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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.

August 2016 Archives

Reside in Two States?

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Question: I live in different states during the year. My summer home is in Michigan; my winter home is in California. Where do I sign up for health coverage? And if I sign up for a plan in one state, how do I find in-network health providers in the other state?

Answer: You don’t have a choice. You must buy coverage in the state where you officially reside. Your official state of residence is where you spend most of the year, where you pay taxes, where you register your cars, or are registered to vote. For instance, if you are buying coverage in California, but spend a significant amount of time in Michigan, you should buy a PPO plan from Anthem Blue Cross or Blue Shield of California, so that you can find participating in-network providers from Blue Cross Blue Shield of Michigan when you are there.

Question: We buy health coverage from Covered California but our son will attend college in Arizona. We want to cover him on our policy. Can we do that?

Answer: Yes, you can. One key consideration, though, will be whether he can access in-network services while he is away at school. In California, only Anthem Blue Cross or Blue Shield of California PPO Plans will give in-network access out-of-state. Both of these carriers offer “Blue Card” benefits outside of California in any state with a Blue Cross Blue Shield Association carrier (36 states including Arizona). To access care, your son would select any BCBS of Arizona provide and his health plan benefits would be the same as if he were in California. All PPO plans also have out-of-network benefits available when in-network providers are not accessible, but the members’ out-of-pocket expenses will be much higher out-of-network.

What is SLCSP on Form 1095-A?

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Question: I have an anthem bronze ppo plan for which I am paying 100 percent of the monthly premium (no subsidy). Reading about the 1095a statement, I NOTICED a column called slcsp. WHAT IS THAT, AND DOES IT APPLY TO SOMEONE IN MY SITUATION? I DON'T QUALIFY FOR ENHANCED SILVER BENEFITS. A WEBSITE I looked at said if the column reads 0 IT IS INCORRECT. I ASSUME IT WOULD READ 0 SINCE I did not get any enhanced silver plan benefits.

Answer: The second-lowest cost silver plan (SLCSP) that applies to you is usually found on your Form 1095-A. If you receive premium assistance during the year, you need to know the SLCSP to figure out your final premium tax credit for the year. If you did not receive any premium assistance during the year, the advance premium tax credit field should be $0. The The SLCSP field may be zero too, since it doesn't matter.

Question: I am receiving a subsidy in 2016 that reduces my monthly health insurance premium. I want it to continue in 2017. Do I have to do anything?

Answer: You should return to Covered California to update your application for financial assistance. You can do this on your own, either by logging in to your account on the web site or by calling your agent to help you do it. If you don’t have an agent, you can call the Covered California Call Center at 800-300-1506.

If you don’t update your application by December 15, Covered California will automatically adjust the amount of your 2016 premium tax credit for 2017. The automatic adjustment will be based on a rough inflation adjustment to your most recently reported income and on changes in the cost of the benchmark Silver Plan in 2017.

Updating your application is a good idea because the automatic adjustments made by the Covered California may not fully reflect your situation. It is important to report any changes in your household income and your family status so your eligibility determination will be up to date and so the amount of financial assistance you receive in 2017 will be as accurate as possible.

Question: I filed my 2015 federal income tax return but didn’t realize I needed to include Form 8962. Can I still receive premium subsidies in 2017?

Answer: If you received advance premium tax credits in 2015, you must reconcile your tax credit amount 2016 year in order to continue receiving advance tax credits next year. Remember, the subsidy you received in 2015 was based on your estimated income for that year. The law requires you to file a tax return at year end and reconcile your estimated income with your actual income. If you had under-estimated your 2015 income, you might have repay some of the 2015 tax credits that you received. If you had over-estimated your 2015 income, you could claim additional tax credit when you filed your return. Either way, the IRS requires this annual reconciliation. People who fail to reconcile the premium assistance they received last year will not be allowed to continue receiving advanced premium tax credits next year.

To continue receiving APTC in 2017, if you haven’t yet filed a 2015 return with a completed Form 8962, you should do so as soon as possible. To do this, you will also need Form 1095-A, which should have been sent to you by Covered California in January with information about your 2015 APTC. If you don’t have form 1095-A, you should call the Covered California Call Center at 800-300-1506 to obtain a copy. As soon as you file your 2015 tax return and completed Form 8962, contact Covered California to update your account to reflect this change.

