Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
The Proof of Coverage form must be submitted by the app-based driver, or other gig worker entitled to the health insurance stipend, in order to receive the stipend from the company. Covered California has done a great job of putting an easy link on top of the member’s home page. With one click, the most recent quarter’s Proof of Coverage form is generated in a PDF document.
The Department of Health Care Services (DHCS), the agency that manages the county based Medi-Cal system, has worked, and struggled, to efficiently determine MAGI Medi-Cal eligibility from the income section of the Covered California application. In a February 19, 2021, All County Welfare Directors letter, No. 21-04, DHCS outlined some of the changes to Modified Adjusted Gross Income (MAGI) calculations for MAGI Medi-Cal eligibility determinations.
Covered California has worked with the health plans to transfer any accumulation of member health care expenses from the off-exchange plan to a new on-exchange plan through Covered California. For example, if you have spent $1,000 toward meeting your deductible under your current plan, that $1,000 accumulation would be transferred to the new plan. Many health plans have announced they will participate in the transfer.
Taxpayers who have already filed their 2020 tax return and who have excess APTC for 2020 do not need to file an amended tax return or contact the IRS. The IRS will reduce the excess APTC repayment amount to zero with no further action needed by the taxpayer. The IRS will reimburse people who have already repaid any excess advance Premium Tax Credit on their 2020 tax return.
The income ranges in the revised table did not change because they were based on the already released 2021 federal poverty levels for income. What has changed is that the California Premium Assistance Subsidy is no longer listed. This is because the new federal Premium Tax Credit subsidies are larger than anything California was offering. Also note that the Federal Premium Tax Credit extends beyond 600 percent of the federal poverty level.
The household contribution percentages progressively increase until they reach 8.5 percent when the Modified Adjusted Gross Income is at 400 percent of the FPL. There is no cap on the household income in order to receive the federal Premium Tax Credit subsidy. As long as the Second Lowest Cost Silver Plan exceeds 8.5 percent of the household income, there will be a subsidy to lower the cost.
The American Rescue Plan is federal legislation that applies to federal Premium Tax Credits. It does not apply to any repayment suspension or forgiveness of the California subsidy. One odd twist is that some consumers may have a higher MAGI, over 400 percent of FPL, and not have to repay the federal subsidy and also pick up the California Premium Assistance subsidy on their California income tax return.
For example, if the annual cost of the SLCSP is $6,200 and 8.5 percent of your household income is $5,000, then the subsidy is $1,200. When divided by twelve months, that would be $100 per month to lower the cost of any health plan offered to you through Covered California. If 8.5 percent of your household income $7,000, and the SLCSP is $6,200, there is no subsidy.
Individuals and families may be eligible for a temporary increase in premium tax credits for this year, with no one paying more than 8.5% of their household income towards the cost of the benchmark plan or a less expensive plan. Meaning, many consumers will be eligible for higher tax credit amounts to help cover their Marketplace health plan premiums.
Without the consent for verification, Covered California cannot forward any monthly Advance Premium Tax Credit subsidy to the health insurance carrier selected by the consumer. Many households, who may have forgotten to update their consent for verification during the Open Enrollment Period are shocked when they must pay the full premium amount of their health insurance. Updating the Consent for Verification restores the monthly subsidy.
