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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.


November 2016 Archives


Age 65 and Not Medicare Eligible?

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Question: I am 65 years old next month, but I have to pay a premium for Part A because I have not worked long enough to qualify. Can I sign up for a Covered California plan?

Answer: Yes, People age 65 or older who are not entitled to premium-free Medicare can purchase health insurance coverage in Covered California (except undocumented immigrants). If you sign up for a Covered California plan, you may be eligible for premium tax credits to make the coverage more affordable depending on your income.

Keep in mind that if you are able to continue working, you may be able to earn enough work history to qualify for premium-free Medicare in the future. So another option for you to consider would be to sign up for Part A and Part B coverage when you turn 65 (you will have to pay a premium for both Part A and for Part B), and when you become eligible for premium-free Part A through your work history, you will then only have to pay a premium for Part B.


Drop COBRA Now?

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Question: My COBRA coverage won’t expire for another 9 months. It’s very expensive. Can I drop it and enroll in Covered California now?

Answer: Yes. During Open Enrollment, you can sign up for a Covered California plan even if you already have COBRA. After Open Enrollment ends (January 31,2017), if you voluntarily drop your COBRA coverage or stop paying premiums, you will not be eligible for a special enrollment opportunity and will have to wait until the next Open Enrollment period. Only expiration of your COBRA coverage triggers a special enrollment opportunity.


Question: I’m getting a monthly subsidy that lowers the premium of my Covered California plan. What will happen to this subsidy if Obamacare is repealed?

Answer: It seems likely that Obamacare will be repealed soon, but it will take a year or two to build a system to replace it. Subsidies will probably continue to be funded through 2017 and perhaps beyond. The new administration has proposed some new ideas for a replacement plan, for example subsidies based on age rather than income.


Medi-Cal for Mother?

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Question: My mom lived with me since 2015 summer. She got her green card recently. She is now 74, she does not have any income.

  • Can she apply for Medi-Cal now? Yes
  • Can the medical benefits (through Medi-Cal) kick in for the remainder of 2016? Yes.
  • What should she show as her household income? $0
  • Does she have to file a separate tax return in 2016 (or) can I still include her as dependent in 2016? No. You can still claim her.
  • After receiving Medi-Cal benefits in 2017, does she have to file a separate tax return in 2017? No

  • Question: Can I update my income, but let my #CoveredCalifornia policy automatically renew?

    Answer: No. When you update your income, Covered California will determine the new amount of your subsidy, and then you will need to re-select your current plan in order for the updated premium tax credit amount to be applied to your premium next year. If you want the new premium tax credit to take effect on February 1, 2017 you will have to update your application for financial assistance on or before January 15, 2017.


    Adult Child Tax Status?

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    Question: I heard is you cannot include your child under age 26 in your Covered CA application unless he/she is your dependent on your tax or by court order. Is this correct? I thought a child is allowed to stay under his/her parents' plan until 26?

    Answer: You are confusing two different ACA guidelines. (1) The ACA has ruled that you can include adult children to age 26 on your family health insurance coverage. This rule has nothing to do with tax status. Your adult child may be financially independent and pay their own taxes. (2) If you are seeking premium assistance for your family through Covered California and wish to include a child under age 26 as part of your household, that child must be a income tax dependent.


    Question: I earn less than 30,000 a year. I have 2 daughters and me. I'm insured through my employer. I am paying $400 a month. Do I qualify for a subsidy?

    Answer: If you pay $400/mo for health insurance that does not include your daughters, it is officially "unaffordable" because it represents over 16% of your income. The law says you can cancel your unaffordable (greater than 9.6% of income) employer-based insurance. You are eligible to buy subsidized coverage at Covered California. Your daughters are eligible for Medi-Cal. Your cost for very good insurance will be about $100 per month.


    Question: How do I find out how much my prescriptions are going to cost?

    Answer: Each health insurance company has a drug formulary posted on their website. No matter which health plan you choose, the drugs will be labeled as Tier 1 (generic drugs), Tier 2 (preferred drugs), Tier 3 (non-preferred drugs) or Tier 4 (specialty drugs). Your cost for your prescriptions will be lowest for Tier 1, and highest for Tier 4. Each carrier must provide current and prospective members with an estimate of the out-of-pocket cost for specific drugs. In 2017, California insurance carriers cannot charge more than $250 per month for one 30-day supply for Silver 70, Gold 80 and Platinum 90 plan members and no more than $500 per 30-day supply for Bronze 60 plan members. These costs apply to Tier 4 (specialty drugs). Drugs in lower tiers have lower costs.


