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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 currently have insurance through Covered California. I have KP Silver 94 HMO plan. I’m trying to predict if I’m going to be dropped into Medi-Cal based on my tax return for year 2019. It looks like my AGI will be around $18,000. Will I still qualify for Covered California or will I be dropped into Medi-Cal?

Answer: In 2020, the annual income limits for Medi-Cal eligibility for a one-person household is $17,237, a two-person household is $23,336, a three-person household is $29,436, and a four-person household is $35,535.

Subsidy Payback Blues?

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Question: I’m shopping for an insurance plan after not being covered for a number of years. The years I had Covered California subsidized insurance I had to pay back the entire amount they subsidized. My concern is whether this will happen to me again come tax season, and what’s the point of seeking financial assistance if I will just have to pay it back in a year.

Answer: Things have changed in California for 2020, namely there’s a penalty for not being insured and subsidies are available for higher income households. Only those taxpayers whose actual AGI exceeds the top eligibility limits (600% of Federal Poverty Level) will have to pay back the entire amount of premium advanced. It’s always better to take the money and give some of it back, than not take it at all. Consider it an interest-free loan.

Question: I will be getting laid off effective 12/31/2019, so if I elect, my COBRA coverage would begin on 1/1/2020. Can I get covered under Covered CA instead? When would I need to sign on with Covered CA if my job and coverage ends on 12/31/2019?

Answer: Yes. You can choose Covered California instead of COBRA. You must apply by December 15, 2019 for your coverage to begin on January 1,2020. If you already chose COBRA you can cancel it. You don’t have to wait for COBRA coverage to end.

Question: My dad is going to retire at the end of the year since he is turning 66. My mom is under his employer sponsored insurance. He will get Medicare and my mom would lose her insurance. Their income annually is ~90k but now that he is going to retire, their annual income will be about 36k. It would be from his social security and pension. My mom would still be 60 years old and taking care of my baby (her grandson). Would she qualify for covered California? We are confused if they will consider their previous years income or 2020's income which would be 36k. Please let us know.

Answer: Yes. Your mother will be eligible for Covered California coverage with significant premium assistance based on $36,000 annual income for a 2-person household. The only income that matters is their 2020 Adjusted Gross Income. If you use the $36,000 figure as an estimate and it turns out they actually have an AGI of $40,000, the IRS will take more tax to make up for the subsidy overpayment.

Question: I no longer get a subsidy. Is covered California just for people who qualify for subsidies? If so, how do higher income people apply?

Answer: If you are not eligible for financial assistance, it would be better to shop for coverage directly from an California insurance company (referred to as “off-exchange”). The reason? Silver plan rates are higher through Covered California. While Covered California Bronze, Gold, and Platinum Plans are the same price, you will pay more for Covered California Silver Plans. Click here to shop and apply for off-exchange health insurance coverage

Question: I recently retired and my dependent minor child receives Social Security benefits based on my retirement. She will be required to file a tax return in her name, although she will not pay any tax because her income is not high enough. How do I handle this income on the Covered California application?

Answer: Your daughter's taxable income is included in your household income. When she files her tax return, she should not take a personal exemption (0 exemptions) that will allow for you to continue to claim her exemption on your tax return

Question: I don't want Medi-Cal. I just want to pay for health coverage at subsidized rate. What should I do? Where do I need to apply for it?

Answer: You can start an online application at www.CoveredCa.com. Your eligibility for subsidized Covered California coverage will depend on your income.

How to Renew Medi-Cal Coverage?

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Question: My son is on Medi-Cal. How do I make sure he is renewed for 2020?

Answer: Medi-Cal coverage is renewed throughout the year on the anniversary of the person’s enrollment in Medi-Cal. This means that a Medi-Cal renewal may not coincide with a Covered California open enrollment. Your son will receive a Medi-Cal renewal form from his local county human services agency. Complete this form and mail or fax it, along with any needed information the county requests, to your local county human services agency. You can also renew by visiting your county human services agency in person or by calling the phone number on the renewal notice. Click here for list of County Services Offices

Question: How do I recover my login password for my CoveredCA account?

Answer: You can recover your username and password at www.CoveredCa.com. To recover your username, click the “Sign In” icon at the top of the page, select “Forgot Username” and type in your email address and date of birth. If you ever created a username it will be provided. If no username, create an account. To recover password, select “Forgot Your Password?” link. Enter your user name and date of birth. After you correctly answer your security questions, you will be able to enter a new password. If you do not remember the answers to your security questions, it is best to leave them unanswered and call the Covered California Service Center at (800) 300-1506. A Service Center representative can help reset your password.

Question: Covered California took my monthly premiums for 8 months. When I went to the doctor, they cut my benefits. When I asked them why they said because the law had changed in January 2019 and insurance was no longer mandatory. Then I asked for a refund for a refund of my premiums and they said no because I saw the doctor once!

Answer: Apparently your Covered California coverage did not renew on January 1, 2019. Most likely causes include non-payment of the monthly premium or loss of eligibility due to an income change. The premiums you paid prior to that date was to pay for coverage before January 2019, that’s why you can’t get a refund even though you only “saw the doctor once”. Do you get a refund of your auto insurance premiums when you don’t have an accident or your home insurance when your house doesn’t burn down? Health insurance works the same way. You pay for the protection against a major financial loss. Health insurance is mandatory in California in 2020. Now’s you chance to get it right, Sign up during Open enrollment October 15m 2019 to January 31, 2020.

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