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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.


January 2015 Archives


Question: When I initially applied for Obamacare through Covered California is was found eligible for Medi-Cal. Three weeks passed before I could correct the income figures in my application. At that time I was approved for Anthem coverage with premium assistance through Covered California which I recently removed. Now, over a year later, Medi-Cal started sending me enrollment questions. They still think I’m enrolling in MediCal! How do I put a stop to this?

Answer: According to, Cathy Senderling-McDonald, Deputy Executive Director of the County Welfare Directors Association of California, county eligibility workers are unable to delete duplicate applications or remove applications upon a consumer’s request. Senderling-McDonald said, “Our county eligibility workers need to be able to tell the system, ‘This person is not eligible,’ or, ‘We need to withdraw this application,’” adding, “The computer can start that process, but our workers can’t and that was a huge oversight in the programming.” So I suggest trying to get your Medi-Cal enrollment cancelled by calling Covered California at 800-300-1506 and ask them to cancel the enrollment from their end.


Question: Hi, I want to download my 1095-A as a PDF. I don't want to have to chase down the paper copy. Is it available online? Please make it easy and obvious to find once I log in.

Answer: The Form 1095-A's have already been posted online. You will have to login to your Covered California online account. You may find the form in your Secure Mailbox (iffy) or more reliably on your Documents and Correspondence page. To get there, click on the Summary checkbox on the home screen and next click the Documents and Correspondence link, select and download the 1095-A document as PDF.


Question: Will an immigration sponsor be responsible for Medi-Cal bills of the immigrant who is holding a permanent green card?

Answer: No. To our knowledge, no government agency in California has sought reimbursement from a sponsor up to now.


Debt Cancellation Distorts AGI?

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Question: In 2013 and 2014 we had a debt cancellation (credit card settlements) since we were in financial hardship and weren't able to pay the credit card payments. We settled with creditors and paid off our debt but creditors have sent us 1099C forms and the amounts of cancelled debts were added to our income in 2013 and will be added in 2014 as well. This has raised our AGI tremendously for both years. Based on our actual income ,we are qualified but considering this phantom income (cancelled debt) seems like we won't be able to qualify. What do you suggest we should do? we need to send the 2013 tax return as proof of income. Can we to deduct the amount of 1099Cs from our AGI and report that amount? Please advise.

Answer: In addition to submitting a copy of your 2013 federal income tax return, you will want to explain to Covered California that your 2013 Income Tax form includes an exceptional one-time lump-sum credit which distorts your adjusted gross income (AGI). Download a free online affidavit form and use it to explain your debt cancellation issue. Otherwise, I would leave your Covered California account as it is for now.


Final Version of Form 8962?

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Question: Phil, you posted a draft version of the IRS Form 8962 a while back. Do you have a download for the final version?

Answer: Yes. Download IRS Form 8962.

When you file your federal taxes, you or your tax preparer will use the information on Form 1095-A to complete IRS Form 8962. You will use Form 8962 to tell the IRS how much premium assistance was paid to your health plan on your behalf in 2014. Using the form you will:

  1. Calculate the total amount of premium tax credit that you are allowed to claim based on your coverage, income and family size.
  2. Compare the amount of premium assistance that was paid in advance on your behalf to the premium tax credit.
  3. Determine the amount by which the premium tax credit exceeds the amount of premium assistance received, if any. And, claim it as the net premium tax credit on your federal income tax return.
  4. Determine the amount by which your premium assistance received exceeds your premium tax credit, if any, and report it on your federal income tax return. You will have to repay some or all of this excess amount.

How to Get IRS Form 1095-A?

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Question: How do I get my 1095A form?

Answer: You don’t need to do anything. Covered California will mail the IRS Form 1095-A to all consumers who got insurance through Covered California in 2014. They also send a copy to the IRS. The Form 1095-A has the information you or your tax preparer will need to file your tax returns. This form has information you gave about your family. The form also tells you:

  • How many months you had health insurance
  • How much you paid in monthly premiums
  • How much premium assistance was paid to your health plan on your behalf (if any)
  • Who was enrolled in your health plan

Unemployed Adult Child?

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Question: Adult non-disabled dependent is long-term unemployed. Parents are retired, on Medicare and income over $100,000. Is the dependent eligible for Medi-Cal if the parents do not claim the adult as a dependent on 2014 tax return?

Answer: Yes. In this case, the parent's income is not a factor in the Medi-Cal eligibility determination. The unemployed adult-child is not a dependent for tax purposes, so he or she is considered a single-person household with no income for Medi-Cal eligibility determination.


