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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: I have coverage with Blue Cross through Covered California. Is my plan required to cover contraceptives without cost?

Answer: Yes, your plan must cover the full range of FDA-approved contraceptive methods, but can impose some restrictions on the contraceptives offered at no cost to you. For example, the plan may require that you choose a provider within the network, and use generic rather than brand name contraceptives, unless the brand name is medically necessary. If the generic drug or device does not work for you, you can ask your doctor to request a waiver from the insurance plan to receive the brand name drug or device without cost sharing.


Enroll While Pregnant?

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Question: I’m pregnant and my baby is due in March. Can I enroll in a Covered California plan now and be eligible for premium assistance?

Answer: Yes. You may enroll during Open Enrollment (until January 31, 2017). You may also be eligible for a premium subsidy, depending on your family income and your eligibility for employer coverage. Once you give birth, you can add the baby to the plan. You will also be allowed to change plans at that time since the birth of a child is a qualifying event that allows you to enroll in or change your coverage, no matter when during the year the baby is born. Your special enrollment period will last for 60 days from the date of birth. Adding the baby will change the plan premium and also your subsidy, assuming you qualify for premium tax credits. Depending on your income, you might also qualify for Medi-Cal and there is not a limited open enrollment period for Medi-Cal.


Question: I’m 63 and enrolled in a retiree health plan from my former employer. Can I look for better coverage and subsidies in the Marketplace?

Answer: Yes. You can drop your retiree coverage and enroll in a subsidized Covered California plan as long as you do so during the Open Enrollment period (ends January 31, 2017). However, it looks like Obamacare subsidies will not be available for more than another year or two. You may want to hang on to your retiree health plan after all.


Child Support Included as Income?

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Question: I receive child support payments from my ex-spouse. Do I count that in determining eligibility for subsidies?

Answer: No. Child support payments are not included in your household income calculation.


Question: My friend and his wife are interested in Covered California, but he's a citizen and she is not legally in the US. They file joint taxes... the children are covered under medi-cal and she has emergency medi-cal only. Is there any way for them to take advantage of a subsidy through Covered California?

Answer: This is a 4-person household with the undocumented spouse declining coverage. The husband and children can be eligible for subsidized Covered California coverage and/or Medi-Cal depending on income.


Unmarried Household Eligibility?

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Question: We are an unmarried couple with two children. How do we count our household size and income when we apply for subsidies in Covered California? Can we buy one policy to cover the whole family?

Answer: It depends on how you file your taxes. Unmarried couples are never eligible to file a joint return, so no you cannot buy one policy for the entire family. If you and your partner file separate returns and you each claim one of your children, you each will be considered as a household of two. The income of each household would be evaluated separately to calculate eligibility for and the amount of premium tax credits and cost-sharing reductions. If one of you claim both children as dependents on your tax return, then you and your children will be considered a household of three. Your income will be the basis for determining subsidy eligibility for the 3 of you. Your partner will be a household of one and his/her eligibility for premium tax credits will be determined separately.


Question: My income varies because I am self-employed. Most years I make between $20,000 and $30,000, though two years ago I did especially well and earned $35,000. How will this affect my application for premium tax credits for the 2017?

Answer: Covered California will compare the amount of income you estimate for next year to the most recent information about your income that is available (at this time that will be your 2015 income tax return). Generally, if that amount is different from the amount you put on your application by more than 25% or $6,000 (whichever is greater), you might receive a “data match inconsistency” notice from Covered California and you’ll need to provide more documentation within 90 days. During that period, you can get premium tax credits based on the income you attested to in your application. However, if you have not resolved the data match inconsistency within 90 days, Covered California will adjust or end your advance premium tax credit based on the most recent income information it can find.


Question: I have a Covered California policy with premium tax credits because the employer coverage was unaffordable (more than 9.69% of income for employee-only). In September, I picked up a second part-time job. Now my employer’s insurance would be less than 9.69% of my total income. I can’t sign up for my employer plan until next June. What should I do? When I file my taxes will I be required to pay back my subsidy?

Answer: As long as Covered California determined you were not eligible for affordable job-based coverage when you initially applied, that determination will hold for the remainder of the year. The IRS refers to this as a “safe harbor,” and won’t require you to go back and re-compute the affordability of your job-based coverage at year end when you file your taxes.

As for 2017, you should report your income change to Covered California as soon as possible. They will determine your new eligibility for premium tax credits, based on your higher income, and adjust the level of subsidy going forward. In June, you can enroll in employer coverage and cancel Covered California coverage.


Question: Is the open enrollment period the same for Covered California and Medicare?

Answer: No. They are not the same, although there is some overlap in the enrollment periods. The Medicare open enrollment period runs from October 15 through December 7 each year. For Covered California, the open enrollment period will run from November 1, 2016 through January 31, 2017. If you are covered by Medicare, and you are interested in reviewing and comparing your Medicare coverage options, make sure the plans you are considering during the open enrollment period are Medicare plans, not Covered California plans. Medicare plans are not sold through the Covered California websites.


Question: I will be 65 soon and and can go on Medicare. My income is $120k and I will be required to pay higher premiums for Medicare Part B and Part D. Can I sign up for health insurance from a Marketplace plan now instead of enrolling in Medicare when I turn 65?

Answer: If you are not yet enrolled in Medicare, you can buy health insurance coverage through Covered California before you turn 65. Once you have a Covered California plan, you can choose to renew it after you turn 65. But once you become entitled to Medicare coverage, you cannot buy a new Marketplace plan. These facts might help your decision. At your stated income of $120,000, you will pay about $300/mo extra for Medicare Part B and Part D bringing your total cost for A,B, and D to about $430/mo. A Silver level Covered California plan which is roughly comparable in benefits would cost you at least $700/mo.

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