Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
The explanation of the rule changes by CMS is peppered with terms like “protect consumers”, “stable marketplace”, “reduce adverse selection”, and “improve risk pool.” However, the individual and family market has been very stable for many years. I have not heard of any California health plans getting sick, going bankrupt, or dying because they could not get health care.
If one of the individuals in that two-person household is pregnant, the pregnant individual could gain Medi-Cal if the income is under $3,756 per month. This is based on the 213% column, full scope Medi-Cal for pregnant individuals. The other adult would still be eligible for Covered California and the subsidy since the monthly income is over 138% of the federal poverty level.
If California congressional Republicans vote to repeal the Affordable Care Act and with its expanded adult Medi-Cal access, they will be irrevocably injuring thousands of their own constituents. Not all Medi-Cal programs that provide assistance to Medicare beneficiaries, children, and their caretakers are intertwined with the ACA. However, we all know that an accident or illness that befalls a household’s primary wage earner can lead to cascading effects for the whole family. Medi-Cal helps people bounce back after an accident or illness to support the whole family.
Covered California households with incomes below 250 percent of the federal poverty will be eligible for a reloadable debit card to purchase food. The monthly amount will be $80 for each eligible household member. Through the application process, it will be determined if the individual or family is experiencing food insecurity.
The MAGI reported on lines 11, 6a, 6b, 2a, 2b, and 1h. Income from the schedules, such as schedule C Profit Loss from a business, is funneled onto line 1. You may need to find a specific schedule to determine the income or deduction to properly estimate your future income for Covered California. This is an income estimate. It is not necessary based on your last file federal tax return.
Regardless of the error, Medi-Cal updates the Covered California income section denying the non-Medicare spouse their private health insurance with the subsidy. The spouse is determined Medi-Cal eligible and their health plan is terminated.
Because of the Social Security Fairness Act, Jan will receive a monthly benefit of $1,000. Unfortunately, Jan doesn’t receive the one-time lump payment for 2025 until December, too late to amend their Covered California income estimate. Jan and David must reconcile the higher annual income on their federal income tax return.
Individuals and families have a 60-day window to enroll in Covered California, or if they are current consumers, change their health plans. If someone has lost their health insurance because of the Palisades Fire, they can enroll in Covered California, outside of Open Enrollment, by March 8. If the individual or family wants the health insurance to start March 1st, they need to enroll by February 28th.
If all you want is the lowest total cost (MOOP plus premiums), you would opt for a Bronze plan if the premium differential is greater than $229.17 per month between the Bronze 60 and Silver 73. If the premium differential is greater than $229.17 per month with the Silver 73, the total costs of MOOP and premium will be more than if you had a Bronze 60.
Covered California checks an IRS database of members to confirm they have filed a federal tax return. If you filed with an extension after April 15th, your federal tax filing status may not have been logged in the IRS system when Covered California checked the tax filing status. Consequently, many people who file their taxes with an extension are getting the Covered California letter stating they cannot confirm if the primary tax filer submitted a tax return. Another issue is if the primary tax filer for the last tax year is different than who is listed on the Covered California application.
