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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.


How Long Does it Take to Verify Income?

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Question: In order to prove that I qualify for premium assistance, I had to upload evidence of my income. I uploaded the required documents a couple weeks ago. How long does the verification process usually take? Should I go ahead and “check out” with a health plan even though I don’t know how much premium assistance I will be getting?

Answer: You can safely assume that you will be getting the subsidy for which you were conditionally approved. Go ahead and select your health plan. Covered California could take up to 90 days to “verify” your income estimate for 2014.

35 Comments

If your current health plan truly is grandfathered, you may have until Nov 30 to renew for 2015.

Your best estimate of your 2015 income is what matters now.

What income time period is used? Self employment income with large loss in 2013 as a big job was paid in 2014? So 2014 am expecting a much larger than usual income. Unless another big job payment does not arrive until 2015. Usually do not file until October due to trying to even out income with how depreciation items are handled. Sounds like a person does not know what insurance will cost until after it has been bought? Currently have a grandfathered Anthem blue shield hospital only policy we have had for about 15 years. At about $470 month couple age 56, it looks cheaper than most of what I am hearing.

John …

Just send in what you have — just your most recent bank statement will suffice, or any one that you have. With millions of documents to review, I sincerely doubt that they have the ability to look at all of them.

You can still go online and submit the document through your CoveredCA account.

Thank you for the wonderful feedback Max. We will pay the premium today.

My question is what happens if we fail to send in the requested verification of income that Covered California asked for? They sent us a letter specifically asking for bank statements, w2 or 1099 for the month of April 2017. We can easily provide bank statements but we cannot provide 1099 thanks to the mistake our employer made on the 1099.

Wont Covered CA cancel our plan eventually if we do not supply the 1099?

John … PAY YOUR PREMIUM IMMEDIATELY!!!

Your 2013 and all prior years’ incomes are immaterial to the premium tax credits, and there is nothing for CoveredCA to verify or approve. They have provided APTC based on your stated income for 2014, and that will be “reconiled” in 2015 when you file your income tax return. If your actual 2014 income is higher than estimated, you may have to repay some of the tax credits to the IRS, if lower, you may receive a refund of the unused credits.

But if you don’t pay your premium now, however, your insurance coverage will lapse.

My wife and I received an invoice for a new policy in advance of a determination as to eligibility from Covered CA. We are afraid to pay it because our income has yet to be verified.

Our previous employer screwed up my 1099 reporting to the IRS reporting my income as TWICE that of what it should have been. Therefore we were unable to file 2013 tax return, therefore we are unable to verify income. I would like to know how scenarios like ours will be handled when a previous employer is preventing us from verification of income?

There must be specific guidelines set in place and there absolutely are none as far as I am aware.

Jamie …

Just access your application and click on the “Eligibility” check-mark. Once on that page, you will see the name(s) of each person in the application and the document requirements. Click on the “Upload Documents” link for each category (there may be more than one) and then select the type of item to be uploaded and “browse” for the file to be uploaded. Once you click on the “upload” button in the lower right corner, the document should be received in a matter of seconds (look for a barely visible green verification of upload statement at the top of the upload window).

Covered california requested income verification. Where could upload info on the website. I can’t find it. Please help

$6,000 annually? That will not get you out of the Medi-Cal loop, because it is less than 50% of the Federal Poverty Level. To be free of Medi-Cal through CoveredCA, your MAGI must exceed about $15,900 (slightly higher numbers for 2014 are expected to be announced in a couple of months).

You are free to purchase health insurance outside the CoveredCA marketplace, but you will not receive premium tax credits either.

My yearly income as of 2014 is 6000.00. I did not know I could add income when I submitted my Covered Calif online application and was given Medi-cal. I did note on my application that I did not want Medi-cal as I am able to pay some towards my insurance premium from my savings account. My emails went unanswered from Covered Calif even though I received a msg that someone would ans within 48 hours. I was never able to get though on the phone or online chat. Now that I figured out the added income option, I qualify for premium assistance and selected Blue Shield. Now Covered Calif wants me to submit my bank statement….if premium assistance is based on income and not assets, why the request for my bank statement? Is there a limit to how much you can have in the bank?

