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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.

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.


Jade …

This YES or NO question is really kind of dopey. Everyone should check the box YES, even if they know for certain that there is no possibility of receiving tax credits.

On the other hand, there is no downside to checking the box NO. The only requirement for receiving tax credits from the IRS is having obtained one’s health insurance through the exchange.

Because I have never checked the NO box on more than 200 applications for clients, I can’t be certain what the end result is when an application gets to the “Eligibility” page, but I wouldn’t be surprised to discover that it still shows a person as being eligible for APTCs.

Either way, before you complete the application, you will have the opportunity to state the amount of premium tax credits you wish to receive in advance. If you don’t want any, then you type $0 in the space provided.

If you need additional assistance, you can contact me through my website or by email at max.herr@verizon.net

Hello Max,

Thanks for replying. I know that if I get the insurance off the exchange, I will not get any premium tax credit come tax time next year.

My question is that if I answer no to the “Do you want to see if you qualify for free or low cost plans?” question, would that prevent me from getting the tax premium credit come tax time next year. Based on the two replies I got so far, it seems that I can still get the tax credit even if I answer no. I don’t think your reply say otherwise but just want to make sure.

I’m self employed. My income fluctuates month to month. I just prefer to do all the calculation at tax time. If I get tax credit then, I get tax credit. If I don’t then I don’t.

I prefer not to go through the “eligibility” stage. From I heard, it may ask for silly documents and may put you into medi-cal erroneously and is hard to back out. I have not go through that stage so I don’t know if it is true not. Any insight on that would also be appreciated.


There is some real confusion here that needs to be cleared up. First, there is no general question anywhere in the CoveredCA application, “Do you need financial assistance.” The opening question is: “1. Do you want to see if you qualify for free or low cost plans?” The concepts may be similar, but the questions are very different.

Everyone applying through CoveredCA should check this the answer to this first question “YES” whether you qualify for advance premium tax credits now or not. There are many people who do not qualify for ADVANCE premium tax credits but who WILL QUALIFY for refundable tax credits at tax filing time. Failure to obtain their health insurance through CoveredCA eliminates the possibility of obtaining the refunded credits.

There is a later question when listing individuals in the household (to be insured or not) about needing financial assistance, but it is a Medi-Cal specific question, and it reads differently: “Does this person need help with long-term care or home and community-based services?” Again, the words “financial assistance” do not appear.

Just wanted to comment on this, if client marks No on that above question then covered Ca do not evaluate case for MadiCal.In case income drops or for any other reason, client is eligible for MediCal, system is not going to give them MediCal eligibility and will evaluate only for APTC.Therefore it is always better to mark YES on that question.

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