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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.

November 2014 Archives

Help Select a Plan?

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Question: I need to find live person to help me select a plan.

Answer: Go to www.Coveredca.com, click on the Get Help menu, then Find Local Help, then Find a Certified Insurance Agent, then enter your ZIP code. Call one of those agents and you'll get the help you need. By law, only a Certified Insurance Agent is allowed to give you advice on selecting a plan, all other "helpers" can only get you to that point, but cannot advise.

Question: My husband is insured through his employer here in California. There is a very small staff (under 10). I have not been offered health coverage, for my husband says that the employer is not obligated to offer it to me, or our son. Is this true? I have read conflicting items online. Thank you.

Answer: It is virtually certain that your husband's employer-sponsored small group coverage includes coverage for dependents even though you may find it unaffordable because the employer is not required to make any contribution toward dependent coverage. That means you have "access" to small group coverage and are probably ineligible for premium assistance and cost-sharing reductions through Covered California. However, if you cannot enroll in your husband's plan now due to being outside the plan's open enrollment period, I see no reason that you can't enroll in CC with premium assistance until you can be added to his employer's plan at the next plan renewal.

Currently in California, SHOP and Cal Choice are the only sources that allow groups to offer coverage to employees without including dependents. Your husband's employer should consider changing coverage to SHOP or Cal Choice and elect "employee-only" coverage. That will free all the dependents to eligibility for premium assistance and cost-sharing reductions through Covered California. If the employer goes with SHOP, the company may be eligible for small group tax credits as well. Employers should contact their broker for more information.

How to Pay Now?

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Question: I just signed up through covered CA for Anthem Blue Cross policy. I tried to make a payment on site but got nowhere. Now what?

Answer: Log in to your Covered California account, go to the summary page and select the "Pay Now" button at the bottom of the page. If you can't do it, let your agent know. He or she can take your payment over the phone.

Question: After having so many problems with Blue Shield through CovCA, I have decided to just go direct with BS during open enrollment for 1/1/2015. Can I just apply directly to BS now and when confirmed I have coverage starting 1/1/15- terminate participation in CovCA/BS eff 12/31/14?

Answer: Yes, you can do that, but the carriers are not immune from screw-ups themselves. The safest way not to create problems for yourself is to do nothing. That way your coverage will renew without changes.

When One Applicant is Over 65?

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Question: I looked at rates for a 2 person household- age 67 and 63. Plan quotes seem to reflect both being covered although the 67 year old , while part of the household for premium subsidy amount, has Medicare and not eligible! Perhaps it would be settled out in application process but meanwhile quite shocking to see the huge rate for 1 person.

Answer: I will assume that you are referring to the "Shop and Compare" tool at the Coveredca.com site. I'll also assume that your 67 year-old spouse is on Medicare. In that case, he or she is not enrolling in Covered California. The online tool has a checkbox that should be left unchecked for the 67 year-old. The silver plan rate for a 63 year old should be about $700/mo unsubsidized. If the older spouse is ineligible for Medical and must enroll in Covered California coverage also, then the premium for the 2 of you will be about $1500/mo unsubsidized.

Question: I'm getting significantly different results when using the Shop & Compare tool versus logging in and using the Preview Health Plans tool. I put in identical data (zip, age, income), and get different premium assistance values from each tool. For example, the Shop & Compare tool gives me a final monthly amount of $80 for a plan I'm interested in (after premium assistance), whereas the Preview Health Plans tool gives me a total of only $17.54. Which number is likely to be correct?

Answer: I don't have a definite answer, but the net premium result you get in the plan selection step of your online application would appear to be the correct number as CC provides a confirmation of coverage and premium at the end of the process. Ideally, they should be identical, but that may not be practical at this point.

Add Dependent for 2014?

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Question: My daughter has her own CC policy in 2014 but I want to include her with mine for 2015 as we will be filing taxes together. A cannot find any way to add a dependent using the CC website. Any suggestions on how I would add her as a dependent?

