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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.


Ending COBRA Now?

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Question: We have been continuing coverage through COBRA since August, but our premiums are so high we want to switch to Covered California. Does canceling the coverage count as a qualifying event if it's accompanied by spouse being pregnant? What are our options if we are unable to enroll in Covered California but still wish to cancel COBRA?

Answer: You can be eligible for Covered California premium assistance if your COBRA coverage is cancelled during the open enrollment period or when the COBRA coverage expires usually after 18 months. If you drop it now, you can probably find an individual plan plan with lower premiums than your COBRA, albeit with less coverage.

Also check Health Coverage Options for Pregnant Women under Medi-Cal.


Question: I have Blue Shield silver 87 but it turns out very few doctors in my aria accept Blue shield, and the few that do take forever to get an appointment too see, So I'm was wondering if I could change my plan I was thinking of Kaiser Permanente gold hmo, even though my monthly payments would be considerable more at least when I had Kyser I could see a doctor in a timely fashion when I needed one!

Answer: No. You can't change your health insurance plan until the next open enrollment period which is November-December 2018. You can switch to Kaiser then and the new coverage will be effective on January 1, 2019.


Question: If my child is offered an insurance at his college, will he no longer be eligible for subsidized Covered California insurance? He is a high school senior now and is planning to attend a college in California this fall.

Answer: Your son can remain on your Covered California health plan and the household will remain eligible for premium assistance even if student health insurance is offered.


Question: I would like to know what website I can go to, to print out my Tax Form 1095A? Can I print it online? Please advise.

Answer: The web address for the Covered California Account Login is: https://apply.coveredca.com/apspahbx/login.portal

If you don't have a login and password call 800-300-1506.

After logging in, you'll be on the Consumer Home Screen. Look for the list of links in the bottom-center of the page.

Click on Eligibility Results
Click on Summary
Click on Documents and Correspondence
Click on _IRSForm1095A_2017


Income Guidelines?

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Question: What are the salary limits for a family of 3 which includes one adult child that turned 26 years old in 2017. What type of income is included in the calculation for Covered California subsidies.

Answer: The adult child, age 26, must apply for his or her own coverage even though he or she lives in the parents household. Eligibility for public insurance or subsidized coverage is based on his or her income alone. Here are the key income guidelines for a single person.

$16,644 - below this annual income, you are eligible for Medi-Cal. Income above this number may make you eligible for premium assistance through Covered California.

$48,240 - below this annual income, he or she is eligible for premium assistance through Covered California, with no assistance above that number.

The parents are a household of two. Here are the key income guidelines for them.
$22,412 - below this annual income, the couple is eligible for Medi-Cal. Income above this number may make them eligible for premium assistance through Covered California.

$64.960 - below this annual income, they are eligible for premium assistance through Covered California, with no assistance above that number.


Roth IRA Withdrawal Income?

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Question: I am 62 years old. My total annual gross income for 2018 is $62,000 for my wife and I. We live in Northern California and qualify for subsidized premiums. If I withdraw $10,000 in 2018 from my Roth IRA, do I lose my eligibility for subsidies for 2018?

Answer: No. Since Roth IRA withdrawals are not taxed, the income from a Roth IRA does not increase your Adjusted Gross Income and does not affect your eligibility for premium assistance.


Question: I want to buy a Blue Shield PPO plan. What are the advantages of signing up through Covered California versus applying directly with Blue Shield>

Answer: If your household income makes you eligible for premium assistance, Covered California is the only place to enroll. When you apply through Covered California you agree to file taxes each year and to allow Covered California to access your tax records through the IRS. When you apply directly through a California health insurance carrier like Blue Shield - referred to as an off-exchange enrollment - you are not asked to provide any income related information whatsoever. Off-exchange, you will find plans that mirror the Covered California plans exactly in benefits and rates, but, you’ll find plans that are unique to the off-exchange-market as well. Click here for an off-exchange quote.


Question: My family of four gets subsidized Covered California insurance. My 24 year-old son is included in our household. He earned about $9,000.00 this year. Will we be penalized on our taxes for 2017? Should he enroll for 2018 for his own plan?

Answer: Your son must file his own tax return for 2017 since his income was over $6,300, but you can continue to include him in your household if you wish. When he files his tax return for 2017, he can opt out of his personal exemption. If so, all you have to do is update your Covered California household account to include his income. The added income will reduce your premium assistance, so you will pay some added tax for 2017. If he takes his own personal exemption for 2017, you must update your CC account by removing him from your household. This will reduce your household size to three going forward, but you do not have to include his income. You will have added taxes to pay for the 2017 tax year, because your tax credits were based on a four person household. You will probably need an accountant to figure out which path leads to the best financial outcome for your family.


Obamacare Sign-up Deadline?

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Question: My wife read that the deadline was December 7th. I thought it was December 15th. Who’s right.

Answer: You’re right this time. December 15th is the deadline for individuals and families in the under-65 health insurance market. You must enroll or make changes to your plan by December 15th to affect coverage on January 1st whether you enroll through Covered California or directly with an insurance company. Open enrollment in California extends until January 31st for new enrollments or changes to existing plans with effective dates to March 1st 2018.

Your spouse is correct if she is on Medicare. The deadline for changes to 2018 Medicare coverage is December 7th.


Out-of-Network Coverage?

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Question: I see a holistic medical doctor who is not in any Covered California networks. It is very hard to find information about out of network coverage. I was looking at Blue Shield PPO plans. Am I correct they will cover only 50% out of network?

Answer: Out-of-network benefits are reimbursed at a level much lower than 50% of the provider charges. The plan pays 50% of the carrier’s allowable amount, not the provider’s bill. For example: if your doctor charges $250. The Blue Shield’s in-network allowable amount for this treatment could be as low as $75. Your benefit amount would be half of $75, not half of $250. In addition, out-of-network coverage has a separate deductible, usually 150% to 200% of the in-network deductible. Don’t look for out-of-network benefits to help much if at all on minor medical expenses.

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