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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: 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.


Lower Income, Repay Subsidy?

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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.


Question: My son, age 23, got hired and enrolled in a PPO health plan at work, because they told him had to. He is still our plan. Can he drop his insurance through work and stay on our plan?

Answer: Your son can be included in your household health coverage through Covered California until age 26, even though he is employed. However, if he is included with your family coverage, your household is not eligible for premium assistance or cost sharing enhancements from the time he was offered health insurance at work.


Recover Covered Ca Password?

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

Answer: Go to the Covered California Online Account, click here. Enter your username if you know it, if not click on “Forgot Username” You can recover your username with your email address and date of birth. To reset your password, click “Forgot Password”. 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.


Covered California for 65+?

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Question: I turn 65 in February and I will be eligible for Medicare. Can I stay in Covered California instead?

Answer: You cannot purchase a Covered California health plan with premium assistance if you are eligible for Medicare. Without premium assistance, coverage through Covered California for a 65 year-old is much more expensive than Medicare. However, if your income is very low, you may be eligible for Medi-Cal in addition to Medicare. The Covered California application automatically checks to see if consumers qualify for Medi-Cal. If you qualify for both Medicare and Medi-Cal, Medi-Cal will help pay for Medicare premiums and cost-sharing requirements. Medi-Cal may cover additional benefits, such as dental services, nursing home care, and personal care services. Medi-Cal may also provide extra financial assistance to help with the cost of Medicare Part D prescription drug coverage.


Am I Renewed or Not?

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Question: I received a renewal notice from Covered California a while back. It seemed to say that I needed to renew my coverage by November 15th, but it also seems to say that I don’t have to do anything and I will be renewed. Which is it?

Answer: If you take no action to actively renew or change plans, you will automatically be renewed into the same plan you had in 2017 if available. However, you still have until December 15th, 2017 to make changes to your coverage or switch health plans.


Adult Child Coverage?

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Question: I thought my daughter could stay under Covered California plan until she is 26 years old? I was told that she had to be a dependent on my taxes. Is this correct?

Answer: If you are eligible premium assistance (a subsidy) for your family and wish to include your daughter as part of your household, she must be a dependent on your income tax return. If you are not eligible for premium assistance, your adult child can be financially independent and pay their own taxes and still be included on your family coverage to age 26.

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