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.

Report Income Change?

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Question: I estimated my 2014 income to be about $35,000. My 2013 income was $33,070. Due to a lay off of one of my jobs, it looks like I will make about $30,00 for 2014 if I don't find another part time job. I am being subsidized from the state for my Anthem Blue cross. If I don't make the money I estimated on, will I get a refund from the California Exchange if I don't have an adjustment made now? Or do they apply it to the next years premiums? (still looking for another part time job)

Answer: The IRS will reconcile the advance premium tax credits (subsidy) you have received for the year on your 2014 tax return. In your case, there is no need to report a change in income at this point as the difference between estimated income and actual income is not very great. In cases where the taxpayer's income increases greatly during the year, reporting the change to Covered California will prevent a big tax bill come tax time. If income decreases significantly, reporting the change immediately may greatly reduce your net premium for the rest of the year.

Question: Retired couple on Covered CA has husband turning 65. Husband is the only income in the household and they are APTC eligible. Now that husband is going to be eligible for Medicare and ineligible for Covered CA how is the income counted for the wife in Covered CA. Will his income be used to determine what her premiums will be in Covered CA? Will she now be eligible for Magi Medical since she has no income? Thanks

Answer: The husband's income is still counted even though he will not be enrolled in Covered California. Since the premium assistance (subsidy) is based on a 2-person household, the wife in this scenario will continue to pay less net premium they were paying as a couple.

Question: I know the 2013 Federal Poverty Level rates were used to determine the premium tax credit subsidy. However, when it comes to reconciliation at tax time will the 2013 or 2014 Federal Poverty Level rates apply? This could make a big difference if a single persons MAGI is $46,500 for the 2014 tax year. Which one? 400% of the FPL for 2013 is $45,960 (No subsidy) or 400% of the FPL for 2014 is $46,680 (Subsidy).

Answer: The IRS will use the 2013 FPL standard to reconcile 2014 MAGI and advance premium tax credits (subsidies). See Fred's comment below for more detail.

2015 Auto Renewal?

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On Thursday, HHS announced that most U.S. residents who have health coverage through HealthCare.gov could automatically be enrolled in their existing plan next year, cutting the need to fill out a new coverage application form through the website, the New York Times reports (Pear, New York Times, 6/26).

About 95% of current exchange enrollees could qualify for automatic re-enrollment if they do not change their coverage plans proactively (Radnofsky, Wall Street Journal, 6/26).

While the automatic re-enrollment feature is designed for the federal health insurance exchange, it also could apply to state-run insurance exchanges, officials said. State officials will also have the option to submit an alternative renewal proposal (O’Donnell, USA Today, 6/26).

While the proposed re-enrollment process would be automatic, consumers would be urged to re-evaluate their coverage benefits and needs during the next open enrollment period (HHS release, 6/26). In addition, enrollees would receive information about how to move forward if their incomes or other life circumstances have changed, which could affect their eligibility for future tax credits.

According to Modern Healthcare, HHS drafted the proposed rule with input from the National Association of Insurance Commissioners and other stakeholders. The rule is open for public comment for 30 days, after which HHS will issue a final rule (Demko, Modern Healthcare, 6/26).

2015 Covered Ca Rates?

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Question: There’s confusing talk about how much Covered California will increase for the 2015 year. When will the new rates be published.

Answer: Rates will be public in early August. As of June 1st, Covered California has been receiving submissions from the insurers in the exchange. An evaluation process will follow, and then a negotiation process through the month of July. Peter Lee announced at the June board meeting that Ca rates will be public “first week in August”.

Question: My Medi-cal was terminated 5.28.14 with no explanation or warning. My pharmacist informed me. After several phone calls, everyone agrees I should have no been terminated but they have no advice (CA Calif. and Medi-cal reps). No one would escalate my call. I reapplied to CA Covered and they will recommend Medi-cal. Meanwhile I am without coverage of any kind. Is the re-instated insurance retroactive is there some protection from termination that was not my fault. The law 14005.37 states that I should have been notified and received a chance to advocate for myself. I have heard nothing. What recourse do I have. Aren't they effectively ignoring the law?


Answer: You'll have to file for a hearing. You have 90 days from the date of the termination letter to request a state hearing. The form for that is on the back side of the termination notice or you can do it by phone. When you file you will receive "aid paid pending" meaning that your benefits will be reinstated pending the outcome of a hearing. When your Medi-Cal coverage is reinstated, coverage will be retroactive to the cancellation date. In the end, you shouldn't be out anything but the massive headache of getting your case back on the tracks.

Non-Resident Child Covered?

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Question: I am the non-custodial father of a child who lives outside the country in Australia. Court orders require me to add her to my health insurance as a dependent for occasions when she visits me in the U.S. (California). Can she be covered under my policy? I was told no because she is not a full-time resident of California. What can I do?

Answer If your daughter is visiting you for a few weeks, international travel insurance will do the trick. If your daughter will be living with you for an extended period of time, you can add her to your health insurance coverage. Your daughter is eligible for a special enrollment once she resides in California. The is no minimum stay required. What might have confused you otherwise is the rule that people who reside outside the US more that 6 months per year are exempt from mandated coverage and penalties.

Question: I am currently pregnant and I don't know how the process works for getting my newborn health coverage. I also have a one and a half year old who is covered under Medi-Cal. Please help!

Answer: As soon as possible after your child is born, notify Covered California to add your newborn to your account. The newborn is covered under the mother's CC coverage during the first month after birth. You say you already have a child on Medi-Cal. If this is because your household income (less than 250% of FPL) makes all of your children under 19 eligible for Medi-Cal, your newborn will be covered by Medi-Cal retroactive to his or her date of birth.

Subsidy Change?

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Question: I qualified for a Covered Cal subsidy based on my estimated 2013 income. Due to higher than estimated investment income my tax filed 2013 income exceeded the subsidy qualification limit. However, my 2014 income will be considerably lower and under the subsidy qualification limit. Do I need to stop the subsidy due to the filed 2013 income?

Answer: No. Your 2013 income is not a factor at this point. If you still expect your 2014 income to be reasonably close to the estimate you used on your application, there is no need to make any changes now. Remember, your advanced tax credits (subsidy) will be reconciled with your actual tax due when you file your tax return for 2014.

Medi-Cal Ineligible?

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Question: I'm a 31 yr old single mother. My 3 month old is eligible for Medi-Cal until he is 1. My 12 yr old is ineligible because of my income, yet I can't enroll him on Covered CA. I'm making $39,000 a year. What can I do?

Answer: If your household is made up of 3 or more individuals and your income is less than $52k, then all of your children age 18 or less are eligible for Medi-Cal. Medi-Cal enrollment is open throughout the year. You may enroll through Covered California at 800-300-1506.

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