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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.


October 2015 Archives


Question: My employer offers dependent coverage that I can't afford for my dependents. What are my options on covered ca.

Answer: You can enroll your dependents in Covered California coverage. However, they will not be eligible for premium assistance. If your income is low enough (for example: less than $27,000 annually for a 3-person household), you can enroll your children in Medi-Cal coverage rather than your employer-based coverage.


Question: Can I decline my employers medical coverage and get covered California at a reduced premium rate?

Answer: Generally, you cannot receive premium assistance with Covered California coverage if you opt-out of your employer's group health plan. Only if the employer-based coverage fails the "affordability test" can you be eligible for premium assistance through Covered California. To be considered "affordable" by IRS standards, the employee-only share of the cost has to be less than 9.5% of the employee's income.


HSA Compatible Plans?

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Question: I am currently enrolled in a high deductible plan with CCA. Can I start an HSA? If so how do I do this? And what expenses are eligible.

Answer: You may have to change your high deductible Bronze plan to one specifically labeled HSA eligible. Once you have done that, you can open an HSA account at the financial institution of your choice.​ Any medical, dental, or vision expense that the IRS recognizes as deductible can be paid with pre-tax dollars from your HSA funds.


Payback Cost Sharing Reductions?

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Question: My wife and I plan to quit our jobs effective 12/31/15 and enroll in Covered California. I have done compare and shop and we will qualify for the Enhanced Silver Plan, probably the Silver 87. What happens if part way into 2016 I find a way to make income. If the increase in income puts me in a more expensive plan I can pay back difference in premiums, but what happens if I had medical care on the Silver 87 in say March 2016 but I later have medical care when I qualify for say the Silver 70 like in October 2016. Would I owe reimbursement for services rendered early in the year at rates later in year if income changes?

Answer: I’m glad to put your mind at ease: there is no recovery of any cost sharing benefits​ you may receive. Only the premium assistance (subsidy) has to be repaid if an increase in income warrants. Since you will be making income adjustments to your Covered California account during the year, you would be well served to have a Certified Covered California agent to handle your initial enrollment and those income changes for you.


Eligible for CC?

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I am unemployed and my cobra coverage being paid by my employer for both my husband and I will end at dec. 2015. He is self employed and not working and I haven't been able to land a job. The only option we might have in the next year is to withdraw from my IRA. Do I qualify for coverage based on what I withdraw? What are my options?

Rose
Rosea09@yahoo.com


Qualify for CC Subsidy?

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I will be unemployed as of 12/31/15, so my income will drop substantially (to about $26,000/yr. until employed or collect unemployment). At this time, I am personally paying $675/mo. with a $5,000 deductible for health care through Anthem BC. I have 2-1/2 more years before I qualify for Medicare. Would Covered California be a viable option for lesser premiums and/or deductible? Thank you for your help. maureen.oconnor.us@gmail.com


I am 63 years old and my doctor put me in State Disability starting April 29 till August 31st, 2015. I resigned to my job on June 29th, 2015. I have two pensions that total $850.00 per month from 2 previous jobs. July 1st. I applied for Medi-Cal for my husband and I. My husband has not worked in 2015. I applied for early retirement today with Social Security and my retirement will be $880.00 per month, and I will obtain a lump Sum of $4000.00 in about 3 weeks. We file jointly taxes and we do not have dependents. We called Medi-Cal office and the income still qualifies for the program, but at that time I didn't know that we were going to receive $4000.00 because the Eligibility Worker qualified me for retroactive. My question is how Medi-Cal will calculate the $4000.00; as a lump sum and this will make us ineligibles for the month of November or they are going to divide the $4000 between the retroactive months and we will have to pay a penalty? Please advise and thank you in advance for your answer. My e-mail address is: marcelacastrillon821@gmail.com. Please note that we are planning to use the entire amount to pay our credit cards.


husband & wife file tax separately

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my email address is suewan26@yahoo.com

We are covered by covered CA currently, and for the last 2 years, we, husband & wife file the tax jointly. But we have decided to file tax separately in the coming year, in that case, will this affect the current Covered CA health insurance plan?


Re-apply to Medi-Cal for Kids?

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Question: My kids are already covered by Medi-Cal, they received their ID cards in the last 2-3 months. I am starting a new job without an employer health plan, so my wife and I will buy our own insurance through the state exchange. Do we have to re-apply for our children to be covered by Medi-Cal when my wife and I buy a plan through the exchange

Answer: Getting a new job usually results in an income change. Since your kids' eligibility for Medi-Cal is based on your household income, they may or may not still be Medi-Cal eligible. In any case, the Covered California online application will include Medi-Cal eligibility information for your children once you complete the application for your entire household. If the children continue to be Medi-Cal eligible, you do not have to reapply with Medi-Cal. If they are no longer eligible, Medi-Cal will drop them automatically (at some point) and your children will be included under your Covered California coverage.


Lost Subsidy. Why?

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Question: According to the website I will be losing premium assistance in 2016. I received around 180 dollars of assistance per month last year and I make almost exactly the same as I did before. Why did I lose my subsidy?

Answer: Probably because your 2014 tax return had an adjusted gross income higher than the estimated income you first entered. Covered California did not receive this information from the IRS until mid-2015, so the income adjustment was applied to the 2016 tax year.


Question: Hi, I and my wife are new immigrants sponsored by my son in CA and our age is > 65. Our combined income is 3k. I have few questions. Can we file tax as "married filing jointly" as income 3K. If so, can we apply for tax credit/subsidy in coveredca for the premium and for cost sharing(deductible/out of pocket cost)vWe are 81 and 77, household size is 2. If our income is about 10K/year, what will be our premium and out of pocket costs, even if its an approximation?

Answer: Medicare would be your first choice, but I assume because you did not mention it that you do not meet the 5-year residency requirement. Based on your income ($3,000 to $10,000 annual), you are eligible for MediCal (not Covered California). Medi-Cal requires only that you reside in California legally.


Question: If I am receiving a Subsidy and become newly employed with an Employer that offers and Affordable Minimum Essential Coverage and continue being enrolled on Covered California for myself with or without my dependents, will I have to repay the subsidy?

Answer: Yes. If you continue Covered California coverage after becoming eligible for employer-based group coverage, you will have to repay any subsidy received after that point. Even without a subsidy, dual coverage is not allowed. It is your obligation to notify Covered California once your employer-based coverage becomes effective.


Why Did I Get a Premium Rebate?

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Question: I just received a check from Blue Shield of CA for my 2014 health insurance premium rebate. However, my premiums in 2014 were fully reimbursed by the ACA subsidies. Shouldn’t this check be going to the government, not to me?

Answer: One of the provisions of the Affordable Care Act (Obamacare) is the requirement that insurers, like Blue Shield of California, spend at least 80 percent of premiums on medical expenses to help make certain that consumers get value for their healthcare dollars. If carriers do not meet this Medical Loss Standard (MLR), they are required to pay rebates to eligible subscribers. Blue Shield of California missed the 80 percent target by 3.3 percent of premiums for its Individual and Family Plans in 2014. By law the rebate is paid to the consumer, not the IRS, regardless of the consumer’s net premium.

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