Concerning documents and verification, I discovered on Monday this week that on a number of my applications the uploaded documents have been erased, and now show “None” where there were previously all of the required documents. In some cases I no longer have copies of the documents to upload and now have to recontact clients to obtain their Driver Licenses and other documents to upload them again — for several, this will be the third or fourth upload of the same information.

I spent the better part of 7 hours on Monday, beginning at 5:30pm to complete four new applications — loading and reloading webpages and restarting my browser and having to reinput data repeatedly. Once the clock passed midnight, however, whether due to people just giving up because the “deadline” had passed or some other reason, the website suddenly began behaving properly, and the last application was completed in 15 minutes.

Eliza…. I chose Blue Shield as my provider. I, like you, was waiting for an invoice. I called Blue Shield and was told that I should have received a phone call and that I had 10 days to pay. When I asked them what phone number they had on file they said they didn’t have one it had been dropped from my CoveredCA data. They did provide me with a website where I could pay my first month’s invoice, called a Binder, online.

In order to keep the January 1st effective date of coverage, all Certified Insurance Agents can continue to key in applications when consumers contact them to complete the application and plan enrollment process. Applications keyed into CalHEERS by 6:00 p.m. on December 28th may receive the January 1st effective date.

Dear v …

There is no way to track the progress of a paper application unless it is one of the handful that were actually input into the system. By December 15, CoveredCA had some 25,000 paper applications waiting to be input. If yours is among them, don’t expect anything to happen anytime soon.

Had you inquired sooner, we would have advised you to file a new application online. The deadline for a Jan 1 start date has now passed. You can still make an online application and your coverage will begin on Feb 1.

Dear Phil,

What if you submit application by mail? How can you check on the website for progress or if any income verification has been requested?

Thanks.

I, too, uploaded proof of income docs about a month ago and am still waiting for verification but my immediate concern is why haven’t I received an invoice from the provider I chose? I know the deadline to pay is Jan 6- should I have received this even though my docs haven’t been verified? The site shows I’m enrolled with the 90 day thing..Very confused. I want to pay. I’m ready to pay. Help!

Cathy …

You should be able to safely assume that your coverage will be continuous and that you will not be uninsured on 1-1-2014. The best thing to do today is contact the insurance company you applied to and ask them if they have received your application, and if not, what you should do now to correct that matter.

I was conditionally approved for a platinum plan in October. I sent (faxed and mailed) all requested proof of finances/taxes, etc on 11/14. I understand there is a huge backlog, but my exisiting policy expired 12/31. I cannot chance being uncovered for months while I wait to hear from CC. What are my options?

Andy …

Judging by some of the posts on this site, there does not seem to be any consistency to what is happening at CoveredCA. I have no idea if they are passing along any of my Medi-Cal applicants to the local county agency.

And as I just posted, the first person I tried to enroll in a paid plan I can’t get the system to accept. How anyone who waits until December 20 to complete this process for January 1, 2014 will actually be assured of coverage on that date is something the bookmakers in Las Vegas might be giving odds on.

I’m usually a pretty patient fellow, but I don’t tolerate sheer ineptitude very well at all. With three years to get a system in place and get people trained, and to have the time to anticipate all the possible “challenges”, CoveredCA, like HealthCare.gov, has dropped the ball on this.

That is compounded by the Legislative design behind CoveredCA which allows the entity to exist with virtually no legislative or governmental oversight and absolutely no transparency.

That’s why the Board was able to flout Obama’s 11th hour appeal to insurers to give back the coverage they were terminating after 12-31-2013. They have no allegiance to anyone, and no one can tell them what to do. CoveredCA is not the only state-created entity with power such as this.

