Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
Covered California must perform periodic data matching between their enrolled members and federal databases. If they determine that a consumer is eligible for Medicare, and the individual is receiving subsidies for health insurance, they will be automatically discontinued.
If Mary Lynn had to repay excess subsidies of $2,000, the repayment would be limited to $975 because her income is between 200% and 300% of the federal poverty level. Because her excess subsidy is less than $975, the $804.84 amount is transferred to line 29 of Part III.
The slope of the curve increases at the $125k income group. This is also the point where, for many families, the 2.5% of income penalty calculation is greater than the flat penalty amount. The highest average penalty happens at the $900k and $4 million income groups. The $900k income group had an average penalty of $7,921 and the $4 million group average penalty was $8,118. There was no data published for the $5 million income group.
It appears the health plan invoiced for the higher premium plus the excess subsidies paid in January and February. Consequently, the March invoice was $314.00 the combination of $275.58 + $19.21 + $19.21.
Covered California has revised their income table to reflect the higher federal poverty levels. The higher dollar amount numbers are effective March 2026. The revision only applies to Medi-Cal programs. When reviewing any income table update, make sure the date in the lower right-hand corner is 3/2026. That is the revised table from the 10/2025 […]
Similarly, Social Security Disability benefits are added to the MAGI. What surprises people is that they may receive a lump sum check for previous months of disability payments from when the disability application was first file. This lump sum benefit covering several months can push the household income over 400 percent.
Regardless of whether the children’s dental coverage is HMO or PPO, there will be long list of dental services that are no charge for children with in-network dentists.
Unfortunately, it can be confusing to know when the deductible applies and what coinsurance means. Coinsurance is simply a percentage of the cost of the health care service that the health plan member is responsible for.
Submitting the online attestation for all of the household members, should clear the verification request. Confirm that all household members are no longer under the proof of income verification request. Once complete, you will be in good standing with Covered California for proof and verification of income. If you change your income during the year, a new income verification request may be generated.
Health insurance premiums cannot be paid out of the Health Savings Account. However, there are many expenses that can be paid out of the Health Savings Account. Virtually everything covered by the health plan can be paid out of the Health Savings Account plus other health related expenses.