    Question: Is covered California just for people who qualify for subsidies? If so, how do higher income people apply?

    Answer: If you are not interested in financial help, you can use the Covered California online application at CoveredCa.com. If you do not want financial assistance for a Covered California health insurance plan or coverage through Medi-Cal, you can indicate that you are not interested in premium assistance when asked. From that point, you will complete the application and select a plan without entering income information.


    Undocumented Family Member?

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    Question: My husband does not have a green card yet, but he pays taxes. We both work but his income is more than mine. We have 2 kids. When I apply at California Covered what do I put in for income, just mine of both?

    Answer: Families that include undocumented immigrants can apply. On your application, include your husband in the household and include his income. Your Covered California eligibility will be based on a 4-person household. Indicate on the application that your husband does not want coverage.


    Continuity of Care?

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    Question: I can save $170 per month by changing insurance companies this year. I just had back surgery and need follow up care, but my doctor is not in the new plan. It’s almost worth paying cash for treatment since I’m saving over $2,000 for the year. Am I overlooking anything?

    Answer: If your doctor does not take your new health insurance, but you are getting treatment for a serious condition, call your new health insurance company to let it know about your treatment. Depending on what illness or condition you are receiving treatment for, your new health insurance company may be able to work with your current doctor while you finish your existing treatment. Be sure to tell your current doctor that you have new health insurance.


    Premium Assistance Options?

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    Question: My income may go up during the year. I don’t want to have to pay a penalty for taking too much subsidy. How do they handle that?

    Answer: If you are paid too much premium assistance during the year, the IRS will recover some or all of it through your tax return. The balance due is added to your taxes due for the year.

    You can avoid having to repay excess premium assistance in several ways. (1) If your income increases during the year, update your Covered California account to reflect the income change and your subsidy will be reduced going forward. (2) You can elect to take less premium assistance on a monthly basis or (3) you can take all of your premium assistance in a lump sum at the end of the year.


    Question: I was recently forced into early retirement and am losing my employer-provided health benefits. I made far too much money in 2016 to be eligible for a Covered CA subsidy, but I will certainly qualify in 2017, since my income in retirement has dropped considerably. Can I take COBRA for the remainder of 2016 (1.5 months), then enroll in covered CA starting on Jan 1, 2017 with the subsidy?

    Answer: Yes. If you enroll in COBRA now, you can change to Covered California during open enrollment for a January 1, 2017 effective date of coverage. Also, your loss of coverage because of job loss makes you eligible for a special enrollment period that lasts 60 days from the date you lose coverage, but your Covered California coverage would not start until January 1st anyway. Something you should know about your COBRA rights: you have a 60-day period during which you can enroll in COBRA. You don't have to enroll now. What that means to you is you may be able to avoid paying for COBRA for a month and a half if you have no medical expenses during that period. If you have unscheduled medical expenses in that period of limbo, you can sign up for COBRA with a retroactive effective date back to the date of your loss of employer-based coverage.


    Primary Care Provider?

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    Question: Why am I being asked to select a Primary Care Physician for a PPO plan? I thought the whole idea of a PPO is to be able to see any provider in the network.

    Answer: Covered California believes that being matched with a Primary Care Provider (PCP) improves your health care. Having a PCP means you will have someone you can turn to for health care advice — whether it’s preventive care, treating common illnesses and injuries, or recommending a specialist when you need one.

    When you renew your plan, your health insurance company will match you with a PCP, in part and when possible, based on the physician you have been seeing. If you have not been seeing a specific physician or are renewing with a new health insurance company, that company will match you with a physician as near to your home as possible. You can change this match AT ANY TIME by contacting your health insurance company.

    Having a PCP does not change your PPO/EPO, but is an added feature. You may still access any provider, inside or outside the network for PPO’s and inside the network for EPO’s, and do NOT need a referral to access specialists.


    Tax Dependent Apply Separately?

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    Question: I believe I would be eligible for Medi-Cal and so I plan to apply through Covered California. When applying, can I/do I apply for myself separately or do I need to apply along with the rest of my family? I currently live with my parents, who report me as a dependent. I am a 22 years old recent graduate, I am currently unemployed but looking for work. I am not covered under my parent's health plans because of the cost.