The people who have elected — and repeatedly reelected — the knuckleheads to office in Sacramento that have allowed this travesty should beg forgiveness for their mistakes. In the meantime, everyone must suffer the consequences.

Concerning Jill’s question about how long it takes to verify income, I can say that sometimes it never happens. I have several clients for whom I have uploaded pay stubs and/or bank statements showing payroll, retirement, or Social Security payments, and have done this repeatedly for some clients, and nothing seems to change. I also take the extra step of faxing documents to the 888-329-3700 fax line indicated in the Eligibility Determination letter.

However, yesterday in a call to CoveredCA (which took a couple of hours of redials to get past a busy signal, and then resulted in a 59 minute music-on-hold experience before getting to a CSR), I was told they are “way behind” on data entry from faxes to that number and was given an additional fax number to use. For everyone’s benefit, that alternate fax line is 916-636-3400. Obviously, that is not a toll-free number, but I use efaxcorporate to send and receive faxes so it doesn’t matter to me.

In the meantime, I have a client who wants to enroll in a health plan and for the past two days (and again just now) I repeatedly get “Your enrollment could not be processed at this time. Please try again later”.

That’s what prompted my call to CoveredCA yesterday. The CSR said, “Oh the website has been working just fine for me all day …” until she logged into my client’s account and, voila!, “Oh, wow! I’ve never had that happen before.” And she had no answer as to what was causing that problem.

But this is one of my clients that I have uploaded and/or driver license, bank statement, and Social Security card at least three times, because his eligibility letter said we need to verify your citizenship, your income, and your Social Security number. The sad thing about this … the client is age 63 and collecting Social Security retirement benefits and a union pension, both of which are direct deposited into his bank account. So why they cannot verify this is beyond my comprehension.

Then again, I only have a master’s degree in communications, and served as the technology coordinator for a Los Angeles Unified School District Middle School for a year ten years ago. So what do I know?

I know this: you cannot eat an elephant in one bite. Obamacare and CoveredCA have seemingly ignored this reality.

I have been asked to verify income, but when I try to do this I get an error message. The number to call is busy. I have mailed the document but would feel more secure uploading it in the computer. Have others experienced this?

I applied for Medi-Cal for 2014 on CoveredCA.com online application. At the end of the application, it asked me to upload proof of my CA residency, so I uploaded copy of my CA driver’s license and received a verification ID number. One week later, I logged into my CoveredCA account, it still showed that I need submit proof of CA residency, so I called CoveredCA customer service. The representative told me to call back in 2 weeks if it still shows the same thing. Two weeks later their system still showed that I need to submit proof and my MediCal status was “pending”. I called CoveredCA and asked them why, and if MediCal will keep on waiting because your system is saying that I need to submit proof. The customer service rep could not answer my question, she transferred me to a Medi-Cal specialist. The specialist checked in the Medi-Cal system and told me there is no application case for me. She took my information over the phone and created my application case for me, also told me it could take up to 45 days for them to review my case. The CoveredCA website wasted me 3 weeks. The 45 days could mean that they would approve my application around Jan 15, 2014 if they have many applications to review and if they need me to submit more documents probably could be longer. Could CoveredCA be held responsible for my delay of getting MediCal?

“I have lived and had a driver license and filed income taxes from the same address for 20+ years. Yet they asked for proof of residency and a copy of my social security card.”

Trust me, you are not the only one. It seems to me that the online enrollments that have come back like this have largely been persons with Hispanic surnames, even though the boxes have been checked “US Citizen” YES and “Naturalized Citizen” NO.

I cannot figure it out either.

It should be fairly standard that the retired people themselves decide on their MAGI income, it is all 401K and IRA withdrawals these days. The income amounts are up to the taxpayer. And the plan deductibles are big. So it is going to be wait until tax return time to determine a subsidy or deduction for a big chunk of the target population.

