Covered California and ACA 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 ACA and Covered California knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.

Question: I am self employed. after my adjustments for self employment and ira contribution, my agi is $18500. But, after that I take deductions for my real estate taxes and mortgage interest, and standard deduction, I am in a very low income tax bracket. Which figure should I use? the AGI or after real estate taxes mtg interest and standard deduction.

Answer: For most of us, MAGI is the same as AGI - Adjusted Gross Income found on line 37 of the 1040. But more precisely, MAGI is the adjusted gross income plus any amounts excluded from taxation by section 911 (the exclusion from gross income for citizens or residents living abroad), any tax-exempt interest received or accrued during the tax year, and any portion of the taxpayer's social security benefits that are excluded from gross income.

Do I Use 2014 Income?

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Question: Next week I will be leaving my current job which provides health insurance. I am curious if covered california uses our income from 2014 to determine which plan we are eligible for or if they use an estimate for this year? I am returning to school and will make about 20,000.00 less than last year so I am a bit concerned?

Answer: When you apply for Covered California coverage use an estimate of your income for 2015.

Question: Is my income based on what I would make in a year if I hadn't lost my job or do I prorate the number for the year? Example. I was making $60,000/year. I got laid off at the end of April. do I prorate the number to $15,000 because that is what I will make if i don't get another job this year.

Answer: If you did not receive another penny in taxable income for the rest of 2015, the amount you already earned - $15,000 in your example - would be your projected annual income. If you are eligible for unemployment income, estimate what you could collect for the rest of the year and add it to the income already earned for your 2015 estimate. If you were to get a job at some point, that income would be added to your annual projection. Any significant income change, such as you described, makes you eligible for a Special Enrollment Period (SEP) during which you can re-enroll and qualify for either Medi-Cal or Covered California coverage with premium assistance.

Question: I received my 1095-a from CoveredCA back in January and noticed that it was not accurate. It showed policy dates of 4/1 to 10/1 with subsides for said months. The problem is that it included a subsidy for the 10th month when in fact it should not have. I filed my dispute over 60 days ago... I never heard from them. That said, I have been calling and have been told that they see the error and that the IT department needs to change the end date to the last day of 9th month. I've not been given a time frame with any certainty as to when this will happen. I have been told that the corrected 1095-a can't be issued until it does. So... my question is: Is there anyway I can get this resolved quicker? Is there a way for me to contact a rep that can actually get it fixed?

Answer: Your don't need a corrected copy of the Form 1095-A to file your federal tax return. The Premium Tax Credit form used as part of your federal tax filing is the IRS Form 8962.pdf You know the correct amounts for total premium and premium tax credits from your monthly health insurance bill. Enter those amounts on the Form 8962 and get on with it.

Sign-up an Unborn Infant?

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Question: My independent 24 yr old daughter has Anthem insurance coverage through her father's workplace (Univ. of So Cal). My daughter is low income and it was our plan to enroll the infant in Medi-Cal through CC. We were under the impression that the infant would be covered by my daughter's plan for the first 30 days. Marin General, the hospital where her doctor delivers, has contacted her to let her know that because she is not the policy holder, the infant has no coverage at birth. They let her know that the infant will incur charges from the minute she is delivered and advised her to get coverage. We can't figure out how to sign up just the baby before birth without a social security number.

Answer: You can't get Medi-Cal coverage for the newborn infant until after the child is born, but the baby's coverage will take effect retroactively to the date of birth. That means Medi-Cal will cover all of the newborn's expenses. Once the baby is born, the mother must apply on behalf of the baby using the Covered California online application even though you know the baby will be eligible for Medi-Cal.

Married Filing Separatey?

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Question: I filed married filing jointly in 2013. My husband moved out after Christmas 2013, & we have been separated. I qualified for assistance using our joint return 2013 for CoveredCA assistance for 2014. We filed married filing separately for 2014. I was accepted for coverage for 2014, but what will happen now? Will I still be covered? My income for 2015 will be less, as it was in 2014, but I am being given a penalty due to filing separately for 2014.

Answer: Had you listed your tax filing status as "married filing separately‚Äč" on your Covered California application, you would not have been eligible for a subsidy. So it seems to me that you have disqualified yourself from the advance premium tax credits you received in 2014. If so, you are still covered and your premium assistance will continue until you notify CC of your tax status change. In order to continue getting premium assistance (assuming you still qualify based on income) you will have to change your tax status to single or married filing jointly.

Question: If you have already been getting the credit, is the 4/15 2014 tax filing deadline firm that covered ca makes you agree to, or is an extension allowed until 10/15/15? what is the final consensus? thanks

Answer: You must pay your 2014 taxes by 4/15/15 along with your application for an extension. In other words, even though you are filing for an extension, you still have to pay your taxes on April 15th.

APTC over 65?

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Question: Can a person over 65 receive APTC?

Answer: Usually not, because most Californians over age 65 are covered by Medicare wich is considered Minimum Essential Coverage (MEC). Applicants who are eligible for MEC are not eligible for financial assistance unless they fall in this exception: If an applicant is eligible for Medicare part A coverage requiring payment of premiums, but is NOT enrolled in the program at the same time he or she enrolls in a Covered California plan (i.e., no dual coverage) will be eligible for financial assistance.

Address Change?

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Question: If I changed my address with Blue Shield and at my doctor’s office, will that the change also be updated at Covered California?

Answer: No. You must change your address in Covered California account. If you don’t, you may not receive correspondence from Covered California - IRS Form 1095-A, important notices, renewal information, etc.

Paying Back The Subsidy?

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Question: I enrolled in Covered CA and opted to take all of the subsidy now rather than at tax filing time. Starting April, I will have a new job that provides insurance. When I file taxes next year, my income will be too high to receive a subsidy. Will I have to make up the difference for the full premium for the 3 months of Covered CA insurance?

Answer: Yes, you will pay, but not that way. The subsidy paid to you in 2015 will be taxed as income based on the scenario you described.

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