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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.

June 2015 Archives

Question: If my employer offers health ins without hospitalization can I still buy into the market place? I have a new job that gives Health Ins with no Hospitalization coverage. They meet the min requirements because they cover preventive care. But the min value part that covers hospitalization is not covered. You can purchase the plan and will not have to pay the penalty for not having insurance because they cover preventive care. But my concern is I will not be able to purchase health care on the market place because I am offered this by my employer.

Answer: Apparently, your employer has a limited-benefit minimum essential coverage (MEC) employer-based health plan - a loophole to avoid penalties for not offering required health insurance - and it protects you the employee from individual mandate penalties. However, you are still eligible for enrollment in Covered California and you may qualify for premium assistance if you meet residence and income guidelines. If you enroll in Covered California, your employer may be fined $3,000.

Question: If employer drops health insurance when can you apply for covered California?

Answer: The law says that you have a 60 days from the date your employer-based coverageends to apply for individual health insurance coverage. In order to avoid a gap in coverage, you can apply for Covered California coverage up to 45 days prior to the date your employer-based coverage ends. For example, if your coverage were to end July 30th, you could apply as early as June 16th for an August 1st effective date.

Insuring My 19 Year-old?

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Question: My daughter is 19, a full time student, and lives at home. Do I have to cover her under my plan at work, or can she apply for covered California on her own? Thank you.

Answer: Yes, you are generally required to cover your dependents with your employer-based coverage. There are alternatives for some people: (1) If your household income is low enough (for example, less than $42,000/year for a two-person household), your children would be eligible for Medi-Cal and she can enroll without considering the availability of group coverage through your work. (2) She can also waive coverage on your group plan and enroll in a Covered California, but that would be without premium assistance. (3) Student health plans are viewed as minimum acceptable coverage by the ACA so that could work too.

Question: My wife recently learned that her employer will be offering coverage for her (50% employer contribution) and spouse coverage with no subsidy. It is a Silver plan and the premiums are going to be higher than if I just stayed with my Bronze plan on the exchange. We do not receive any premium assistance. Am I allowed under ACA to keep my Bronze plan through the Exchange, or do I have to accept the employer-offered spouse coverage Silver plan the my wife's employer?

Answer: It is your responsibility to notify Covered California that your spouse has been offered employer-based health insurance. However, since you are not receiving premium assistance, there is no penalty for not reporting the change. You can remove your wife from your Covered California plan and continue on your own, if that works better for you. Know that you will be ineligible for premium assistance through Covered California, regardless of your household income, as long as your spouse is offered employer-based health insurance.

Question: I Just received a corrected Form 1095-A from Covered California with the result that I received too much subsidy in 2014. What do I do now? Do I have to refile my tax return?

Answer: No. You don’t have to file an amended return for 2014. The IRS says you don’t need to do anything if you already filed your 2014 tax return. Covered California says that this corrected Form 1095-A is “only for your own records”.

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