I have lived and had a driver license and filed income taxes from the same address for 20+ years. Yet they asked for proof of residency and a copy of my social security card. What are they looking at that they can’t see that ? Since the state is so bad at this, they should just get the hell out of the way.

BobG …

You’re welcome! As for the comments section, I don’t think anyone actually reads that, and for the life of me, I don’t know why it is marked as a required field.

While to CoveredCA website seems to be functional, I’m not sure the CoveredCA bureaucracy is. Obviously, there is a learning curve that has to be overcome, and thanks to HHS and their littany of “Final Rules” that still are not 1005 final, there are many questions remaining to be answered.

So don’t expect definitive answers even from Supervisors at CoveredCA. There are only two persons in the entire federal government who have them all, but the problem is they can’t agree on any of them.

The old saying, “How do you eat an elephant? One bite at a time.” was not given much consideration by Congress in their closed-door rush to cobble together the PPACA in 2010. They have crammed the elephant down the throats of everyone in the US.

Bob - your understanding is correct for your specific example. They’ll take your word on income going up, or income going down up to 10%. But if your attested MAGI for 2014 is greater than 10% from your 2012 MAGI, and they do know if that’s the case, then 2013 is the “bridge of proof” that allows them to say, OK OK we’ll give you the subsidy and see how it turns out. But 2013 can’t be proof until it’s a hard doc like a 1040, until then it’s hearsay.

This is particularly relevant for those like, like myself, that derive their income not from reliable sources like W-2’s but income from 1099’s. It’s the same thinking that has mortgage lenders more likely to give you a loan if you have a steady job vs. big bank balances that theoretically could disappear next time you go to Vegas.

My understanding is that your 2013 1040 is of minor relevance. It is the 2014 income that is important. For example let’s say that in 2013 you did not receive Social Security but in 2014 you did. Your income in 2014 would be quite a bit higher in 2014 and that is what matters. Thinking that if you file early and provide a 2013 1040 as definitive may be a shot in the dark. Of course, the only reason we are grasping at straws because we don’t know exactly what CCA wants to see in order to close the issues.

Thanks, Fred. I’ve done my homework and I concur that on paper I should be safe - meaning during the 90 day period eligibility and the APTC should be provided. And yet, though my circumstances are similar to yours, my choice of carrier (Blue Shield) as of yet has nothing on me in their system. This is checking under: SS#, name, and Covered CA Application ID #. My application was “completed” in Covered CA, meaning a plan picked, on 10/17.

Strategically, as has been pointed out on other posts, the thing is to stay within the Exchange, pay the unsubsidized premium if need be, and look to get it back at year end.

One thing I will do if it’s still not cleared up by January 30th, 2014, is E-file a 2013 tax return. 1/30 is the first day you can do this, and I’ll do it even if I don’t have all the necessary supporting docs or data. The 2013 1040 should be THE definitive income doc, period. If I need to amend it later on, then so be it.

Max, thank you for the response (anonymous). I was allowed to upload the recent bank statements possibly because they had a different name and size than the previous uploads? Also, in the comments section I did clearly specify exactly where my 2014 income would come from. I have not yet heard from my selected insurance company and the only thing I have heard from CCA has been confusing so my confidence is low and anxiety rising. I have called, chatted, and written without any clear recommendations or resolutions. At this point I am in a wait and see mode but would much rather be proactive.

Dear Anonymous — you are not alone in this. There is either a computer routine sceening documents visually as to type and not for content, or there are humans doing this who simply get a paycheck and have no clue what they are doing. It could even be a combination of the two.

The CSR read or type answers to questions out of a manual — no brain power involved. So don’t expect much help there if they can’t even figure out what question you are asking.

In insurance, we are guided by the concept known as “utmost good faith” that what a client tells us is true and unless it seems to be blatantly wrong, we are not expected to challenge what they tell us. Covered California does not seem to grasp that concept. If a person says, “My income is $0” how do they “prove” that? What document can I find that proves $0 income?