Question: I currently have private health insurance. I am looking at my options if I retire in 2015. My retirement AGI would be low enough to qualify for a subsidy under Covered Ca, and this may reduce my premiums by more than 50%. If I understand correctly, a low enough AGI might make me ineligible for this subsidy since I would qualify for Medi-Cal. Is this correct? What are the AGI thresholds for a single person in 2015? There seem to be many retirees in this same situation. They can afford to pay the subsidized plans, and they would rather not switch to Medi-Cal since it may not be accepted by their current doctor. Their options seem to be to either pay the full cost plan, or switch to Medi-Cal. Your thoughts?

Answer: Since many retirees can control their income through investment withdrawals etc, it make sense to know what the Medi-Cal income benchmark is. The Medi-Cal threshold is set at $138% of Federal Poverty Level (FPL). In 2015, that's $16,105.


Group Insurance or Medi-Cal?

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Question: I have a family of 4 with gross income of $28k. My employer offers me affordable insurance for myself but no contributions to my dependents. Can I and my family go on Medi-Cal? Joe

Answer: Medi-Cal eligibility rules do not conform to the ACA and IRS guidelines regarding access to affordable employer-based coverage. Your $28k income for a 4-person household makes you and your dependents eligible for Medi-Cal. You may opt out of your employer-sponsored coverage and apply for Medi-Cal.


Question: I will become Medicare eligible 7/1/2015 and elect a Medicare Supplement or Adv plan. My wife has another year before Medicare Eligibilty. When/how should I notify CovCA and /or Blue Shield that I am going off but wife needs to stay on plan. I have heard of others who had both spouses cancelled and huge headache to get straightened out. Do not need that hastle! Thanks.

Answer: You will need to cancel your Covered California coverage by June 15, 2015. You can remove yourself from coverage, leaving your spouse's coverage unchanged, through your Covered California online account. If you are not comfortable with the online method, your agent can handle it for you or you can call Covered California at 800-300-1506.


VA vs Employer Coverage?

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Question: I have had no medical insurance for 2014 except for how I am covered at the VA. The job I have for 2015 now offers insurance. Will I be penalized for using the VA and not acquiring CC insurance for 2014?

Answer: VA health coverage is recognized by the ACA aa meeting the "minimum acceptable coverage" requirement, so you are not subject to penalty if you opt out of your employer-based coverage. If you take the employer's coverage and keep the VA coverage, your benefits will be coordinated with the employer coverage used first and the VA covering the gaps.


Medi-Cal Managed Care Options ?

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Question: Hi, I received a Medi-cal card, but no information on where to go, who to see!! It has been weeks, not sure who to contact. I had Kaiser prior which my parents were paying but it became too expensive. I would like to continue with Kaiser since i already have MDs there I am comfortable with. Is this a possibility?

Answer: When you first qualify for Medi-Cal, you are covered under Medi-Cal Fee-for-Service. However, you must choose a managed-care health plan within 30 days. Managed-care plans like Health Net or Anthem come with their own provider networks. What that means to you is you don't have to struggle trying to find doctors that are accepting Medi-Cal patients. If you do not choose a plan within 30 days, the State will choose a plan for you. The county in which you live will determine your choice of Medi-Cal managed-care plans. For example, if you live in Los Angeles county you can choose between LA Care or Health Net while next door in Orange County you have one choice - CalOptima. Click here for a list of Medi-Cal managed care plans available in your county. If you find only one health plan, the county has chosen this plan for you. Please wait for your health plan information mailer in the mail. If you find multiple health plans listed, please explore each plan and choose the one that suits you and your family's needs. Remember, if you do not pick a plan within 30 days of receiving your health plan information mailer, Medi-Cal will pick a plan for you. However, you may also choose to stay in Fee-For-Service Medi-Cal.


Should Have Been on Medi-Cal?

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Question: I had a six figure income in 2013 and a 2 thousand dollar income in 2014. I work freelance and some years are very dry. I projected $29,000 in income when I applied for Covered CA. It didn't happen, but I left it as is because I thought one of the jobs would come through. So, I guess I should have been on Medi-Cal, though. What do I do now? And, will there be an issue since I received premium assistance in 2014? Thank you.


Answer: You are obligated to notify Covered California of your change of income which would make you eligible for Medi-Cal, but there is no penalty for not doing so. If your 2014 income was under 100% FPL ($11,670), any excess tax due to over-payment of advance premium tax credit is limited to $0 for the year. For 1-person househol with income over 100%FPL but less than 200% FPL ($23,400), any excess tax due to over-payment of advance premium tax credit is limited to $300 for the year. Any cost-sharing reductions received through Covered California during the year are not recoverable. Covered California will receive your 2014 tax return data in the summer of 2015 and at some point after that, CC will require you to verify your claimed income if your 2014 AGI was more than 10% higher or lower the income you claimed.


Switching from Cobra?

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Question: If I end my health insurance with Cobra on 1/31/15 because it is to expensive and sign up for Covered CA when will the insurance start?

Answer: If you apply through Covered California by January 15th, your new coverage will be effective on February 1st, 2015.

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