Californians ask questions about new health insurance exchange.
California residents were invited to ask questions about the new Covered California health plans in a live chat held through Facebook this past Thursday. Ken Wood, Senior Advisor for Products, Marketing and Health Plan Relationships for Covered California, answered 47 questions over 90 minutes. While fourteen of the questions dealt with different aspects of the health plans being offered, the bulk of the questions focused on income requirements for the tax credits and coverage options for different family scenarios.
New post on household income: What income is counted for Covered California ACA plans
Covered California has made numerous changes to their online application including how to report income, immigration and other household information. To review the changes and download Job Aid documents visit 2016 income and application changes for Covered California enrollment.
Covered California Live Chat
The variety of questions surrounding families and dependents illustrates the diversity of households and the challenges people face in accessing health insurance for everyone under their roof. Ken Wood was able to give positive answers to most people seeking answers to complicated questions. I tried to group the questions by Family, Tax and Income, Medi-Cal and Plan Selection. But you’ll notice that some questions touch on all four different themes.
Update October 2014
IRS waiver of low income
Kaiser Health News is reporting, Consumers Whose Income Drops Below Poverty Get Break On Subsidy Payback, which indicates that the IRS won’t go after individuals and families that were deemed eligible for APTC but whose ultimate income is below the FPL. With in the article they cite §1.36B-2 Eligibility for premium tax credit from the IRS for this claim. While this may hold for states who did not expand Medicaid up to 138% of the FPL, I’m not sure if it is completely applicable for California who has expanded Medicaid up to 138% of the Federal Poverty Line. There is also the issue that within the Covered California agreement a household must report any changes to income within 30 days. My question has always been, if someone is approved for APTC at $20,000 at the beginning of the year, and then their annual income drops to $15,000 in the middle of the year (making the individual technically eligible for Medi-Cal) and this change of income is not report-
Will the individual owe the APTC for the period when the income dropped below 138% of the FPL?
Will they have to repay all the APTC for the entire?
The KHN provides a glimmer of hope that the IRS won’t come after people if their income dips below the FPL as stated on their 2014 federal tax return. But I really want to see it explicitly written in English by the IRS before I’ll believe it.
Family Questions
Veteran Husband
Hi…I am wondering how CA Care will effect my husband who is a Veteran with a 10% disability, so he has some VA medical benefits, and is also on SDI medicare eligible.
Ken Wood, CoveredCA:
Your husband’s situation is complex. I would recommend that you contact the California Department of Veteran’s Affairs, who could help answer this question. Visit: www.calvet.ca.gov
Families and Medi-Cal
Hello, I am a healtcare advocate for LAUSD – CHAMP and we would like to know what happens to families with mixed eligibility. If a family has 4 members and 1 is eligible for medi-cal and the other 3 are eligible for plans through the exchange, can the family pick the exchange for everyone? Do families have a choice to pick the exchange plans if they do they want medi-cal, eventhough they may qualify for medi-cal?
Ken Wood, CoveredCA:
The enrollment process for Covered California is designed to deal with split families. Someone eligible for Medi-Cal can purchase the individual plans at Covered California, but they would not be eligible for the tax credit to offset the cost.
Families defined by tax status
If a family member claims me as a dependent, would that family member be considered part of the household?
Ken Wood, CoveredCA:
Yes, a household is typically defined by how taxes are filed.
Unmarried Couples
Will unmarried couples that dont file taxes together be looked at as a household for tax credit purposes or medicaid qualifying?
Ken Wood, CoveredCA:
You would be two separate calculations, since households are defined by taxpayers and their dependents.
Full-Time Caregiver and Son
I live with my brother that has a full-time job. My mother is retired and receives social security. I am her full-time live in caregiver. We all file separate tax returns. But I will not file taxes this year because I have no income. Am I a household of one?
Ken Wood, CoveredCA:
Yes, you would be a household of one. If you did not have sufficient income to file a tax return, you are likely eligible for Medi-Cal. You do not need to wait to apply for Medi-Cal if you meet the current eligibilty requirements.
Roomates
if you live with “roomates” is that a household or do you consider that just one person in a household. We are not family or blood related. Just someone I am renting a room with and other people live in the house.
Ken Wood, CoveredCA:
Each individual living in the household would need to apply for coverage individually. Each roommate would be considered a separate calculation, since households are defined by taxpayers and their dependents.