The CSR told me on chat to simply write a statement that the individual has no income. Wonderful. If they will accept that, they should not attempt to second guess what a person states in their application.

I uploaded a bank statement as proof of income for an individual, which clearly showed one deposit of Social Security Retirement income and one deposit of a Baker’s Union pension payment. The Eligibility Determination letter stated, you are eligible for up to $4200 in premium tax credits, but you need to provide proof of income.

Excuse me? What other proof do they need besides what they were given? So I faxed the documents to them again, because once the upload of documents is complete, you cannot upload online again. That’s redundant.

It’s clear to me that Covered CA is attempting to do the right thing, but they may be overly reliant on technology of some sort (kind of like facial recognition software) that is not perceptive enough to read tiny type. I don’t know.

The other thing that seems to be happening is the number of times persons of hispanic descent are being required to provide “Proof of US Citizenship or lawful presence in the US” even when the checkbox “Are you a citizen of the United States” is checked YES and the “Are you a naturalied citizen” box is checked NO. Again, utmost good faith must come into play at some time.

If you need additional help with your application, go to my website where my phone numbers are listed and give me a call. I will be happy to help as much as I can.

I am retired but am not receiving social security nor any other pensions nor benefits. Basically I live off of my savings, interest, and dividends. I uploaded my bank statements showing interest income YTD as well as a recent investment statement showing YTD dividends. I was approved for 90 days and once again asked to submit recent bank statements, which I did. A phone call to coveredca could not resolve why I am being asked for the same information and specifics about what is needed. Since 2012 nor 2013 do not have a direct bearing on 2014, which is the only income coveredca is concerned about, why do we have to be so detailed about 2012 and 2013? If we misrepresent our 2014 income estimate we will face penalties and we needed to sign a legal form that we accept that. One reader posted that he sent in an affidavit but by signing up for a subsidy haven’t we basically done the same thing? I continue to be confused as to my application and its status and don’t know what else to do?

Did you check your “Secure mailbox” for your Eligibility Determination letter. That usually comes just one or two days after uploading the last document. It will tell you what you “may” be qualified for.

Andy, Phil is correct. The federal law and regulations (as well as California regulations) clearly state that if proof of income is required, the exchange shall initially provide the advance premium tax credit (and cost-sharing reduction if applicable) based on the applicant’s statement of income.

In my case, proof of income was required because my stated current income was more than 10% below the latest data available to Covered CA (my 2012 tax return). In the meantime, I have called my health insurance company and they have verified that they have my 2014 enrollment data in hand and quoted the coverage and premium as expected (i.e. based on my stated current income).

If I do not submit acceptable proof of income, the regulations provide that my APTC and CSR will then be revised and based on the 2012 income data.

As to the original question, I strongly suspect that the verification process at Covered CA will take a while. Bureaucratically, they seem to have taken a posture of putting things off to as late as possible (as evidenced by their total lack of urgency in processing October enrollments to completion). In the case of income verification, the earliest date that they might have to take action is January (90 days after the earliest enrollees filed). I suspect that they may wait until the first wave of 90-day expirations in January to begin reviewing submitted documents and statements. And keep in mind that if they do not find your proof acceptable, they must contact you with the decision (or request for more info) and notify you of your appeal rights. If you prolong the process with more evidence or a formal appeal, I believe that your APTC and CSR will remain unchanged (i.e. continue to be based on your statement of current income) pending final resolution.

Phil, it seems you’re saying that carriers will bill applicants for the initial new policy premium who are in their 90 day window, with verification to be determined afterwards. Cancellation of the policy to follow if warranted, would be the logical conclusion.

Are you absolutely certain this is the mandated procedure, as compared to Covered CA waiting until verification of proof is determined BEFORE they pass the application along to the applicant’s choice of carrier?

The procedural difference between these two approaches is night and day and critically important. Do you have knowledge of this, or does anyone here know anyone who has received an invoice for a new policy in advance of a determination as to eligibility from Covered CA?

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