law requires insurers to provide.

Free Women's Preventive Services?

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Question: What are the free preventive services for women with #CoveredCalifornia?

Answer: All Covered California plans offer preventive services for women without cost sharing. For example, these include counseling and screening services including prenatal and preconception care; breast and cervical cancer screening; genetic counseling and testing for women at high risk of breast cancer; Chlamydia and Gonorrhea screening and counseling for high risk women; at least one well woman visit a year; contraceptive counseling, services and supplies including prescriptions for FDA approved contraceptives; breastfeeding counseling and support services including breast pump rental; and intimate partner violence screening and counseling. So long as the preventive service is performed by an in-network provider, is not billed separately from the office visit, and is the main reason for the office visit, then the visit and the preventive service will be covered by the insurer without cost-sharing.

Question: Will #CoveredCalifornia Go Away? If so, how soon?

Answer: It now seems certain that Congress and the Trump administration will repeal and replace the ACA (Obamacare). How soon your Covered California health plan would go away is hard to know, but there are some clues. Early this year, when lawmakers sent President Obama an ACA-repeal bill, which they knew he wouldn’t sign, they included in the legislation a two-year period before the marketplaces and other parts of the law ceased. Right now, the open enrollment for 2017 marketplace health plans is underway. The plans that consumers can buy until Jan. 31 have pledged to participate through 2017.

Question: I received financial assistance from #CoveredCalifornia in 2016. In October of this year, I lost my job and my total income for this year ended up being just under 100% of the federal poverty level. Will I have to repay the premium tax credits that reduced my premiums all year?

Answer: No, there is a special rule to protect people in your circumstance. If Covered California found you were eligible for premium tax credits at the time you enrolled and if your income later fell below the poverty level, you are still eligible for the tax credits you received last year. You will not be required to repay the premium tax credit when you file your tax return. To benefit from this special rule, advanced premium tax credit must have been authorized and paid for one month or more during the year.

Question: I’m collecting a VA disability pension and benefits. Does #CoveredCalifornia count this in determining my eligibility for subsidies?

Answer: No. Veterans Administration disability pension benefits generally are not subject to federal income tax and so are not counted as income in determining eligibility for premium tax credits.

Question: Is there any reason #CoveredCalifornia wouldn’t automatically adjust and continue my premium tax credit at renewal time?

Answer: Yes. (1) It could happen if you failed to authorize Covered California to check online income data, including from your tax returns, for another 1 to 5 years. If you did not authorize this, your financial assistance will NOT be automatically continued for next year. If so you can reapply for financial assistance if you want the subsidy to continue for another year. (2) Covered California will check the most recently available federal income tax return. If the income you reported on your tax return was more than 500% of the federal poverty level ($59,400 for a single person, $121,500 for a family of 4), your financial assistance will not automatically be continued for 2017. To continue receiving APTC in 2017, you will have to reapply for financial assistance and provide information about your expected 2017 income (3), If you did not file a 2015 federal income tax return including Form 8962, your financial assistance will NOT be continued for 2017. You will need to file a 2015 tax return as soon as possible, including a completed IRS Form 8962.

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