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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 are Changes in Cost Sharing Reductions Handled?

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Question: Hi - I'm currently unemployed and am considering signing up for an Enhanced Silver Plan for 2016. If I start making more income either before 2016 or after the year begins, if I get removed from the Enhanced Silver Plan, what will my options be at that point? Will I get to choose a new plan, or will I be switched to the same plan in a non-enhanced version?

Answer: Covered California cost sharing reductions (CSR) are enhanced benefits such as lower copays and deductibles on silver plan benefits for those with income levels between 138% and 250% of federal poverty level (about $16,500 to $29,500 for a 1-person household). These enhanced plans come in three levels: Silver 94, Silver 87, Silver 73 - covering 94%, 87%, and 73% of covered medical expenses. Since the benefit is based on income, reporting an income change during the year may change one's level of benefits. If so, your coverage will automatically change to the appropriate CSR level or off enhanced benefits entirely to the Silver 70 level. A change of this nature does not trigger a Special Enrollment option so you cannot change plans either with the same or different insurance company. CSR benefits are not recoverable. Not reporting an income increase will probably result in an overpayment of premium assistance (subsidy) which may require payback to the IRS, but there's no payback for enhanced benefits.

1 Comment

I think you should recheck this answer. I believe that a person is eligible for an SEP under both state and federal law for a change like this.

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