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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.

Cost Sharing Repayment?

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Question: If I underestimate my income for 2017 and end up earning more than 250% of the federal poverty level next year, will I have to pay back the cost sharing subsidies?

Answer: Cost sharing reductions are available for those with incomes between $138% to 400% of the Federal Poverty Level (FPL). Cost sharing reduces the deductibles, copays, and the out-of-pocket maximum on your coverage. Unlike premium tax credits, which are reconciled each year based on the income you actually earned, cost sharing reductions are not reconciled.

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Help! I signed up for California Medi-cal one year ago after I quit my job and before I applied for both California Disability and Social Security Disability. I have received free medi-cal benefits for this last year and they are now resubmitting the annual application. After I first received medi-cal, I then began receiving $1091 per month in social security disability payments and $1780 per month in california disability payments. I failed to report these income changes. If I do report them to medi-cal, will I have to repay benefits and how does that work? Or, I thought I was under some program called MAGI and I didn’t need to report the income. Am I in legal trouble if I don’t report the changes? What if I just wait until Medicare starts in one year and I forget about medi-cal. Thanks for answering me.

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