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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.


July 2014 Archives


Two Residences?

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Question: Adult lives approx. half the year in California and the other half in North Carolina. Currently has coverage in California but needs to see doctors in North Caroline as well while there. Do you have coverage for this?


Answer: You could qualify for a special enrollment period in North Carolina if you claim NC as your home address. If so, select Blue Cross Blue Shield of NC PPO coverage (once you confirm that they offer Blue Card coverage outside of NC). You will be covered by in-network benefits while in California as long as you see a Blue Shield of California PPO network provider. If you want California based coverage, select Blue Shield of California PPO (only Blue Card in CA) coverage effective 1/1/15 during the next open enrollment period starting November 15th.


Question: My family is losing COBRA coverage on 9/16 (expired). Anthem, Blue Shield, and HealthNet and Cigna all will only give a 10/1 effective date. Will anyone give a 9/17 effective date to avoid a gap in coverage?

Answer: No help from the carriers on this loophole. Right now the consumer with expiring COBRA coverage may have to wait up to 30 days for the ACA compliant coverage to kick in. Eventually the feds will get it ironed out. In the meantime there's short-term coverage perhaps?


Report Income Change?

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Question: I estimated my 2014 income to be about $35,000. My 2013 income was $33,070. Due to a lay off of one of my jobs, it looks like I will make about $30,00 for 2014 if I don't find another part time job. I am being subsidized from the state for my Anthem Blue cross. If I don't make the money I estimated on, will I get a refund from the California Exchange if I don't have an adjustment made now? Or do they apply it to the next years premiums? (still looking for another part time job)

Answer: The IRS will reconcile the advance premium tax credits (subsidy) you have received for the year on your 2014 tax return. In your case, there is no need to report a change in income at this point as the difference between estimated income and actual income is not very great. In cases where the taxpayer's income increases greatly during the year, reporting the change to Covered California will prevent a big tax bill come tax time. If income decreases significantly, reporting the change immediately may greatly reduce your net premium for the rest of the year.


Question: Retired couple on Covered CA has husband turning 65. Husband is the only income in the household and they are APTC eligible. Now that husband is going to be eligible for Medicare and ineligible for Covered CA how is the income counted for the wife in Covered CA. Will his income be used to determine what her premiums will be in Covered CA? Will she now be eligible for Magi Medical since she has no income? Thanks

Answer: The husband's income is still counted even though he will not be enrolled in Covered California. Since the premium assistance (subsidy) is based on a 2-person household, the wife in this scenario will continue to pay less net premium they were paying as a couple.


Question: I know the 2013 Federal Poverty Level rates were used to determine the premium tax credit subsidy. However, when it comes to reconciliation at tax time will the 2013 or 2014 Federal Poverty Level rates apply? This could make a big difference if a single persons MAGI is $46,500 for the 2014 tax year. Which one? 400% of the FPL for 2013 is $45,960 (No subsidy) or 400% of the FPL for 2014 is $46,680 (Subsidy).

Answer: The IRS will use the 2013 FPL standard to reconcile 2014 MAGI and advance premium tax credits (subsidies). See Fred's comment below for more detail.

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