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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 provide more than 50% support for my friend/roomate, which means I can now claim her as a dependent on my taxes. We dont want her to loose her insurance, she cant afford her own. If I claim her as a dependent on my taxes would she then have to include me on the household number and my income information for her Covered CA health insurance application?

Answer: Your friend can file a tax return, but not take a personal exemption (Line 6A for IRS Form 1040). That way you can claim a dependent exemption for her on your tax form without affecting her eligibility. She must complete her Covered California enrollment application as a single person household using her income only.


Question: What is the penalty for not having any health insurance?

Answer: In 2016, the penalty is $695 per adult and $347 per child up to a family cap of $2,500 or 2.5% of household income, whichever is greater. In 2015, it was $325 for adults, with a $975 maximum or 2% of household income. Kaiser Family Foundation predicts that in 2016, average penalties will increase, on average, from $1,177 to $1,450 per household. According to Peter Lee of Covered California, “The bigger penalty could be showing up in the emergency room and walking out with a bill in the tens of thousands of dollars,”.


Did I Make the Obamacare Deadline?

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Question: I just completed the application and asked me to upload a form for the manage verification page, which I did. After it does not ask me anything else and says someone will contact me after reviewing my form. My question is, today is the last day to enroll, if someone does not review my form by today, can I not get anything? Or did i do everything already on my part for the deadline.

Answer: As long as you started your application today - 31 January 2016 - you made the deadline for a 1 March 2016 effective date of coverage. However your application may not be complete. You have until 6 February 2016 to get a Certified Agent of Covered California representative to finish it for you.


Question: I started Covered CA enrollment on 1/27/16, but got hung up on credit freeze, or submitting Documentation. Will finish ASAP, but need a few more days to finish. Can I get a few more days to finish?

Answer: You have until midnight Sunday January 31st to finish your Covered California application yourself. But even if you get stuck and can't get it done by then, We'll get it done for you in overtime. That's right, you can have until midnight Saturday February 6th to finish it provided you use a Certified Insurance Agent or a Covered California Representative to complete it for you.


Question: Can I apply by myself for Covered CA even if my parents claimed me as a Dependent? I am 21 and do not live at home with my parents, yet I did not make enough to be independent.

Answer: Yes. Apply as a 1-person household and use your own income projection for 2016. You will have to file a tax return for the 2016 tax year, but you must waive the personal exemption. That way your parents can continue to claim your dependent exemption on their return.


Question: Our medical insurance has been through my husband's work, and he is retiring April 1 (with no retirement benefits). He is over 65, but I am 59, giving me 6 years before Medicare. I've run the numbers, and we won't be eligible for subsidies. It seems I should purchase insurance on the open market through an insurance company's individual plan. Am I missing something; should I consider going through Covered California? I thought the only reason was to get financial help with the monthly premiums, and can't see a reason otherwise. If I should go through Covered California anyway, please explain why.

Question: If you are not within the income range for a subsidy, there is no compelling reason to apply for coverage through Covered California. Some might argue that you may as well apply through CC now just in case you are eligible for a subsidy later. That way you could simply adjust your income in your online CC account and become eligible for subsidies immediately. However you could complete your CC application at that point where you income drops. It would take just a few more minutes to do it then. Purchasing an off-exchange plan directly from the insurer also offers some plan designs not available on Covered California. Finally, you don't have to disclose your personal IRS history to the insurer in a direct purchase as you would with Covered California.


Gap Between Kaiser and Medi-Cal?

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Question: My roommate is moving from Kaiser to Medi-Cal with Kaiser (she just got her packet from the state yesterday, and will sign up with Alameda Alliance). My question is, will there be any gaps in her coverage? At some point she'll have to stop with Kaiser and get on Medi-Cal, but I'd like for her coverage to not be interrupted. She can pay her Feb premiums-can she elect to start Medi-Cal coverage on March 1st? The Alameda Alliance person I talked to indicated she'd have to cancel her plan with Kaiser first, but couldn't one just stop and the other start right after? She has a lot of health issues and would like to keep her health insurance through any gaps.

Answer: Medi-Cal coverage starts immediately once the application is approved. Your friend is already covered by Medi-Cal. Electing Alameda Alliance as your managed care provider within Medi-Cal should be done immediately as well. She should not continue to pay insurance premiums for her previous coverage.


How Can I Get My Form 1095-A?

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Question: How can I get my 1095-A form to do my taxes.

Answer: During the month of January 2016, Covered California mails out the IRS Form 1095-A to all who received premium assistance in 2015. Covered California also makes the 1095-A forms available for download from the insured’s online account. If you know how to log on to your California account, do so. Then, from the home page, click on the Summary box. Then from the left margin menu, select Documents and Correspondence. If your 1095-A is available now, you’ll see it listed as CalNOD62AIRSForm1095A. Click on view and print or save the form. If you’ve given it time, (let’s say it’s February 15th and you have not received it) and you have no idea how to log on to your CC online account, and you don’t have a certified agent to help you, you’re going to have to call CC at 800-300-1506 and click on I’m feeling lucky.


Question: I am single with no dependents , I am currently covered by med I cal. I recently started getting more hours at work. my pay before taxes is now averaging around 900.00 to 1,100.00 every two weeks .Work can also slow down but for now that is my average. What is the rate that tells me if I qualify for med I cal or need to apply for insurance other than med I cal? do I need to ask med I cal? or is there a rate chart? Confused…

Answer: For a one person household that number is $16,243 per year or $1,354 per month. So it seems that your income is high enough now to move to Covered California with premium assistance. First, you have to get Medi-Cal to release you. You will do that by proving to them that you are now earning what you claim. That may take some time. Here’s a chart others can use who have the same or similar issue. Household Income Subsidy Guidelines.pdf


Question: My 28 year-old daughter lives with me. She is unemployed, no unemployment benefits, currently zero income. I have employer-based insurance for myself, and my income is over the thresholds for ACA subsidies. If my daughter earns nothing for the whole of 2016 (or less than $4,000) she is my "dependent relative". My question is, does that necessarily make us both part of one household, and therefore disqualify her for Medi-Cal because of my income? What happens if I choose to NOT claim her, even though I could?

Answer: Your daughter should apply for Medi-Cal directly through your county office. Medi-Cal is only interested in your daughter's income and assets. That way you can continue to claim her as a "dependent relative" on your tax return.

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