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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.

How to Compute Estimated Income?

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Question: Is my income based on what I would make in a year if I hadn't lost my job or do I prorate the number for the year? Example. I was making $60,000/year. I got laid off at the end of April. do I prorate the number to $15,000 because that is what I will make if i don't get another job this year.

Answer: If you did not receive another penny in taxable income for the rest of 2015, the amount you already earned - $15,000 in your example - would be your projected annual income. If you are eligible for unemployment income, estimate what you could collect for the rest of the year and add it to the income already earned for your 2015 estimate. If you were to get a job at some point, that income would be added to your annual projection. Any significant income change, such as you described, makes you eligible for a Special Enrollment Period (SEP) during which you can re-enroll and qualify for either Medi-Cal or Covered California coverage with premium assistance.


As a tax preparer, I am encountering a difficult situation, over and over again. A taxpayer worked as a temp and had Covered California for several months. They gave her permanent employment, which meant better pay and health coverage. She discontinued the CC right away. So she had 8 months of APTC, and 4 months of employer coverage. Now she is asked to pay back every penny of the APTC, which is a terrible burden. She estimated fairly, but is now being punished for getting a better paying job. She did everything she was supposed to do. Why is the income/APTC ratio not calculated only for the months they needed Marketplace coverage? It seems very wrong to now want money back for a situation that was valid at the time it was put in place, and was updated as soon as possible.

I collected Cover Ca Ins for 5 months, I was collecting unemployment for the first 2 months ($1,800), Then I was hired as temp without benefits. I was hired and my medical started after I’d been on Covered Ca for 5 months. I notified Cov Ca that I was working.($1,000 per week) My insurance premium didn’t get increased, now I’m being told that I have to pay more for the 3 months I worked and earned more than the $1,800 I was earning on EDD. How much will I have to pay for the Medical for the 3 months?

I only pay $100.00 a month for medical, dental & vision through my current employer!!

Hello. First off, thanks for all of your answers! You’re website has been incredibly helpful to me. I have a question about this response. I spoke with an agent who said that a significant income change isn’t enough for me to qualify for special enrollment. I can’t find anything on covered california’s qualifying event page about significant income changes. Can you point me to where you learned this? Thank again.

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