    Answer: You are eligible for Medi-Cal. Apply through Covered California for yourself alone. You will have to promise to file a tax return in 2017. When you do file your tax return for 2017, you need to check a box on your own tax return to report that you can be claimed as a dependent on somebody else's tax return. Your parents can continue to claim you as a dependent until you earn more than half of your total support for the year or reach age 24.


    Medi-Cal Asset Recovery?

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    Question: I am over 55 and have my own health insurance, but my son, who is 9 years old, receives Medi-Cal. Can the state take from my estate after I die in order to reimburse themselves for my son’s premiums?

    Answer: No. California only seeks to recover assets from the estates of those who have used Medi-Cal to pay for nursing home expenses.


    Unemployed Adult Living w/ Parents?

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    Question: I am 25-years-old, have no health insurance, am unemployed, and currently live with my parents. I have no income and so I don't personally file income tax, but my parents have been kind enough to cover my limited expenses. I am a student enrolled half-time at a nearby community college and I am currently in the process of preparing all the things required to enroll into a nursing program for an ADN. One requirement is for proof of health insurance and so I will need to apply for a plan. I am not enrolled under one of my parent's plans due to them being cost prohibitive. My question then is what are my options? What course of action may prove best for me?

    Answer: You are eligible for Medi-Cal. You can sign up now through Covered california and be covered immediately. Medi-Cal enrollment will satisfy your nursing program requirement.


    Proof of $0 Income?

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    Question: Hello, I work for my mother I'm her caregiver, she pays me with a VA Benefit Aid and Assist, which is only for her care this income is not tax deductible, therefore I don't file income tax, how do I provide proof of my income for subside? Thank you.

    Answer: If you have $0 taxable income, you are not eligible for a subsidy. You are eligible for Medi-Cal. You can provide proof-of-income with a letter explaining your income details.


    Consumers After Obamacare?

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    Question: I currently get a subsidy for my insurance on Covered California. If the Affordable Care Act is repealed, will I be able to change my plan to a lower-cost plan?

    Answer: While it now seems certain that the Affordable Care Act (Obamacare) will be replaced, nobody knows what will replace it. We can make some educated guesses though. President Elect Trump had indicated that he wants to keep the "guaranteed issue" feature, but those with preexisting conditions could pay a higher premium. Look for subsidies as well as penalties to go away. The health insurance companies will be less restricted in what they can offer. Look for cheaper plans that don't cover as much. So you will probably not be able to buy a lower-cost plan, but without a subsidy.


    Question: Is dental coverage included in Covered California plans?

    Answer: Children’s (through age 18) dental coverage is included as part of all health insurance plans sold through Covered California. This is known as “embedded children’s dental coverage.” Embedded children’s dental coverage is part of all health insurance plans sold through Covered California, so no additional enrollment is needed to receive children’s dental benefits if you already have a health insurance plan through Covered California. The dental benefits for children are part of the coverage you have purchased.

    Optional adult dental benefits are also available through family dental plans. All plans include free preventive and diagnostic care, like cleanings, X-rays and exams. Family dental plans are offered during the renewal period, but you must purchase a health plan through Covered California in order to be eligible.


    Question: Do people holding temporary visas like H-1 and student visas have to buy health insurance or be penalized?

    Answer: All “lawfully present” individuals in the United States must have health insurance or pay a penalty unless exempt. Lawfully present includes temporary US residents holding worker visas and student visas. The IRS grants exemptions from penalty if the income is below the minimum tax filing threshold also if minimum essential coverage is unaffordable.


    Question: If the consumer does not have an online account and wants access to their application information, what is your first step

    Answer: (1) Go to the Covered California Login Page and Apply for Coverage. (Looks like this: CC1.pdf) (2) At the Login page, create an account (Looks like this: CC2.pdf)


    Question: My husband makes less than $20,000 a year and he's currently on my insurance plan through my employer but it has gotten too expensive and we cannot afford it. I wanted to see if he can apply for covered California on his income alone. We file our taxes separately & file single. Does he still have to report my income to apply? I make over $50,000 a year and I'm sure he won't qualify for tax subsidy if he reports my income.

    Answer: Your spouse has access to your employer's health plan. That makes him ineligible for premium assistance (subsidy) through Covered California. So he can only buy private insurance coverage at full price, if not from your employer. His income (or your income) has no affect on this case. Your tax filing status is dicey (should be either married filing joint return or married filing separate return but not single taxpayer), but has no affect on this case either.


