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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.

March 2016 Archives

Back Payment to Medi-Cal?

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Question: I am single with no dependents. I have been covered by Medi-Cal since March 2015. I had a surgery in October 2015. My AGI for 2015 would be around $19,000. Will I be subject to back payment of healthcare expenses? If so, how much?

Answer: There is no penalty or repayment required for your previous Medi-Cal benefits. At $19,000 single-person household income, you are no longer eligible for Medi-Cal. You need to notify Medi-Cal of your higher income. They must release you before you can be eligible for Covered California coverage. You will be eligible for premium assistance and cost sharing reductions under Covered California​.

Question: We have a family coverage that's through my employer. It's a PPO. Can we still have a covered CA insurance just for our son? There are certain therapy he needs that's not covered by my insurance.

Answer: Your son cannot have a second health insurance plan, either Covered California or off-exchange, if he is already covered by your employer-based insurance plan. There is no option to make a change in his coverage at this time. Even if you were willing to pay full-price for health plan for your son, you would have to first voluntarily cancel his coverage under your group plan, but that would make him ineligible for a Special Enrollment in 2016. You will have to wait until Jan 1, 2017 to make that change.

Question: Where can I find the 1095 form for my son who was covered under medi cal 2015?

Answer: Each person who is or was enrolled in Medi-Cal will get his or her own Form 1095-B. Therefore, a household with more than one person covered by Medi-Cal may get a Form 1095-B for each person that had coverage. The 1095-B form will be mailed to you by March 31, 2016.

Change Coverage Now?

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Question: I chose Molina when I enrolled not knowing that Kaiser was available to me. I want to know how I can change from Molina to Kaiser. Is there a number I can call?

Answer: You can only change plans during open enrollment. Your next opportunity to change you health insurance plan will begin in November 2016.

Can My Son Go on Medi-Cal?

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Question: I'm 52. My wife is 49. We make 60 thousand a year. My son is 19 and he live in our basement but is never home. He files his own taxes and claims himself. He works full time but would be on medical if our income was not added to covered cal. Does he have to pay for insurance or can he file medical by himself.

Answer: ​Yes. He can apply for Medi-Cal by himself. Be aware that once you drop him from your Covered California account you become a 2-person household and your subsidy will be less than it was as a 3-person household given the income is the same.

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