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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.

January 2016 Archives

Question: I started Covered CA enrollment on 1/27/16, but got hung up on credit freeze, or submitting Documentation. Will finish ASAP, but need a few more days to finish. Can I get a few more days to finish?

Answer: You have until midnight Sunday January 31st to finish your Covered California application yourself. But even if you get stuck and can't get it done by then, We'll get it done for you in overtime. That's right, you can have until midnight Saturday February 6th to finish it provided you use a Certified Insurance Agent or a Covered California Representative to complete it for you.

Question: Can I apply by myself for Covered CA even if my parents claimed me as a Dependent? I am 21 and do not live at home with my parents, yet I did not make enough to be independent.

Answer: Yes. Apply as a 1-person household and use your own income projection for 2016. You will have to file a tax return for the 2016 tax year, but you must waive the personal exemption. That way your parents can continue to claim your dependent exemption on their return.

Question: Our medical insurance has been through my husband's work, and he is retiring April 1 (with no retirement benefits). He is over 65, but I am 59, giving me 6 years before Medicare. I've run the numbers, and we won't be eligible for subsidies. It seems I should purchase insurance on the open market through an insurance company's individual plan. Am I missing something; should I consider going through Covered California? I thought the only reason was to get financial help with the monthly premiums, and can't see a reason otherwise. If I should go through Covered California anyway, please explain why.

Question: If you are not within the income range for a subsidy, there is no compelling reason to apply for coverage through Covered California. Some might argue that you may as well apply through CC now just in case you are eligible for a subsidy later. That way you could simply adjust your income in your online CC account and become eligible for subsidies immediately. However you could complete your CC application at that point where you income drops. It would take just a few more minutes to do it then. Purchasing an off-exchange plan directly from the insurer also offers some plan designs not available on Covered California. Finally, you don't have to disclose your personal IRS history to the insurer in a direct purchase as you would with Covered California.

Gap Between Kaiser and Medi-Cal?

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Question: My roommate is moving from Kaiser to Medi-Cal with Kaiser (she just got her packet from the state yesterday, and will sign up with Alameda Alliance). My question is, will there be any gaps in her coverage? At some point she'll have to stop with Kaiser and get on Medi-Cal, but I'd like for her coverage to not be interrupted. She can pay her Feb premiums-can she elect to start Medi-Cal coverage on March 1st? The Alameda Alliance person I talked to indicated she'd have to cancel her plan with Kaiser first, but couldn't one just stop and the other start right after? She has a lot of health issues and would like to keep her health insurance through any gaps.

Answer: Medi-Cal coverage starts immediately once the application is approved. Your friend is already covered by Medi-Cal. Electing Alameda Alliance as your managed care provider within Medi-Cal should be done immediately as well. She should not continue to pay insurance premiums for her previous coverage.

How Can I Get My Form 1095-A?

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Question: How can I get my 1095-A form to do my taxes.

Answer: During the month of January 2016, Covered California mails out the IRS Form 1095-A to all who received premium assistance in 2015. Covered California also makes the 1095-A forms available for download from the insured’s online account. If you know how to log on to your California account, do so. Then, from the home page, click on the Summary box. Then from the left margin menu, select Documents and Correspondence. If your 1095-A is available now, you’ll see it listed as CalNOD62AIRSForm1095A. Click on view and print or save the form. If you’ve given it time, (let’s say it’s February 15th and you have not received it) and you have no idea how to log on to your CC online account, and you don’t have a certified agent to help you, you’re going to have to call CC at 800-300-1506 and click on I’m feeling lucky.

Question: I am single with no dependents , I am currently covered by med I cal. I recently started getting more hours at work. my pay before taxes is now averaging around 900.00 to 1,100.00 every two weeks .Work can also slow down but for now that is my average. What is the rate that tells me if I qualify for med I cal or need to apply for insurance other than med I cal? do I need to ask med I cal? or is there a rate chart? Confused…

Answer: For a one person household that number is $16,243 per year or $1,354 per month. So it seems that your income is high enough now to move to Covered California with premium assistance. First, you have to get Medi-Cal to release you. You will do that by proving to them that you are now earning what you claim. That may take some time. Here’s a chart others can use who have the same or similar issue. Household Income Subsidy Guidelines.pdf

Question: My 28 year-old daughter lives with me. She is unemployed, no unemployment benefits, currently zero income. I have employer-based insurance for myself, and my income is over the thresholds for ACA subsidies. If my daughter earns nothing for the whole of 2016 (or less than $4,000) she is my "dependent relative". My question is, does that necessarily make us both part of one household, and therefore disqualify her for Medi-Cal because of my income? What happens if I choose to NOT claim her, even though I could?

