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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.


December 2017 Archives


Question: I want to buy a Blue Shield PPO plan. What are the advantages of signing up through Covered California versus applying directly with Blue Shield>

Answer: If your household income makes you eligible for premium assistance, Covered California is the only place to enroll. When you apply through Covered California you agree to file taxes each year and to allow Covered California to access your tax records through the IRS. When you apply directly through a California health insurance carrier like Blue Shield - referred to as an off-exchange enrollment - you are not asked to provide any income related information whatsoever. Off-exchange, you will find plans that mirror the Covered California plans exactly in benefits and rates, but, you’ll find plans that are unique to the off-exchange-market as well. Click here for an off-exchange quote.


Question: My family of four gets subsidized Covered California insurance. My 24 year-old son is included in our household. He earned about $9,000.00 this year. Will we be penalized on our taxes for 2017? Should he enroll for 2018 for his own plan?

Answer: Your son must file his own tax return for 2017 since his income was over $6,300, but you can continue to include him in your household if you wish. When he files his tax return for 2017, he can opt out of his personal exemption. If so, all you have to do is update your Covered California household account to include his income. The added income will reduce your premium assistance, so you will pay some added tax for 2017. If he takes his own personal exemption for 2017, you must update your CC account by removing him from your household. This will reduce your household size to three going forward, but you do not have to include his income. You will have added taxes to pay for the 2017 tax year, because your tax credits were based on a four person household. You will probably need an accountant to figure out which path leads to the best financial outcome for your family.


Obamacare Sign-up Deadline?

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Question: My wife read that the deadline was December 7th. I thought it was December 15th. Who’s right.

Answer: You’re right this time. December 15th is the deadline for individuals and families in the under-65 health insurance market. You must enroll or make changes to your plan by December 15th to affect coverage on January 1st whether you enroll through Covered California or directly with an insurance company. Open enrollment in California extends until January 31st for new enrollments or changes to existing plans with effective dates to March 1st 2018.

Your spouse is correct if she is on Medicare. The deadline for changes to 2018 Medicare coverage is December 7th.


Out-of-Network Coverage?

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Question: I see a holistic medical doctor who is not in any Covered California networks. It is very hard to find information about out of network coverage. I was looking at Blue Shield PPO plans. Am I correct they will cover only 50% out of network?

Answer: Out-of-network benefits are reimbursed at a level much lower than 50% of the provider charges. The plan pays 50% of the carrier’s allowable amount, not the provider’s bill. For example: if your doctor charges $250. The Blue Shield’s in-network allowable amount for this treatment could be as low as $75. Your benefit amount would be half of $75, not half of $250. In addition, out-of-network coverage has a separate deductible, usually 150% to 200% of the in-network deductible. Don’t look for out-of-network benefits to help much if at all on minor medical expenses.

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