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.

Question: What can agents who are dissatisfied with Covered California service do to be heard by the people who run the agency?

Answer: Max Her replies, "If you, like I, are dissatisfied with the performance of CoveredCA, the Call Center (FOUR hours on hold today pursuant to the notification that four of my clients' documents were not in order and that they are in jeopardy of losing their coverage -- none of which is accurate), $58 payments for Medi-Cal enrollments that have never materialized, and so on, please email me (max.herr@verizon.net) with your complaints and concerns."

"I have decided to fly to Sacramento for the September 18 CoveredCA Board Meeting and will try to find a way to air our grievances with the Board in public session. We are, I believe, not being given the credit we deserve for effecting a significant percentage of both Medi-Cal and QHP enrollments for 2014, nor are we being asked for our input on how to make the system more efficient and accountable, and I believe it's high time to hold Peter V. Lee and the Board accountable to us for a change."

I look forward to hearing from you. I will print your emails and deliver them personally to the Board at the meeting. Ideally, it will be a large stack of paper.

Question: I currently have my children covered under my employers group plan. Our group plan open enrollment is now. I have been told that if I add my children now, I can't remove them on 1/1/15 to go to individual plans. Is individual open enrollment a qualifying event?

Answer: Once enrolled in a group plan your cannot voluntarily drop your coverage without a qualifying event but you can drop coverage for your dependents anytime, no qualifying event required. There is no need to wait for open enrollment. Your children are not eligible for premium assistance (subsidy) because they are offered group coverage through your employer. You can purchase off-exchange individual coverage for them, or they may be eligible for Medi-Cal.

Rate Change for All on Jan 1st?

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Question: If a person signed up for a September 1st start date because of a special enrollment period due to loss of group coverage. Will their rate change on Jan 1st,2015?

Answer: Yes. All ACA-compliant individual health insurance plans change rates annually on January 1st.

How to Report Income Change?

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Question: In a household of two, from 1/2014 - 8/2014 my income was roughly $50,000~, however I am retiring and my current income is $2700/mo. Do I report my income with the $50000 included from earlier in the year(and not eligible for subsidies), or do I use my current income?

Answer: Your current monthly income alone is used to calculate your new subsidy and cost-sharing reduction. The current Covered California online application allows for entering your higher income for the first 8 months (in your case) and the lower income for the last 4 months, however only the current income is used in the calculations for assistance not an average of both.

Chargeback for Medi-Cal?

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Question: I have a friend who applied thru Covered CA using her current income which put her into Medi-Cal...but she also received some alimony payments earlier in 2014 which she did not account for. She expects her 2014 MAGI to be about $30,000 which is too high for Medi-Cal. Medi-Cal won't release her back to Covered CA to choose a subsidize plan unless her current income changes. Is it a problem that when she does her taxes, her AGI will be too high for her to qualify for Medi-CAL?

Answer: No. There is no chargeback, nor any other tax consequences, for one who is insured by Medi-Cal and subsequently reports income in excess of the Medi-Cal MAGI (modified adjusted gross income) benchmark. During the next open enrollment period, your friend should re-apply through Covered California and adjust her income to include the alimony income.

Question: My sons ages 12 and 16 are enrolled in Medi-Cal because of my income. Their primary care doctor will no longer treat them while they are on Medi-Cal, and I can’t find one who will take him. What can I do?

Answer: It was bad before the ACA (2011-2013), with only about 60% of the California primary care doctors accepting new Medi-Cal patients. It has gotten much worse this year as the ACA added over 1 million new cases to the Medi-Cal roles. However, the distribution of Medi-Cal visits among California physicians is highly skewed. About one-third (35%) of physicians accounted for 80% of Medi-Cal visits. Emergency doctors and others who work primarily in hospitals had the highest rate of Medi-Cal participation (82%). Physicians at community health centers and public clinics had the highest rate of Medi-Cal participation (92%), and those in solo practice had the lowest (54%). You may have better luck finding a doctor for your sons in a large multi-doctor practice or community health center.

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.

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