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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.

December 2014 Archives

Can I Get Private Insurance Subsidy?

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Answer: I am fortunate to live with a daughter who has paid for my entire monthly insurance plan out of her pocket (she didn't claim me as dependent, so she also doesn't get any tax credit). For upcoming 2015 year, we feel that it is putting a lot of strain for her to pay close to $9000. Though Medical is an option for me, we both would prefer to stay with private insurance. I don't have any income. I live with my daughter who provides me with everything. If I can get CC subsidy, I wouldn't mind filing a tax return. My question is: is there any way I can go through CC and opt out of medical? My daughter is willing to pay me for housework, etc. Wondering if that's something I can report to IRS, thus I can become eligible for CC subsidized plans.

Answer: You are eligible for Medi-Cal, but you don't have to take it. You can choose private coverage instead, but will not be eligible for a subsidy. Your daughter can pay you a salary, but you would have to earn over $16,500 per year for you to qualify for a subsidized private coverage rather than Medi-Cal.

Change Plans after Dec 15th?

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Question: Can I switch plans in 2015 if I decide to do so?

Answer: Yes. The open enrollment period ends February 15, 2015. You can make changes until that date.

How Long Does it Take?

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Question: I signed up with KP and made the initial payment on CC over the weekend. I called KP today and it said it does not have the application nor the payment yet and may take 4 weeks for the info to show up in its system. Does it really take that long?

Answer: No. This business of putting you off for 4 weeks is just lazy or incompetent, probably both. Call Covered California and confirm that your enrollment is correct in their system. When it is, ask them to resend the enrollment to Kaiser and get an incident number from CC. Wait a couple of days and call Kaiser back with the incident number. If you get the 4-week BS again, demand to speak to a supervisor.

Deadline Extension?

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Question: Does the recent extension for enrollment by Dec 21st ( vs Dec 15th) for 1/1/15 effective dates apply only to applications already started by Dec 15th? Or can agents/CIAs assist any New Individuals with applications/enrollments by then?

Answer: Covered California has extended the deadline for January 1, effective date to midnight Sunday, December 21 for all applicants, agents and consumers.

Children Forced into Medi-Cal?

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Question: Why am I only being given the option for Medi-Cal for my children (age 5) on our CoveredCa application? We want them on our chosen plan (a Blue Shield PPO) but Covered Ca is not allowing that option. Our income is far above the Medi-cal limits for a family of 4.

Answer: For a 3-person household, your income would have to be $50,000 or more for the children to be eligible for subsidized private insurance while it only has to be $20,000 or more for the adults to be eligible. Why is that? It's a lot cheaper to cover people on Medi-Cal than to subsidize them with private insurance. Ultimately, it costs the taxpayers less and reduces the overall cost of healthcare.

Find Providers for Anthem Blue Cross?

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Question: How do I find providers for anthem blue cross under covered california?

Answer: To view a list of in-network doctors for your Anthem individual health plan:

1. Go to www.anthem.com/ca.
2. Under Useful Tools on the right, select Find a Doctor.
3. Under Search by selecting a plan/network, go to Select a state.
You can enter the name of your state or select it from the
drop-down list.
4.Under Select a plan/network, you can enter the name of your
plan/network or select it from the drop-down list then choose
Select and Continue.
5. Using the drop-down boxes, select what type of doctor and the
location you're looking for, then select Search.
6. For more info about a provider (like skills and training), just select
that name in the directory.

Question: CC qualification is based on income only while Medi-Cal is based on both income and assets. So if a person with no income but has more than $2,000 in the bank would not qualify for neither CC nor Medi-cal?

Answer: No. Qualifying for Medi-Cal no longer considers assets if one applies through the Covered California. So, no, a "low-income" applicant cannot be found ineligible for both. On the other hand, if one applies for Medi-Cal directly through the DHCS, assets are still considered. Go figure!

Question: If an employer offers “affordable” coverage for the employee, but the family cannot afford the dependent coverage and the family income is below the Medi-Cal eligibility threshold, is the family still eligible for Medi-Cal? Is the employee disqualified from Medi-Cal by the “affordable” employer plan? If so, are the wife and kids eligible for Medi-Cal?