Answer: Now that open enrollment has started, you can make the change yourself. If you know your username and password, you can use the "Account Sign-In" link (click image to enlarge) Sign-In.png. Once in your CC account, click on the "Renew" button. You will have to verify your identity by uploading a copy of your ID (license etc.) and then you can add a family member.

Non Tax-Filer Refund?

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Question: I overestimated my income for 2014. I do not pay any taxes, so I cannot get a tax credit. A Covered CA rep said I would get a refund check in the mail for the amount I over-paid on my insurance premiums. Is this correct?

Answer: No. If you do not file a tax return for the 2014 tax year, you are not eligible for a tax credit. If you should decide to file taxes, the tax credits based on your income will be reconciled on your tax return. You will pay less tax, but there will not be a refund check.

College Tuition Deduction?

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Question: I find the area of tuition with regard to CC to be confusing. The paper application identifies tuition and fees as a deduction from income. In looking at drafts of tax forms like 1040, 8962 and 1095A, I don't see how this will work. The tuition deduction has been removed from 1040 and I have not seen anyplace where tuition will affect income as it relates to CC. Thinking it should be deducted as the forms continue to have that as a deduction from estimated income. Would you have any insight into how tuition will be deducted from income for purposes and can you confirm that it would be deductible?

Answer: According to IRS Tax Publication 970, you can reduce your income subject to tax by up to $4,000 per year. This would apply to Covered California subsidy eligibility as well.

Shop and Compare Tool?

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Question: When will the CoveredCa.com “Shop and Compare” tool be quoting 2015 rates.

Answer: It’s up and running today. A quick test indicates that it’s accurately quoting 2015 rates.

Spouse Eligible for COBRA?

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Question: I will be retiring at age 66 in February but will need to work part time as a self employed freelance electrical estimator. I will have Medicare, but my wife is only 63 years of age. The question is can she pick up the cobra plan for the spouse thru my company even though I will be retired and self employed.

Answer: (Corrects previous response) Yes. Your wife is eligible for COBRA continuation. She can also purchase individual health insurance any time after December 15th for coverage effective February 1st 2015.

Still Too Many Bugs?

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Question: I've been trying to submit an income verification via the website for the last week. Every time I try to do so, I get an error message. I just trying calling CoveredCA, and got a message that said their call volume is greater than normal, goodbye. So all this time, and they still haven't gotten the basics working yet? Anyway, my question is, should I wait until the fix uploading verification on the website, or mail or fax it in? Last year I was never sure which method to trust.

Answer: I would trust the online upload above fax or mail. If it doesn't work, wait until after 11/15/14 to try again. Let's review the online upload process, just in case it's not a bug. (1) Access your CC account and click on the "Eligibility" check-mark. (2) you will see the name(s) of each person in the household and the document requirements for each.(If you don't see a document verification required, then wait for after 11/15/14 to contact CC.) (3) Click on the "Upload Documents" link and select the type of item to be uploaded, (4) Browse your computer for the PDF file to be uploaded. (5) 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.

Underestimated Income Penalty?

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Question: I underestimated my daughters income thinking her college tuition would be deducted. Now, thinking it will not be which makes her income closer to 200% (around $22,000) which would put her in a bronze plan as opposed to the 94% shared plan she has had. Looks like her monthly payment would be similar for both. Should I contact Covered CA now to ask and potentially correct or just wait until next year when taxes are done? Will there be any charges if she no longer qualifies for the 94% plan she has had?

Answer: Your daughter can choose a Silver plan or any other "metal" level of coverage regardless of her income. Her income still qualifies her for cost-sharing reductions (lower deductible and lower copayments) which are only available with Silver plan. If she is no longer eligible for the Silver 94, then she will qualify for the Silver 87 plan. In any case her share of the premium will be around $110 per month. If she was advanced too much tax credit as a result of underestimating her income, she'll give some back when she pays her taxes for 2014, but it should not exceed $600 if her income is 200% FPL or less.

2015 Paper Application?

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Question: Has anyone found a link to a Paper Application for 2015 Open Enrollments?

Answer: The Covered California paper application used last year is still good. Here's the link to download:

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