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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.


Can We Split Our Family Enrollment?

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Question: … if one person in a three person family unit decides to opt for insurance without any subsidy inside or outside the exchange, do the other two automatically forfeit any subsidized insurance through the exchange because of that fact? Does it matter what the family income level is?

Answer: The eligibility for premium assistance in this scenario would be based on the income for a household of three. If the household is eligible for a subsidy, two members can enroll in Covered California while the third chooses unsubsidized coverage off-exchange. If not eligible for a subsidy, you could also enroll two members on exchange and one off-exchange, but there would be no benefit in so doing. In this case, it would be easier for all three family members to enroll off-exchange and split the enrollment among family members in any which way.

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Premium tax credits are only available to the principal taxpayer in a household. Generally, this is husband and wife, in either order. An adult child, especially one with his/her separate income, is going to significantly affect the household income, possibly wiping out all tax credits.

An adult child is not required to be covered under a parent’s policy — the law says that child MAY remain on the parent’s policy.

As I understand the tax rules, if the child files his/her own tax return, those three adults could constitute two separate “households” even if residing at the same address. Just can’t obtain a “household of three” designation for tax credit purposes if the tax returns are going to be filed as two different households.

But the husband and wife CANNOT split their tax filings in an attempt to obtain tax credits if they are living together at any time in 2013 or 2014.

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