Answer: Under the ACA, qualification for Medi-Cal is completely separate from subsidy-eligibility rules. Employees, will not be disqualified from Medi-Cal if their employer provides benefits, whether or not those benefits meet affordability guidelines. (This answer was provided by expert agent, Anne Kelley.)

Reporting Border-Line Income?

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Question: My income puts me on the border line of me getting premium assistance or Medi-Cal. It fluctuates greatly from month to month. Would I get switch back and forth between CoveredCA and Medi-Cal?

Answer: If you estimate your income for 2015 to eligible for Covered California premium assistance, you will not be switched to Medi-Cal during the year unless you notify Covered California that your income makes you eligible for Medi-Cal. Conversely, if you start the year in Medi-Cal, you won't be switched to CC unless you report higher income to Covered California.

How to Send Verification Documents?

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Question: Where do I send covered ca requested verification documents?

Answer: Send your documents in one of these three ways:
• Online using your account at www.CoveredCA.com
• By fax to 1-888-329-3700 (1-888-FAX-3700)
• By mail to:
Covered California
PO BOX 989725
West Sacramento, CA 95798-9725

Do You Need Financial Assistance?

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Question: One of the first questions asked in Cover California website is that "Do you need financial assistance?". If I answer "no" for now and it turns out that I'm qualify for assistance when I do my 2015 tax a year from now. Would I still be able to get premium tax credit?

Answer: Yes. If you answer no th the question, "Do You Need Financial Assistance?", your Covered California account still include your tax information and you will be able to claim a tax credit later. However, if you enroll off-exchange, you cannot later claim tax credits.

Current or Future Income?

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Question: I'm 24 and living in my parents' home. I'm currently unemployed (since Nov '14) and have $0 current income. I will be starting a contractor position in January. Should I keep my current $0 income and make changes later or must my current application somehow reflect changes that will come about in 2015?

Answer: In estimating your 2015 income, you would be more accurate to use your income from the contractor position as if it would continue for the year. You can change your income later, if you have a significant income change one way or the other.

A Bird in the Hand?

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Question: My income fluctuate from month to month. I prefer to pay the premium first then get the premium in tax credit, if any, in one lump sum after I do my tax for 2015. Can I do that? If so, what happens to the case if my AGI qualifies me for medi-cal? Would I still be able to get any tax credit in that case?

Answer: Yes you can opt to take your tax credit at the end of the year. However, if your income makes you eligible for Medi-Cal you will receive no tax credit. On the other hand, should you take your tax credit as an advance and later be found eligible for Medi-Cal, your income tax liability will be much lower than the tax credits you received and your payback will be limited to a fraction of what you got. I'm not recommending gaming the system, but at least for now, that is the way it is.

Tax Credit Reconciliation Forms?

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Question: Where on the tax form is the Covered California premium reduction reconciliation done? As I was going through my taxes on TurboTax, it told me that based on my income, I was not eligible for the full premium reduction that I received, which means I owe some of that back. I can't see this reconciliation anywhere on the summary of my tax return. Where does this appear and where can I see how much I owe?

Answer: There are 2 IRS tax forms that you are going to need. First, IRS Form 1095A (draft version of form here) is issued by Covered California to every household eligible for a subsidy in 2014. It will be sent to you by 1/31/2015. It documents your coverage by month including premiums paid and advance premium tax credits received in 2014. Then, you will use IRS Form 8962 (draft version of form here) to reconcile 2014 federal income tax due with advance tax credits received.

Adult Child in Household?

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Question; My daughter is 26 and will be needing her own insurance. She lives at home but files her own income tax and is not claimed on ours. Does she apply as a household of 1 or do all household members have to be put on her application.

Answer: Yes. If your adult child files a tax return, she would apply for coverage through Covered California as a one-person household. Her income alone will determine her eligibility for premium assistance or Medi-Cal.

No Way We Qualify for Medi-Cal?

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Question: Our stated family income for a family of 5 was $80k for 2015 yet they sent us a letter that we all qualify for medi-cal. Letter says we can appeal but I see no way to do it on their website and cannot get through on the phones. Can't read secure mailbox due to some java issue. Advice?

