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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.


Effects of Mid-Year Change in Income?

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Question: If a family’s estimated income for 2014 is just above the threshold of California Poverty Line that makes them eligible for premium assistance and cost sharing and in June 2014, it finds that its annual income is dropped below the poverty line making it ineligible for premium assistance and cost sharing. Please answer the following questions. a) Will this family’s health coverage be switched over to Medi-Cal in July 2014 or continued to the end of 2014? b) What will happen to its monthly premium assistance and cost sharing benefits availed of from January to June 2014? How those ones will be considered at the time of filing 2014 tax return? c) Also answer these question in vice-versa circumstances i.e a family’s estimated income comes under poverty line and in June 2014 its income increases making it eligible to premium assistance and cost sharing.

Answer: a) If this family were to report a change in income to the exchange that would make them eligible for Medi-Cal, for example becoming unemployed, they would be switched to Medi-Cal. The IRS would reconcile Advance Premium Tax Credits (APTC) received to that point on the family’s tax return. If the family’s income was below 100% of FPL for that year, there would be no recovery of APTC. (See previous entry on this subject). There is never any recovery of Cost Sharing Reductions (CSR). b) Conversely, increased income reported mid-year could move this family from Medi-Cal to subsidized exchange coverage. Again, the IRS would settle-up for the tax year.

1 Comment

I have old husband and wife application today. They get the enhanced silver 94 plan. “shop and compare” to quote for them, the PPO plan premium for them from Anthem ( after $1400 ) deduction is only $57, while the enhanced silver plan from Blue Shield costs $187.

could anyone here tell me why Blue Shield is so much more expensive than Anthem? For client, is there any benefit/advantage to use blue Shield than Anthem here

PS: also, my commission from Anthem will only be $24 per month( husband and wife app ); But if Anthem choose Blue Shield, my commission will be $60. Almost 3 times difference. Why ??

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