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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 for 90 Days?

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Question**: If I applied for Covered Ca and came back pending verifications for either Magi or APTC and am told to wait for a letter in the mail. Is it true that I am eligible and covered for the first 90 days and if verifications are not submitted I can will be discontinued?

Answer: Yes. You are approved for APTC for 90 days of coverage. APTC beyond 90 days is contingent on providing the requested income verification.


Great question and great answer. So, when will we find out when we have been approved for the full APTC? I have sent in all my income verification, twice, and have not heard anything back. I would hate to find out after 90 days that my income verification has not been approved. I have tried several times to inquire as to specifically what I need to send in to satisfy the requirement but can not get a clear response.

The question is oddly worded, but if I understand it correctly, the answer is NO.

It sounds like the applicant has been notified that he or she qualifies for coverage for 90 days, and qualifies for the Advance Premium Tax Credit (APTC). But he is also told that he must submit proof of income. (The wording in the letter that he will receive will say something like “We were unable to verify your household income with electronic verification sources. We need proof to see if you qualify.”)

Here’s what happens if he does NOT submit proof of income. Covered CA will redetermine his eligibility based on the information from those same “electronic verification sources” (which for most people would be the 2012 federal income tax return).

Let’s say this is a simple case of where someone is alleging current income that is more than 10% lower than his 2012 income. If he does NOT provide proof of income, Covered CA will then revise or discontinue his APTC using the higher 2012 income figure. There is NO discontinuation of coverage. The applicant is notified of the decision and informed of his appeal rights. If the applicant files a timely appeal, his APTC will continue to be based on his alleged current income pending final resolution of the appeal.

This procedure is clearly spelled out in the California regulations (which mirror the Federal regulations). The original question only referred to APTC, but the same would apply to any applicable cost sharing reduction (CSR) that has been approved for 90 days.

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