Unmarried with Children
You mentioned a little while ago to a guest who is unmarried with a child that they would be considered a family of 3, and then you just told antoher guest who is unmarried that they and their partner would be seperate. Can you please explain the rule a little more for unmarried couples?
Ken Wood, CoveredCA:
I’m sorry if I was unclear or misread a quesiton. Unmarried individuals would be considered as two separate households — households are defined by how taxes are filed and who is considered a dependent. So, when a child is involved, the individual claiming the child as a dependent would be a household of 2 and the other individual would be a household of 1.
Undocumented Parents/Citizen Children
Hello, I work with many families with mixed immigration statues (i.e. an undocumented mother with a child that is a U.S. citizen). Can an undocumented parent enroll their child into a Covered California qualified health plan if he/she does not file taxes? Is there any other form of income verification that can be submitted? Where can I find information regarding enrollment for families with a mixed immigration status?
Ken Wood, CoveredCA:
Great question. In this situation, this child is likely eligible for Medi-Cal now. On our www.CoveredCA.com website, there is a “Need Help Now” button that can get you the information you need.
Dependents
I saw a household is the taxpayer and dependent however the websites only list dependent children. How does it work for other “dependents”
Ken Wood, CoveredCA:
Technically the household includes all dependents you cover on your tax return, which at times includes others.
Married with group health
What can someone do if they are married (thus don’t qualify for health coverage), but are not covered under a spouse plan?
Ken Wood, CoveredCA:
If I understand the question, one spouse is covered at work and the other spouse is not covered. The uninsured spouse could purchase from Covered California but may not be eligible for premium assistance.
Income and Tax questions
Income eligibility for the tax credit subsidy is probably one of the least understood elements of the Affordable Care Act. While it is straight forward in its application, there are a variety of situations that can cause confusion. Even Ken couldn’t answer all the questions because not all of the forms to determine the Modified Adjusted Gross Income (MAGI), which will be used to determine eligibility, have been written.
Tax Credit applied to multiple plans
Can a family that is eligible for a tax credit subsidy apply that credit to any metal level: Bronze, Silver, Gold or Platinum?
Ken Wood, CoveredCA:
While the tax credit can be applied to other benefit levels, many people who are eligible for a tax credit are also eligible for enhanced benefit plans that are richer than the Platinum plan. Thus we will educate people who enroll about the plans that give them the best value. But to your specific question, yes the tax credit can be applied to other plans.
Dependent on Social Security
Hello, My mom lives with me. She will be 61 when October comes around. She gets Social Security. When it comes time to determine if she will get any subsidies will my income come into play? I currently claim her on my taxes as a dependent however my work insurance won’t allow me to have her on it. Thank you.
Ken Wood, CoveredCA:
You have a complex situation! Our enrollment process will ensure that your mother gets the subsidies she is eligible for. Starting October 1st, our Covered California Call Center will be live and you can work with them to provide your confidential information (like income) which is important to determine your status.
Low income high premiums
Will I be able to keep my same coverage? I have Kaiser. How and when will we know of the cost. Making me very nervous. I make less the 18 thousand a year, and right now almost pay 500 a month ouch.
Ken Wood, CoveredCA:
If you are covered by a Kaiser individual health plan, you should definitely apply for Covered California. You may well be eligible for a substantial premium assistance. Kaiser will be participating in Covered California and will offer a range of plans. Given your income, you could also be eligible for enhanced benefit plans with low out-of-pocket costs. These enhaced benefit plans are much better than most individual plans on the market today.
How income is determined
How is “Household Income” defined to determine subsidy eligibility? Can income be derived from a tax form 1040 line item or is it an off sheet calculation?
Ken Wood, CoveredCA:
The income used to determine eligibility is called Modified Adjusted Gross income, or MAGI. Your tax return provides a good estimate, but there will be a worksheet that converts your tax return income to the MAGI income.
Unmarried household
Good AM It’s Me (52yr old male) My “wife” (55yr female) and Our 17 yr old . Myself and wife have zero health ins. 17 yr old has Med Cal (was formerly Healthy Fam) We have been together 27 yrs but are not legally married. Her AGI Is $24000 Mine is $4151 we file Taxes separately. Do we qualify as a household of (3)???
Ken Wood, CoveredCA:
Yes, you will be eligible as a household of three.
Living with family members filing separate
I have been paying almost $700 to Anthem Blue Cross for CAL COBRA. My savings are gone! Will I be declined coverage by CoveredCA if there is a gap in coverage? Will you use the income of my family (that I had to move in with) as household income?