Question: My projected income was over 400 percent of the fpl. However, it will wind up being lower. When I initially signed up last year, I think I chose to get a subsidy in one lump sum. Obviously, I have not gotten anything, because my projected income is high 83k.Is there a way to look at the website and see what I chose. I WOULD RATHER NOT CALL THEM, FOR FEAR THEY WOULD ASK ME ABOUT INCOME CHANGE. Do I need to worry about what I chose, since my projected income disqualifies me for aptc. Would I have been given a subsidy option with my income that High? I can't remember exactly what I did when signing up. Plus, I did call to report an income change, and the person on the phone asked me to break Down my income from various sources by month, so I am not sure if something might have been changed. My projected income was still higher than the 400 percent. Should I just not call them and leave it for reconciliation at tax time next year.

Answer: If you opted for premium assistance in one lump sum, you are in good shape. If you qualify for a subsidy, you'll get it when you file your taxes. if you were not due any premium assistance, there's nothing to repay. Logon to your Covered California online account, from the homepage select "Summary" and then select "Change Premium Assistance Amount" and the next page you see will explain which payment option you have - monthly or lump-sum. If it's not what you want, you can change it.

Question: I will be applying to Medi-Cal in September of 2016. I do not know if I should provide ONLY my information in the application or my parents information AND my information in the application. I was claimed as a dependent when they filed taxes on Feb. 2016 and when they file taxes on Feb. 2017 I will NOT be claimed as a dependent. In other words, I will be independent.

Answer: Apply through Covered California even though you know you are eligible for Medi-Cal. The online application process at CC is much easier than applying at Medi-Cal. Since your parents will not be claiming you as dependent for the 2016 tax year, apply as an individual. You will not provide any information regarding your parents or their income.

Question: If I wish to cancel my covered ca. Plan at the end of the year, can I do it easily on the website or do I have to call them. Is it as easy as clicking a cancel membership button and indicating the desired date of cancellation?

Answer: To cancel coverage online, logon to your Covered California account and find the link that reads "Terminate Plan". If you are uncertain, contact the Covered California service center for assistance at 800-300-1506.

Question: My Anthem Blue Cross PPO plan through Covered California won’t be offered again in 2017. Now what do I do? * Answer*: During Open Enrollment, you can shop for a different plan either with Anthem or any other insurance company available through Covered California. Or you can do nothing and Anthem will automatically enroll you in another plan it offers that is similar to what you had this year. You will receive a notice from AQnthem that describes that alternative plan and how it differs from your current plan.

Question: I’m leaving my job and will be eligible for COBRA. Can I shop for coverage and subsidies on the Marketplace instead?

Answer: Yes. Leaving your job and losing eligibility for employer-based health coverage will trigger a special enrollment period (SEP) that lasts for 60 days. You can apply for Covered California health plans and (depending on your income) for premium tax credits (subsidy)and cost sharing reductions during that period. However, if you enroll in COBRA coverage through your former employer beyond the 60-day SEP opportunity, you will need to wait for the next Open Enrollment period to voluntarily cancel COBRA and enroll in a Covered California plan.

What are Catastrophic Plans?

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Question: I just lost my job and I’m buying Covered California. I notice “Catastrophic Plans” that look even cheaper. What are those and can I buy one if I want?

Answer: Catastrophic plans have the highest cost sharing - deductible and coinsurance. Not everybody is allowed to buy catastrophic plans. They are only for adults up to age 30, and for older people who can’t find any other Covered California policy that costs less than 8.13 percent of their income. In 2016, Catastrophic plans have an annual deductible of $6,850 ($13,700 in family plans). You will have to pay the entire cost of covered services (other than preventive care) until you’ve spent $6,850 out of pocket; after that your plan will pay 100 percent of covered services for the rest of the year.

Question: I don’t have a green card yet. Can I buy a California Cover health plan?

Answer: If you are not a U.S. citizen, a U.S. national, or an alien lawfully present in the U.S., you are not eligible to buy a plan through Covered California. However, you can shop for health insurance and buy insurance directly from one of the health insurance companies offering off-exchange plans. Insurers outside of the Covered California are prohibited from turning you down based on your health status or your immigration status and must follow generally the same rules as plans in Covered California.

Question: I am moving to California next month. Will I qualify for a Special Enrollment Period of 60-days after I move?

Answer: The feds just passed a new rule affecting permanent moves. Starting July 11, 2016, if you move to another state, you will be eligible for a special enrollment period only if you had previously had been enrolled in other coverage. The new rule is that you have been enrolled in minimum essential coverage (such as a job-based plan, Marketplace plan, or Medicaid) for at least 1 day in the 60 days preceding the date of the permanent move in order to qualify for the permanent move special enrollment period.

Should I Buy in CA or NV?

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Question: I live in California, but drive across the border every day to work in Nevada. What state should buy coverage?

Answer: Generally, you should buy coverage in California, the state where you live.

Question: I just moved from Arizona to California. I am staying with a friend until I find a job and can get settled, but I need health insurance right away. How can I establish residency in CA?

