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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.

Recovery of Cost Sharing Reductions?

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Question: I made more money than I estimated, so I will have to pay back some of the subsidy I received. My question is about the cost-sharing benefits I received with my Silver 87 plan. Will they charge me for that too.?

Answer: Covered California enrollees at the lower end of the income spectrum receive cost-sharing reductions (CSR) in addition to premium assistance. CSR benefits include lower deductibles for medical and prescriptions drugs and lower out-of-pocket maximums. Currently the IRS can recover premium assistance overpayments, but not CSR payments. That may be changing. We recently noticed that some Covered California accounts are beginning to show a CSR monthly dollar amount - see CSR Amount Sample.pdf. Once a dollar amount is established, can recoverability be far behind?

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I qualified for Covered California last year, so I signed up for a horrible plan that I used just one time and it cost me $120 for the office visit. My agent was not affiliated with Covered California and it turns out that he had just started working for the association at the time. Anyway, after thorough research on my part, it turned out that I was actually covered through MEDICAL benefits in San Joaquin CO. My caseworker contacted her supervisor and they apologized for the fact that I had been ill informed. Unfortunately I’m now obligated to pay the IRS $725 out of pocket for having medical coverage through Covered California. How is this fair? Seems a bit irrational to me. Help would be greatly appreciated. Sincerely, Cecily Lobretto

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