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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.

Question: It is February now. We just found out a doctor that we have been seeing does not accept our plan this year. Can I change my plan to another carrier now?

Answer: If your insurance carrier listed your doctor within their provider network in error, then you are eligible for a Special Enrollment Period (SEP). That means you can choose another health insurance carrier that includes your doctor.

Question: We are married but filing separately. Do we apply Medi-Cal or Covered CA separately also? or must be together?

Answer: You must apply as a couple, but because you file taxes separately, you will not be eligible for premium assistance through Covered California. Your tax filing status will not matter if you are eligible for Medi-Cal coverage based on your income.

Adding Out-of-State Children?

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Question: My kids mother and I are divorced. I live in California and she lives in Tennessee. As part of our child support agreement she would like for me to add our kids to my covered California insurance even though they live with her for most of the year. I currently have Kaiser. Will it be possible to add them to my plan even though they live in another state?

Answer: No. (1) Your children are not California residents. (2) Kaiser Permanante has no doctors or facilities in Tennessee.

Need PPO Insurance?

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Question: I recently lost my disability income and therefore lost my subsidy for PPO. I was given Medical but they only cover 4 out of my 15 medications and my doctors are not in their network. How can I purchase a PPO insurance on my own? It has taken my doctors 3 years to get me stable, I can't go back to near death over insurance dilemmas. I need to get my medications and the cash cost is over $2k per month! Please help!

Answer: You can shop, compare, and buy California individual health insurance at http://www.cahba.com.

Visitor Insurance?

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Question: My parents will be visiting me for 4 months this year. Can I purchase health coverage for the duration of their visit through Covered California?

Answer: No. Your parents will not be eligible for coverage through Covered California while they are visiting. California residency is required. The best option for your parents is International Medical Insurance.

Add Daughter After Open Enrollemnt?

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Question: My daughter is 18 and on my ex husband's health insurance policy at his work. I claim her as a dependent on my taxes. If he drops her from his policy after open enrollment closes, does that create a special enrollment for her under my Covered california policy?

Answer: Yes. She will be eligible for a Special Enrollment Period (SEP) for 60 days after her loss of coverage. Since she is part of your household, you can add her to your Covered California coverage at that time.

How to Download Form 1095-A?

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Question: How can I get my 1095 A online. I'm trying to do my taxes??

Answer: The Form 1095-A's have already been posted online. Login to your Covered California online account. You will find the 1095-A form in your Documents and Correspondence folder. To get there, click on the Summary checkbox on the home screen and next click the Documents and Correspondence link, select and download CalNOD62A_IRSForm1095A_2016.

Payback All the Subsidy?

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Question: My 20 year old son is a dependent on my covered CA. His income put me over the Max amount of earnings to qualify. My tax credit was approx $1000 a month. Does that mean I have to pay back $12,000.00 dollars?

Answer: When you say "over the max amount of earnings", I assume you mean that your combined household income was over 400% of the Federal Poverty Level (FPL). If that is the case, then you will have to pay back all of the premium assistance (subsidy) you received in the previous year.

Canceling Now Without Penalty?

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Question: I want to cancel my #CoveredCalifornia insurance plan, under the ACA because President Trump used his executive order to repeal the Obamacare mandate. Can I cancel the ACA insurance plan immediately right now without having to be punished with fines for not having insurance or do I have to wait a certain date when the mandate is no longer applied to American citizens?

Answer: The Affordable Care Act has not been repealed or replaced. The mandate is still the law and tax penalties will be enforced until further notice. So you should wait if you want to cancel your insurance without penalty.

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.

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