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.

Reporting a Change?

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Question: If after I completed my application and my QHP has been effectuated, I now need to change an incorrect birth date. Do I make that change through Covered California or through the QHP. If Covered California what is the process?

Answer: To change a date-of-birth go to Covered California not the carrier. Login into your CC account and make the change yourself, have your broker do it, or call CC at 800-300-1506.

Employer Offers No-cost Plan?

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Question: Employer is offering what is exactly like the lowest cost bronze plan on covered CA and it would not cost me anything out of my monthly salary. In fact, they said that I would even get an extra 1300.00 at the end of the year from them. However, I have type 2 diabetes and would be paying 100% of lab and drs visits before the $5,000 deductible is met. I am in the 138% of poverty range and am not able to do this. unfortunately if I turn it down I cannot get any help from subsides because of their offer being considered affordable. Any ideas?

Answer: Sorry, I have nothing. You cannot get any help from subsides because your employers group coverage offer is considered "affordable". You have to accept the company plan. However, the $1,300 you receive at the end of the year will go a long way in covering your out-of-pocket expenses for doctor visits and labs.

Health Insurance Tax Deduction?

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Question: Can I claim self-employed health insurance deduction (1040, line 29), if now part of my premiums are subsidized by Obamacare? If yes, what will happen after IRS reconciles the advance premium tax credits (subsidy) for 2014 and withholds certain amount, because my income is more than I projected? Will I be able to claim that I paid this extra amount as health insurance premiums and add it to 2014 deduction?

Answer: You can only claim the net premium - the portion you actually pay after the subsidy - as an expense. Enter that portion as your self-employed health-insurance deduction. If there is a subsidy reduction for added income at the end of the year, that incremental net premium would also be added to your self-employed health-insurance deduction.

Former Employer Won't Drop Me?

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Question: Hi, my ex employer refuses to drop me from his group health insurance policy. i dont understand why he is doing this but it's barring me from getting my own independent coverage from the same provider. Should i just try to find a different provider or is there something I can do?

Answer: Your former employer is breaking his contract with the insurance company that underwrites his company health plan. Group coverage is only for employees currently on the payroll. You can put a stop to it by calling the insurance carrier's customer service department and explaining what he is doing. In the meantime, buy coverage from another carrier if the value proposition is similar.

Mid-Year Income Change?

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Question: I estimated my income to be $24,000 for 2014 at the beginning of the year. As months are going by I am now estimmating it at $60,000. Should I make that change on my profile or wait?

Answer: That's a pretty significant change of income. It makes a big difference to your bottom line. If you are a single person, you're net premium now is about $150/mo at $24K annual income. At $60k, you are no longer eligible for a subsidy, so you pay the full premium based on your age and zip code - anywhere from $200 to $800 a month. If you don't bite the bullet now and pay the higher premium, you'll pay the difference in a lump on April 15, 2015 tax time.

Question: After enrolling in Brnoze plan on 3/14/2014, my income dropped down much in 8/14/2014. 1)What proof of income like Bank statement for that month to be submitted? 2)Only silver plan is to be selected for cost sharing? 3)Suppose after 90 days if proof of income could not be shown what happens.? Will the new revised plan be cancelled or will it continue but without subsidy?

Answer: Your change of income can be verified in a number of different ways depending on whether you are an W2 employee or self employed. Covered California can help you with that if you call 800-300-1506. Yes, only the silver plans qualify for cost-sharing reductions. If proof of income to support the change is not supplied within 90 days, the new plan will continue without subsidy and cost-sharing reductions.

Question: Does "ca covered" offer dental for adults? I have kaiser if it makes a difference.

Answer: Adult dental coverage cannot be purchased during the Covered California enrollment process nor as an add-on later. You can purchase your adult dental coverage directly from your current carrier (Kaiser) or from a wide selection of other stand-alone dental insurers. Click here for a quote and online application.

Two Residences?

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Question: Adult lives approx. half the year in California and the other half in North Carolina. Currently has coverage in California but needs to see doctors in North Caroline as well while there. Do you have coverage for this?


Answer: You could qualify for a special enrollment period in North Carolina if you claim NC as your home address. If so, select Blue Cross Blue Shield of NC PPO coverage (once you confirm that they offer Blue Card coverage outside of NC). You will be covered by in-network benefits while in California as long as you see a Blue Shield of California PPO network provider. If you want California based coverage, select Blue Shield of California PPO (only Blue Card in CA) coverage effective 1/1/15 during the next open enrollment period starting November 15th.

Question: My family is losing COBRA coverage on 9/16 (expired). Anthem, Blue Shield, and HealthNet and Cigna all will only give a 10/1 effective date. Will anyone give a 9/17 effective date to avoid a gap in coverage?

Answer: No help from the carriers on this loophole. Right now the consumer with expiring COBRA coverage may have to wait up to 30 days for the ACA compliant coverage to kick in. Eventually the feds will get it ironed out. In the meantime there's short-term coverage perhaps?

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.

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