    Political Asylum Pending Status?

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    Question: I am here on a political asylum and my status to be approved for political asylum is still pending, however, I do have a work permit and a Social Security number. By law, do I have to purchase health insurance under my current status?

    Answer: The rule on pending asylees is as follows, "Applicants for asylum are eligible for Marketplace coverage only if they've been granted employment authorization or are under the age of 14 and have had an application pending for at least 180 days." That includes your situation, but your question was "do I have to purchase health insurance?". Yes. You have to purchase minimum acceptable coverage or pay a penalty. That's because you have the right to work in this country. As a taxpayer, you are eligible for subsidized health insurance coverage. With the eligibility for taxpayer benefits comes responsibility to insure yourself so as not to be a burden on other taxpayers.


    Question: I work part time and share rent with my parents. I'm 29. I earn an average of $750 net per month. Aren't there any other more affordable plans for part-time workers? I want to abide by the law. So, now what are my options?

    Answer: Your income makes you eligible for Medi-Cal. Apply at CoveredCa.com. Your coverage will start immediately and it should be nearly free both in terms of monthly cost of coverage and out-of-pocket expenses for medical care.


    Question: My income will vary next year. Let's say i think i will make $40,000 next year and my covered calif. premium is $265 a month. But after the year ends i find out i only made $35,000 which would mean my premium would of been $199 a month. Will i get a refund then since i overpaid on my premiums compared to what my actual income came out to be

    Answer: You will get every penny of subsidy due you based on your income. Income fluctuations from month to month get ironed out at the end of the year when you file your tax return. The IRS computes your total premium assistance on an annual basis at that time based on your adjusted gross income. You add up all the premium assistance your received during the year (Form 1095A) then match it against the IRS computation. If you did not use all the premium assistance you were due for the year, you will get the difference as an additional tax credit against your federal taxes due. Conversely, if you received too much premium assistance, given your final annual adjusted gross income, you will pay the difference as added tax to your federal income tax.


    Do Student Health Plans Count?

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    Question: Do student health plans count as Obamacare coverage? What happens to the parents Covered California household if one or more dependents are on student health plans?

    Answer: Yes. Student health plans count as “minimum essential coverage” under the Affordable Care Act. Students can opt out of their student health plans and purchase coverage through Covered California. A student with no income would be eligible to receive low- or no-cost coverage through Medi-Cal. Also, if students are a tax dependent of their parent(s) or under the age of 26, their eligibility for student health coverage does not make them ineligible to be covered on their parent’s family health plan.

    If students choose to stay or accept their student health plan, their parents would still be eligible for tax credits through Covered California, if otherwise eligible. However, parents must correctly state on their application that although their child (the student) is a tax dependent, they are not seeking health coverage through their (the parents’) Covered California health plan.


    Exemptions for Students?

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    Question: Does a student, earning no income, need to purchase health insurance or be penalized?

    Answer: Most students will have to purchase health insurance or they will be subject to a tax penalty. If you are not claimed as a dependent by your parents and you do not file taxes because you are below the tax filing threshold, you are can qualify for an exemption from the tax penalty. You can apply for an exemption at healthcare.cov


    Question: My Daughter recently got hired as a elementary teacher and enrolled in a PPO plan through Blue Cross. She is 23 years old. When she met with the advisor they told her she had to enroll in a plan, she enrolled in the same insurance my husband and I have. Her first paycheck they took out 798.00. She is currently on our plan still as I have never dropped her. Since she is only 23 and she is single with no dependents can she just drop her insurance through her work and stay on ours??if so since she is still on our can she drop hers anytime as long as she shows proof that she is still insured through us or does she have to wait till open enrollment to drop hers. Which isn't until next July ?

    Answer: Your daughter can be included in your household health coverage through Covered California until age 26, even though she is employed. However, your household is not eligible for premium assistance or cost sharing enhancements from the time she was offered health insurance at work. If she is still included in your household coverage with Covered California and your household is drawing a subsidy, you will have to pay some of that back for this tax year. I would advise you to drop her from your CC coverage now. It almost always works out better for an individual to take the employer-based coverage, because by law the employer has to pay at least 50% of employee's cost of coverage. If her employer deducted $798 for health insurance, it must cover several months. That's certainly way more than her monthly cost for health insurance.

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