Speak with a Covered California certified agent! Call (888) 413-3164 or Shop Online Now

Shop and Compare

California Health Insurance Plans and Rates

It's easy. Just enter your zip code.

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: 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?

By on | 3 Comments

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?

By on | No Comments

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?

By on | No Comments

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?

By on | No Comments

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.


Lower Income, Repay Subsidy?

By on | No Comments

Question: I had Covered California with a big subsidy in 2016 because of my low income. I lost my job in October, so my income will be even lower than it was when I applied for coverage. I am now eligible for Medi-Cal. Will I have to repay the premium tax credits that got this year?

Answer: No. You are still eligible for the tax credits you received last year. If your income later fell below the Medi-Cal eligibility level, you will not be required to repay the premium tax credit when you file your tax return.


Question: What is the advantage of signing up through Covered California, instead of directly through through Kaiser?

Answer: Your income may make you eligible for premium assistance and Covered California is the only place to enroll for health insurance coverage with premium assistance. 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 Kaiser Permanente - referred to as an off-exchange enrollment - you are not asked to provide any income related information whatsoever. Off-exchange, you will find more available health plan, some that mirror the Covered California plans exactly in benefits and rates, and other plans that are unique to the off-exchange-market.

Do You Have California Health Insurance Questions?

Ask An Expert

View Previous Questions
Call Us at (888) 413-3164

Subscribe to the Q&A

© 2018 California Health Benefit Advisers, LLC
Home / About / Start Shopping / Ask a Question

“Covered California,” “California Health Benefit Exchange”, and the Covered California Logo are registered trademarks or service marks of Covered California, in the United States. This web site is owned and maintained by California Health Benefit Advisers, LLC, which is solely responsible for its content.