Answer: If you already have Covered California coverage and your status was recently changed to Medi-Cal eligible, it's because the IRS has reported that your 2013 AGI was $38,000 or less. So if you can show that your current income is closer to $80,000, then you will be able to to get your status changed back to subsidy eligible private coverage. If you are applying for for Covered California coverage the first time and you reported your income at $80K and are found eligible for Medi-Cal, you've probably made an error on the application. The most common cause for this error is by entering an incorrect "end date" when entering your income. LEAVE THE END DATE BLANK. (How a casual user would know to do this is beyond me as we only learned through trial and error.) As for how to get through to Covered California, I have no sure-fire advice other than to avoid the busiest times - normal business hours. Try calling just after 8:00 AM or just before 8:00 PM. Good luck.

Question: Can a Self Employed person continue to deduct INDIVIDUAL Medical Insurance Premiums in 2014? Does it matter if they got their coverage ON or OFF the exchange?

Answer: Yes. If you are self-employed, a tax deduction generally available for medical (on-exchange or off-exchange), dental or long-term care insurance premiums for yourself, your spouse and your dependents. (The insurance can also cover your child who was under age 27 at the end of 2014, even if the child was not your dependent.) You must have a net profit from self-employment. You would report this on a Schedule C, Profit or Loss From Business, Schedule C-EZ, Net Profit From Business, or Schedule F, Profit or Loss From Farming. You had self-employment earnings as a partner reported to you on Schedule K-1 (Form 1065), Partner's Share of Income, Deductions, Credits, etc. You were paid wages reported on Form W-2, Wage and Tax Statement, as a shareholder who owns more than two percent of the outstanding stock of an S corporation.

Preventative Care?

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Question: What is a preventative care appointment include? Labs, Pelvic Exams, Office visit?

Answer: All ACA-compliant health plans and must cover the following list of preventive services without charging you a copayment or coinsurance. This is true even if you haven’t met your yearly deductible. (This applies only when these services are delivered by a network provider.) 1. Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked 2. Alcohol Misuse screening and counseling 3. Aspirin use to prevent cardiovascular disease for men and women of certain ages 4. Blood Pressure screening for all adults 5. Cholesterol screening for adults of certain ages or at higher risk 6. Colorectal Cancer screening for adults over 50 7. Depression screening for adults 8. Diabetes (Type 2) screening for adults with high blood pressure 9. Diet counseling for adults at higher risk for chronic disease 10. HIV screening for everyone ages 15 to 65, and other ages at increased risk 11. Immunization vaccines for adults—doses, recommended ages, and recommended populations vary 12. Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk 13. Syphilis screening for all adults at higher risk 14. Tobacco Use screening for all adults and cessation interventions for tobacco users

Newborn Coverage Gap?

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Question: I am currently pregnant and have Blue Shield Silver 87. Based on my family income, newborn will be placed to Medi-Cal. I am worried that newborn's cost of staying/treatment in the hospital will not be covered by Blue Shield since the doctors and hospitals are not Medi-Cal network. Do you know if they have exception for this case and cover newborn? Truly appreciate your answer.

Answer: Your Blue Shield policy will cover your newborn's medical costs automatically up to 31 days after birth. You should apply through Covered California as soon as possible after giving birth and if your infant is Medi-Cal eligible, his or her coverage will be effective immediately. In any case, you should not experience any gap in coverage for your child.

Adult Dependent Coverage Options?

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Question: I need to know if I am required to put my 21 year old son on my employer insurance now? He does not work and would qualify for Medi-Cal. Also, if I claim him as a dependant does that factor into if I must add him?

Answer: Your son can opt out of your group health insurance plan and enroll in Medi-Cal even though he has been offered affordable, minimum-standard value health insurance through your employer if you do not claim him as a dependent in 2015. If you do claim him, his eligibility for Medi-Cal (or subsidized private insurance) will depend on your household income, not his.

Question: My adult daughter is 24 and single. She is no longer our dependent for tax purposes. Due to the ACA, she continues to have insurance through her father's plan through USC until age 26. She is expecting a child in April 2014. Will the child be covered? And will the child continue be covered until our daughter turns 26?

Answer: No. Your newborn grandchild will not be eligible for coverage under your husband's employer-sponsored plan. Your daughter must complete a Covered California application for herself right after the child is born, indicating that she has "been offered affordable, minimum standard value health insurance" and that only the baby will be enrolling. Depending on your daughter's income, her newborn child may be eligible for Medi-Cal or subsidized Covered California coverage.

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