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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.


Social Security Income and MAGI?

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Question: Are annual social security benefits counted towards MAGI, including the untaxed portion (as far as CC is concerned)? Sometimes, depending on income only a portion of my wife's SS is considered taxable.

Answer: MAGI (modified adjusted gross income) includes your adjusted gross income, tax-exempt interest income and half of your Social Security benefits. Some people who get Social Security benefits must pay federal income taxes on up to 85% of their Social Security benefits. If your income is less than $25,000 for individual tax filers or less than $32,000 for joint income tax filers, you pay no tax on your Social Security benefits. If you are married and file a separate return, you probably will have to pay taxes on your benefits.


Question: My projected income was over 400 percent of the fpl. However, it will wind up being lower. When I initially signed up last year, I think I chose to get a subsidy in one lump sum. Obviously, I have not gotten anything, because my projected income is high 83k.Is there a way to look at the website and see what I chose. I WOULD RATHER NOT CALL THEM, FOR FEAR THEY WOULD ASK ME ABOUT INCOME CHANGE. Do I need to worry about what I chose, since my projected income disqualifies me for aptc. Would I have been given a subsidy option with my income that High? I can't remember exactly what I did when signing up. Plus, I did call to report an income change, and the person on the phone asked me to break Down my income from various sources by month, so I am not sure if something might have been changed. My projected income was still higher than the 400 percent. Should I just not call them and leave it for reconciliation at tax time next year.

Answer: If you opted for premium assistance in one lump sum, you are in good shape. If you qualify for a subsidy, you'll get it when you file your taxes. if you were not due any premium assistance, there's nothing to repay. Logon to your Covered California online account, from the homepage select "Summary" and then select "Change Premium Assistance Amount" and the next page you see will explain which payment option you have - monthly or lump-sum. If it's not what you want, you can change it.


Question: I will be applying to Medi-Cal in September of 2016. I do not know if I should provide ONLY my information in the application or my parents information AND my information in the application. I was claimed as a dependent when they filed taxes on Feb. 2016 and when they file taxes on Feb. 2017 I will NOT be claimed as a dependent. In other words, I will be independent.

Answer: Apply through Covered California even though you know you are eligible for Medi-Cal. The online application process at CC is much easier than applying at Medi-Cal. Since your parents will not be claiming you as dependent for the 2016 tax year, apply as an individual. You will not provide any information regarding your parents or their income.


Question: If I wish to cancel my covered ca. Plan at the end of the year, can I do it easily on the website or do I have to call them. Is it as easy as clicking a cancel membership button and indicating the desired date of cancellation?

Answer: To cancel coverage online, logon to your Covered California account and find the link that reads "Terminate Plan". If you are uncertain, contact the Covered California service center for assistance at 800-300-1506.


Question: My Anthem Blue Cross PPO plan through Covered California won’t be offered again in 2017. Now what do I do? * Answer*: During Open Enrollment, you can shop for a different plan either with Anthem or any other insurance company available through Covered California. Or you can do nothing and Anthem will automatically enroll you in another plan it offers that is similar to what you had this year. You will receive a notice from AQnthem that describes that alternative plan and how it differs from your current plan.


Question: I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

Answer: Yes. Leaving your job and losing eligibility for employer-based health coverage will trigger a special enrollment period (SEP) that lasts for 60 days. You can apply for Covered California health plans and (depending on your income) for premium tax credits (subsidy)and cost sharing reductions during that period. However, if you enroll in COBRA coverage through your former employer beyond the 60-day SEP opportunity, you will need to wait for the next Open Enrollment period to voluntarily cancel COBRA and enroll in a Covered California plan.


What are Catastrophic Plans?

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Question: I just lost my job and I’m buying Covered California. I notice “Catastrophic Plans” that look even cheaper. What are those and can I buy one if I want?

Answer: Catastrophic plans have the highest cost sharing - deductible and coinsurance. Not everybody is allowed to buy catastrophic plans. They are only for adults up to age 30, and for older people who can’t find any other Covered California policy that costs less than 8.13 percent of their income. In 2016, Catastrophic plans have an annual deductible of $6,850 ($13,700 in family plans). You will have to pay the entire cost of covered services (other than preventive care) until you’ve spent $6,850 out of pocket; after that your plan will pay 100 percent of covered services for the rest of the year.


Question: I don’t have a green card yet. Can I buy a California Cover health plan?

Answer: If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan through Covered California. However, you can shop for health insurance and buy insurance directly from one of the health insurance companies offering off-exchange plans. Insurers outside of the Covered California are prohibited from turning you down based on your health status or your immigration status and must follow generally the same rules as plans in Covered California.


Question: I am moving to California next month. Will I qualify for a Special Enrollment Period of 60-days after I move?

Answer: The feds just passed a new rule affecting permanent moves. Starting July 11, 2016, if you move to another state, you will be eligible for a special enrollment period only if you had previously had been enrolled in other coverage. The new rule is that you have been enrolled in minimum essential coverage (such as a job-based plan, Marketplace plan, or Medicaid) for at least 1 day in the 60 days preceding the date of the permanent move in order to qualify for the permanent move special enrollment period.


Should I Buy in CA or NV?

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Question: I live in California, but drive across the border every day to work in Nevada. What state should buy coverage?

Answer: Generally, you should buy coverage in California, the state where you live.

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