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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.


Can I Get a Subsidy After I Overestimated My Income?

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Question: I estimated my wife's self employed income at 30 k but so far she has only made around 3k. She gets paid sporadically and it is very possible that she will end the year with the estimated income. If she does not, we would become eligible for premium assistance. If I do not report the change now in the hopes of her making that money, will There be some sort of penalty. Right now we are not eligible based on the estimate and have not taken any assistance. Also, is one required to take premium assistance even if one qualifies for it. My wife has her own private health insurance, and I have covered california which, even without assistance, is cheaper than what I had off the exchange. Can I say I do not want premium assistance and skip the hassles of reporting income change ges, proving income, etc. Or would I still be subject to all of that

Answer: If you enrolled through Covered California, you can receive premium assistance retroactively. For example, let's say your estimated you household income (both you and your wife) for the 2016 tax year above the amount that would make you eligible for premium assistance (subsidy). However, at the end of the year your actual income is lower than you estimated (there is no penalty for overestimating your income) and now your actual income makes you eligible for a subsidy. You will get that money as a lump sum tax credit on your 2016 tax return. However, there is a potential snag in your situation. You say, "My wife has her own private health insurance". I take that to mean that your wife has off-exchange health insurance. If that is the case, her portion of the premium assistance will be lost. She has to be enrolled through Covered California in order to be eligible for a subsidy now or later.

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