Answer: The fact that you don’t have a permanent home should not affect your eligibility in California as long as you are currently residing here and intend to remain here. Covered California will accept an applicant’s statement regarding their state of residence without other verification. In situations where other information available to Covered California suggests that the applicant may live in a different state, it may ask for verification. This could happen in your case if records available to Covered California show your prior address in Arizona. You will need to provide a statement or other documentation showing that you have moved and now intend to reside in California. Also note that, starting July 11, 2016, to qualify for a special enrollment due to a permanent move, you must also have had been enrolled for at least one day, during the 60 days leading up to your move, under other minimum essential coverage, such as under a job-based health plan, another Marketplace plan, or Medicaid.

When Does My Coverage Renew?

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Question: I signed up for a Covered California health plan in April after I lost my job. Does my coverage get renewed in January or at the anniversary date next April?

Answer: All Covered California health plans provide coverage based on a calendar year. Coverage under your current plan continues through December. Open Enrollment (November 1, 2016 through January 31, 2017) is the time to renew coverage. You can return to the Covered California website or call Covered California to renew coverage yourself so that it continues in 2016. If you don’t act to renew your coverage by December 15, 2016, they will automatically renew coverage for you. If your coverage is automatically renewed, but you would still like to change plans, you can still do so until the last day of Open Enrollment, January 31, 2017.

Question: How do I prove that I had coverage?

Answer: You should receive a form 1095-B from your health plan or insurance company indicating the months in 2016 when you were covered under the plan. If you were enrolled in family coverage, Form 1095-B will indicate the names of all family members who were covered with you under the plan. A copy of this form will also be reported to the Internal Revenue Service.When you file your tax return for this calendar year, you will have to enter information about your coverage on the return.

Question: Do I need to be on the same plan as my spouse?

Answer: No. There is no requirement in the Affordable Care Act that spouses be on the same plan. But if you want to qualify for a premium tax credit, or subsidy, to lower the cost of your insurance, be aware that subsidies are based on your total household income level. So even though your spouse will not be covered by the subsidized insurance plan, his or her income will be included when determining the level of subsidy you are eligible for.

Question: I can barely pay my Anthem Blue Cross monthly bill now and that’s with a subsidy. I need the health insurance since I have diabetes.

Answer: If your current plan becomes unaffordable after the 2017 rate increase, you have a couple of options available to you without losing your health insurance, but both options involve trade-offs.

  1. If you have a Silver or higher tier plan, you can downgrade, for example from Silver to Bronze. If you stay with the same insurance carrier, Anthem Blue Cross in your case, you will stay in the same provider network of doctors and hospitals. The trade-off is higher out of pocket medical expenses because of higher deductibles and copays.
  2. Shop a cheaper Silver Plan with one of Anthem Blue Cross’s competitors. For example, you may find that you can change to an 2017 Oscar Health Silver EPO plan at the same rate as you had for Anthem Blue Cross Silver PPO plan in 2016. However, you will have to check carefully to make sure your doctors and other providers are in the Oscar health network. The trade-offs in this example are loss of out-of-network coverage in switching from PPO to EPO plans as well as the network considerations.

If you do not already have a Certified Health Insurance Agent now is the time to get one. Your agent can help clarify your options, guide you through the application process, and if subsidies are involved, make sure you get the best outcome possible.

Question: Will I be able to keep the same plan in 2017 that I have this year?

Answer: Probably. It depends on where you live. United HealthCare, after just one year of limited participation in Covered California, is pulling out in 2017. Other plans, including Oscar, Molina and Kaiser Permanente, are expanding into some regions. But even if you can keep your plan, a rate hike could put it out of your financial reach. To find a better price, more Covered California enrollees will have to switch plans, which means they could lose their current doctors. According to Covered California, about 80% of consumers will be able to pay less than they do now or cap their rate increases at 5% if they shop around and buy the lowest-cost plan at their current benefit level. Now more than ever, California health care consumers will benefit from the assistance of a Certified Insurance Agent to help them find a plan they can afford that includes access to their doctors and other health care providers.

Question: If I am getting premium assistance and the premium on my plan rises by 20% next year, does that mean I’m going to have to pay 20% more out of my pocket than I did this year?

Answer: Not necessarily. As premiums rise, so do tax credits, which means that, all things being equal, the premium assistance will absorb at least some of the rate hike. But you won’t be able to research your specific situation until early October. Because the Covered California online shopping tool won’t be updated for 2017 rates until then. If you already have a Covered California plan, you will receive a notice from Covered California in October explaining how much your current plan’s premium will change and what your tax credits — if any — will be for next year. You can keep the same plan at the new rate or switch plans during open enrollment.

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