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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.

What Happens if Your AGI is Higher than Your Estimate ?

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Question: The way that I understand it, subsidies will be calculated from your estimate of your AGI. That is, you would seed this value with your AGI from the previous year, and, presumably, adjust it for whatever additional information you have about the current year. What happens then, if your income increases or decreases enough during the year to affect the subsidy amount ? What should you do in this case ?

Answer: Your most recent AGI will be referenced during the application by direct connection to the IRS hub. If your self-reported income makes you eligible for a subsidy but doesn’t match your AGI, it “will result in the consumer being conditionally eligible for Covered California subsidies… Their conditional eligibility will be for the 90-day reasonable opportunity period which provides consumers adequate time to resolve the inconsistency. The consumer will be required to demonstrate their eligibility by resolving the inconsistency in order to maintain coverage beyond the 90-day timeframe.”

During the year, periodic electronic data matching occurs semi- annually. “In the event the periodic data matching indicates that the consumer’s income is different compared to what was originally used to determine their initial eligibility, a notice will be sent to the consumer which identifies the new income that was indicated using electronic data sources. The consumer will have 30 calendar days to respond to the notice. If the consumer does not respond to the notice, the consumer will be able to maintain their Covered California eligibility and tax credit, based on their original eligibility information. However, the consumer will have to confirm their eligibility during the annual eligibility redetermination process and will be required to reconcile the tax credit at the end of the year through their annual tax filing.”


What if the income data you use is based upon investments like capital gains and those investments don’t occur until later in the year (November). How will the insurance credit regulator/administrator consider this information and are there any other types of credits/tax adjustments for this type of situation?

So this holds true I assume if income drops? For instance when I go from working full-time to retirement, which will be approximately 54% of my current pay, my AGI from the previous year will be inaccurate.

When they say “…demonstrate their eligibility by resolving the inconsistency…” would a copy of my CalPERS retirement check provide that resolution?

You are welcome and yes, Phil Daigle is a real person :)

This isn’t really a question, but I couldn’t find anywhere on the site to contact the folks running the site. In any case, I wanted them to know that this Q&A section of the site is very appreciated. I have submitted several questions, all of which have been quickly answered, and have helped me iron out most of the uncertainties that I have had as we approach 2014. Thank you very much

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