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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.

Covered California and Same Sex Couples

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Question: How does the Supreme Court ruling on DOMA affect gay and lesbian couples, married or not, in eligibility for Covered California coverage in 2014?

Answer: The U.S. Supreme Court on Wednesday struck down the Defense of Marriage Act, or DOMA, ruling that legally married same-sex couples are now entitled to the same federal benefits as married opposite-sex couples.

This has implications for Covered California premium assistance. For example, same-sex partners who each have an income of $35,000 may be eligible for the premium assistance tax credits under the ACA - but only if they remain single. If they marry, then they would lose eligibility because their income would be over the threshold 400% FPL for a household of two.

But marriage would be a benefit for couples who have significantly different salaries. For example, say one spouse is unemployed and one earns $50,000. Separate, the unemployed person would qualify for Medi-Cal, but the $50,000 earner would be ineligible for premium assistance. Together, their combined earnings are now low enough to qualify both of them for a Covered California tax credit.


Thank you. I guess tax year 2013, in my case, is not used for any calculation (October 2013 is the enrollment month for CoveredCA and the my tax year ends in December 2013). So I’ll use a prospective income of 2014.

Maybe IRS will have advice for married couples like us. (CA - a community property state).

In November 2014, eleven months into ACA’s state exchange for individual coverage, I will turn 65 - Medicare. My problem vanishes or changes to that healthcare coverage system.

(Thinking about moving to Canada or France, residency then citizenship. US is just too backward).

“What is the definition of ‘annual household income’”

The PPACA refers to “modified adjusted gross income” (MAGI). Adjusted gross income is a taxpayer’s taxable income after all personal income and deductions are tallied. MAGI also includes nontaxable sources of household income, such as the earnings of a spouse or children that would otherwise not be reported for income tax purposes.

Additionally, the PPACA uses “prospective” income rather than known income. In other words, you must estimate your 2014 income rather than rely on your known income for 2012 (the last full year for which you would have figures). If you qualify for an advance tax credit but your 2014 income ends up being higher than anticipated, then you will have to repay the credit when you file your income tax return in 2015.

Sound complex? Of course it’s complex. When did the government ever do something new that wasn’t?

Your situations will be especially complex. While the Supreme Court struck down the definition of marriage, DOMA still says that a state that does not recognize same-sex marriage is not required to recognize the legal marriage of a same-sex couple married in a state that does.

My husband and I are a same-sex couple, legally married in California, but we are moving to Arizona - which does not recognize same-sex marriages. What now?

This example was very helpful, but I am still at a loss for planning. October is too late for saving, budgeting and financially connected retirement elections before the end of the year.

What is the definition of “annual household income” for the Affordable Care Act - Covered California?

Since the Supreme Court decisions for DOMA and Prop 8 affect so many federal and state agencies, what date can I reliably use to calculate from?

Date of our marriage? (2008) Date of SCOTUS decisons? (June 27, 2013) Date of government agency rule? (?? 2013 or later)

If we are considered married for federal purposes in 2013 for a specific agency like IRS, does that apply to the entire year?

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