Answer: Your daughter should apply for Medi-Cal directly through your county office. Medi-Cal is only interested in your daughter's income and assets. That way you can continue to claim her as a "dependent relative" on your tax return.

Question: My employer offered me, my spouse and my children a employer sponsored minimum essential coverage effective 01/01/2016. If my spouse and my children decline the employer sponsored minimum essential coverage offer, are my spouse and my children eligible for Covered California subsidy when my household income is greater than 266% of Federal Poverty Level?

Answer: No. The fact that your spouse and children have been offered employer-sponsored health insurance makes them ineligible for premium assistance in Covered California even if household income is between 128% and 400% FPL.

Question: My mom, a new green card holder, has an income less than $4000 from my home country. I have sponsored her green card, and signed the affidavit of support (I-846). I am not claiming her as a tax dependent. I've read that for certain federal and states benefits (including non-emergency medi-cal--see source below) my income would be counted as her income to assess her eligibility under "immigrant deeming rules". I have a high enough income that if added to hers, makes her ineligible for medical or discounts on CoveredCA market place. The medi-cal staff did not seem to know much about this and they say they are trained to count the IRS household income to assess eligibility, which means my income does not matter. Which one is correct? Is she eligible for medi-cal? If she is not eligible under medi-cal, does CoveredCA also deem my income as hers? The staff seem to be clueless. My research on this seems to go nowhere. I appreciate your help.

Answer: You can apply for health insurance for you mom through Covered California. Since you do not claim your mother as a dependent, her income alone is considered for eligibility. Since her taxable income is far less than the Covered California minimum, she will be deemed eligible for Medi-Cal. She can "buy into" Medicare once she has been in the US for 5 years.

File Your Own 1095-A?

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Question: Our 1095-A for 2015 is nearly completely wrong. I went to Medicare in may but my wife was and still is on the same Covered California Kaiser policy, Because of this I expected some problems, but the form only has her coverage for the first 4 months, nothing for my coverage in that period, and does not show her continued coverage for the last 8 months. I believe it is because it took a great deal of effort to get them to continue her coverage. They had me listed as primary and first dropped her coverage and then reinstated it, I assume with her as primary. I think this is the problem now, but it shows wildly wrong numbers and will cost me dearly if I cannot get it corrected. How do I do that when they have no way for me to communicate with them? They give no email addresses, the message board will not accept replies, and the chat people don’t have any idea what to do, other then assure me she has coverage. I don’t have any confidence that they will get me a corrected form so that I can file.

Answer: If you cannot get an accurate 1095-A before the tax deadline, you can file your own 1095-A. Here is what to do:

Download a blank 1905-A form at https://www.irs.gov/pub/irs-pdf/f1095a.pdf Now collect the following pieces of information for PART III - Household Information:

  • The months you, your spouse, and dependents had coverage.
  • Your total premiums paid for you, your spouse, and dependents.
  • The cost of the Second Lowest Cost Silver Plan in your Marketplace at https://www.coveredca.com/shopandcompare/2015/
  • The total amount of Advanced Premium Tax Credit that was paid on your behalf. (Your insurer will have this information too) NOTE: You can compare what you actually paid to the full price of the plan, the difference is your Advance Payment of Premium Tax Credit.
  • If you are married then you’ll also need “Policy Number (Form 1095-A, line 2)”. So it’s a smart move to get the policy number from the Covered California or your insurer. You only need to enter the LAST 15 digits of the policy number (that’s all that show on a 1095-A sent to you as well).

Now that you have all of that information, add the total amount in for each column.

Affidavit as Proof of income?

