Question: Our family income for 2013 is likely to be very low, since we started a new business earlier this year — probably between 100 and 250% of FPL. I expect however that our income in 2014 will be higher, likely exceeding 400% of FPL, the level at which the subsidies phase out. A couple of questions: 1. If our 2013 income is low enough to qualify us for Medi-Cal (instead of subsidies) for 2014, can we still purchase health insurance on the exchange? Is there any good reason to do so? For example, I’ve heard that many providers don’t accept Medi-Cal and that the quality of care available may be subpar. 2. I know that if we get subsidies for 2014 based on our 2013 income, they will have to be paid back during tax time if our 2014 income makes us ineligible. But what about the reverse? Suppose we subscribe to a plan in the exchange and pay for it in full, but it turns out that we were in fact eligible for a subsidy based on our actual income. Can we then claim this subsidy amount as a credit when we file our 2014 taxes? Many thanks for your help.
Answer: (1) If your income qualifies you for Medi-Cal, you can choose not to apply for Medi-Cal and enroll in Covered California without premium assistance. And no, there is no good reason to do this, since you would be passing up virtually free coverage for unaffordable coverage - end of story. (2) If you enroll in a Covered California qualified health plan and your premium assistance is underpaid, you can recover what you were due at tax time.