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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.

California Individual Health Insurance Market Expected to Explode

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Question: How big could the individual health insurance market be, say by 2016?

Answer: No one really knows exactly what the size of the California individual market is going to be, but it is certainly going to be much larger than it is today, which is about 1.5 million people. About 500,000 of those currently self-insured in the individual market will qualify for premium subsidies and move to the Exchange. About 3 million currently uninsured are expected to enroll in individual market through the Exchange. Non-Exchange individual business could add another 1 million people. So, the 2014-2015 individual insurance market in California should be about 5 million lives. Also, it remains to be seen how many employers - especially those under 50 (employees) - will decide to drop coverage and point their employees to the Exchange. California could have anywhere between 5 million and 8 million people in individual health plans by 2016.


Yes, but what is the incentive to enter the year defensively, ie. assuming little subsidy. Why should I predispose myself to an outcome where I will most likely leave on the table the cost sharing reductions I am entitled to. The insurance premium subsidy I reconcile, but apparently the cost sharing not, I overestimate, I lose the money forever.

Better yet, why not start the year claiming maximum possible subsidy, reconcile the insurance premium at the end of the year (as I must, but with no penalties) and pocket the cost sharing reductions which apparently cannot be retracted.

Apparently there are no penalties for over-claiming irreversible cost sharing reductions? But if penalties are eventually imposed, then it will become a nightmare for those who in addition to other unpredictabilities of life, also have unpredictable income, and now unpredictable penalties to boot.

P.S. Sorry, I should have started a new thread on this. I did not realize I was already inside a thread when I posted. Feel free to do so if it would be more informative overall.

During the Covered California application process you can choose to defer some or all of the tax credit to which you are eligible until you submit your tax return for that year. This would be the best option for you if you are concerned with an overpayment of your subsidy.

You have to be enrolled as eligible for a tax credit during the tax year to get an adjustment on your tax return. If you are concerned about getting too much tax credit, you could overestimate your income at enrollment. You cannot return or recover cost sharing reductions over-credited or under-credited.

If one cannot predict his family’s income (contract work, variable hours, overtime, unknown investment returns etc.) can they pay the higher unsubsidized premiums and then claim the insurance premium subsidy as a tax refund at the end of the year (Perhaps through their tax return?)?

How about cost sharing reductions? Can those be reclaimed after year end, once the exact income is known?

Only if they file taxes jointly.

If three people live in one home. Do they all add up the line 37 on the 1040 to get household income. all file own taxes and are single.

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