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Question: I have just opened up a new law office. I worked for an attorney for 13 years and would Gross over $200,000 per year. The practice is Social Security Disability appeals. The covered California said I cannot prove my income and must go on Medi-Cal. I do not want to do that. They gave me 90 days to appeal Any suggestions would be much appreciated. I do have three cases that are scheduled for hearing. I believe I will make $20,000.00 net after my first year as a solo practitioner. Thank you in advance for any help you can offer me.

Answer: While you are getting your business started, the common forms of proof-of-income may not available to you. You can submit an Affidavit - a signed and dated statement with the word "Affidavit" on top - explaining how much income you can expect to make and how you will earn it 2016.

Question: I read that sponsors of immigrants who sign the enforceable affidavit of support (Form I-864) may be required to repay the government for "means-tested" benefits used by the immigrant after he or she becomes a lawful permanent resident." and that "non-emergency medi-cal is a means-tested benefit". That says that if sponsored immigrants get on medi-cal, the sponsor should repay. Is that correct?

Answer: Yes. The sponsor is legally liable. The enforceable affidavit of support (Form I-864) states: "If a Federal, State or local agency, or a private agency provides any covered means-tested public benefit to the person who becomes a permanent resident based on the Form I-864 that you signed, the agency may ask you to reimburse them for the amount of the benefits they provided. If you do not make the reimbursement, the agency may sue you for the amount that the agency believes you owe." However, it is very rare for the sponsor to be sued. States are not required to go after sponsors, and to our knowledge, no government agency in California has sought reimbursement from a sponsor up to now.

Question: Can our sister, who is our financial dependent for IRS, federal taxes, also get benefits from California medi-cal and federal Medicare as her retirement income is insufficient to cover food, board and medical needs?

Answer: Your sister is eligible for Medi-Cal if she meets residence and income guidelines. She should apply directly through her county Medi-Cal office, not Covered California. Here's a link for MediCal contact info: https://www.medi-cal.ca.gov/contact.asp

Question: Does a new green card holder who stays in the US for 6 months a year only have to be covered by an ACA compliant plan? If yes, does it have to be for the entire year or just the duration of the stay in the US?

Answer: Yes. You must buy health insurance or pay the IRS penalty. You can cancel your coverage when you leave the country and reapply under Special Enrollment provisions when you return.

Can I Change My Health Plan Now?

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Question: Please help me figure out if I can change my health plan right now. I'd like to change from Heath Net to Blue Cross, because the doctor I need only takes Blue Cross.

Answer: Yes. You can change your plan selection any time before the current open enrollment period ends on Jan 30, 2016. The effective date of the new coverage will be February 1st, if you make the change by January 15th, or March 1st if you change between January 15th and 31st.

Question: Our family of four, husband Wife and two kids, with yearly income of $48000 qualify for premium assistance and cost sharing (Silver 87 Plan) according to Covered California’s shop and compare tool. However, when we applied, Covered California qualified kids for Medi-Cal. Pregnant wife also qualified for Medi-Cal. Now Covered California says the husband does not qualify for any premium assistance and cost of sharing plan because it will not consider Medi-Cal eligible members in the household size for covered California. Medi-Cal eligible members reduced the family size to one member for Covered California.Does Covered California not include Medi-Cal eligible members in the family size while determining eligibility? Does Medi-Cal not include Covered California eligible member in the family size while determining eligibility? Are Covered California and Medi-Cal programs mutually exclusive or inclusive or overlapping?

Answer: (1) Your 4-person household will receive premium assistance and cost-sharing (Silver 87) benefits based on your $48k annual income. The fact that your kids are eligible for Medi-Cal does not reduce the subsidy or cost-sharing (still calculated based on 4-person household, not a 2-person household). (2) Your wife’s pregnancy provides additional choices. When you apply through the Covered California enrollment portal you will be enrolled in Covered California coverage and your application will also be sent to Medi-Cal in your county. In your family’s case, your wife is eligible both the Medi-Cal Access Program and Covered California during her pregnancy and immediate postpartum. You cannot have the Medi-Cal Access Program and Covered California at the same time; you must make a choice. (3) If your wife chooses to enroll in Medi-Cal Access until after the baby is born, the husband’s Covered California eligibility will still be based in a 4-person household, but with only one person enrolling. He is still eligible for a subsidy and cost-sharing reductions, but the net Covered California premium for the husband alone would be higher than the net premium for both spouses in enrolling Covered California.

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