Kevin Knauss: Health, History, Travel, Insurance
Posts on the development and implementation of the California health insurance market place, application, account, enrollment, termination.
On May 2, 2024, I received an email, allegedly from Covered California, requesting I update my information for their store front program. The first clue that this was a phishing scam was that I never applied to the Covered California store front program.
Schedule 3 gathers additional credits and payments of the taxpayer. In this case, the taxpayer only has the $500 additional Premium Tax Credit to report and that goes on line 31 of form 1040.
Covered California has run a test using AI on several parts of the application process and found that the AI verification solution was successful 80 to 96 percent of the time in correctly identifying the documents submitted.
However, even though COBRA may be more expensive than a Covered California plan with the subsidies, there can be good reasons to opt into a COBRA plan. The COBRA plan will be the continuation of the employer plan, usually without any employer contribution to lower the monthly health insurance premiums.
The paths to health insurance in California: Medi-Cal, IFP, Employer, Medicare, overview.
Just because Joey’s 2023 final Modified Adjusted Gross Income was in the range for Medi-Cal, he will not lose his 2024 health plan and subsidies. The IRS does not report his income to Covered California to flip him into Medi-Cal. His 2024 subsidy is based on his good faith honest estimate of his 2024 income.
I have created this income table that has the monthly income numbers for Medi-Cal eligibility next to the 2024 annual income amounts for the Covered California subsidies.The Medi-Cal income columns of the Covered California income table are 138% FPL for adults, 213% FPL for pregnant women, 266% FPL for children 18 years and younger, and 322% FPL for children in certain counties of California.
While some incorrect information may be corrected by calling the Covered California customer service line, other errors can only be fixed by filing a dispute form. The data that can be disputed are coverage start and stop dates, health insurance premiums, monthly subsidy forwarded to the health plan, missing family members, or household members who should not be in the tax family 1095-A.
Unfortunately, consumers should not have to go through this byzantine process of becoming private detectives to learn why they were denied enrollment or the subsidies. Covered California should spell out the specific reason either in a letter or on the phone. However, when all else fails you can file an appeal to kick the human process in gear to review your account.
In the second half of 2023 and continuing into 2024, we have seen some cases where the subsidy has mysterious disappeared. The estimated income is high enough for subsidies and nowhere near Medi-Cal range. The household member is enrolled in the selected health plan, but the subsidy has vanished.
