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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.


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.

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