Ken Wood, CoveredCA:
Starting in 2014, the entire indivdiual market must insure any applicant regardless of their health status. So you will not have difficulty getting enrolled. As long as you are filing your own tax return, your eligibility will not be based on the income of other family members.
Receiving the tax credit
If I qualify for a tax-credit/subsidy, will it be paid to me at the end of the year when I file my taxes? Or, will this credit be paid directly to the insurance company in order to lower my monthly costs and help me make my insurance payments?
Ken Wood, CoveredCA:
You have a choice. You can have an estimate of the credit paid to your insurance company every month and then settle up with the IRS when you file your taxes. Or you can wait until you file your taxes and have the subsidy apply to your overall tax calculation.
Where is the income form?
Thank you for answering my question on “Household Income.” Can you provide a reference to the tax return income to MAGI conversion worksheet or the components for MAGI? I have received many inquiries regarding what types of income are part of the MAGI and want to provide education and accurate answers.
Ken Wood, CoveredCA:
We are working on a simpler explanation than what is in the IRS tax code. We hope to have it out later this summer. While the adjusted income on an individual’s tax return is reasonably accurate, there are several adjustments to that number.
Credit or Subsidy
What is the difference between a tax credit and subsidy? Who’s eligible for a tax credit? Thank you
Ken Wood, CoveredCA:
These terms tend to get used interchangeably. The Affordable Care Act provides two ways to help make health care more affordable. To offset the premium cost, a tax credit is provided based on income. To make care more affordable when you receive care, lower income individuals and families are eligible for enhanced Silver plans with low copays (like $3 to see the doctor and $5 for brand name drugs). Some people use the word “subsidy” to refer to both types of support.
Silver Plan reduced cost sharing
Will the reduced cost sharing copayments of the Silver Plan be available to everyone or are they income based like the tax credit subsidies?
Ken Wood, CoveredCA:
The reduced cost sharing copayments are tied to income and are only available to individuals who are eligible for tax credit subsidies.
Income level questions
I’m confused on the income level. Is there a reference that shows income ranges that could apply for this program?
Ken Wood, CoveredCA:
Yes — Visit our website at:http://bit.ly/11yHZWR
Income paperwork
Will the income verification process require extensive paperwork?
Ken Wood, CoveredCA:
You will need your prior year’s tax return, your social security numbers (you and everyone applying), and the full names of everyone applying. That is pretty much all that will be required for most people.
Tax penalty mandate
What are the penalties for not having “minimal essential coverage”?
Ken Wood, CoveredCA:
In the first year, it is 1% of your income above the level required to file a tax return or $95 — whichever is greater. In future years, the penalty grows to 2.5%.
No income and Medi-Cal
Although I have no income, MediCal says I don’t qualify because I am not 65 or disabled. Will that change next year?
Ken Wood, CoveredCA:
Medi-Cal expansion in California will expand coverage to individuals with household incomes up to 138% of Federal Poverty Level. You can find more information at www.dhcs.ca.gov. The site is currently experiencing technical difficulties, so please check back soon.
Medi-Cal and Covered California
As the last question illustrated, there were many questions about how Medi-Cal works with the new health insurance exchange.
Medi-Cal and Medicare eligibility
I retired early and living on savings but will start collecting ss in Aug. when I turn 62. Because I didn’t pay taxes last year I will qualify for Medi-Cal. Is it possible to upgrade to the platinum plan and will I have to pay full price for it?
Ken Wood, CoveredCA:
If you are eligible for Medi-Cal, you can purchase the Platinum Plan, but you would not be eligible for the tax credits to offset the cost.
Medi-Cal for dependents
My 17 yr old has Medi Cal now what happens when her mom and I apply for The new coverage what happens to her Medi Cal if we still don’t qualify for family medi cal?. Her mom and dad have Zero medical ins. now.
Ken Wood, CoveredCA:
Eligibility for Medi-Cal is being expanded, so it is possible that you and your wife may be eligible for Medi-Cal. If your income is above the level for Medi-Cal, you likely will qualify for premium assistance for the Covered California plan with your daughter remaining in Medi-Cal. The good news: it looks like you will have good coverage for your entire family in January.
Must family move from Medi-Cal
My family is currently on Medi-Cal, how will this reform affect our coverage? Will we be able to get better coverage in the exchanges?
Ken Wood, CoveredCA:
If you are currently receiving Medi-Cal, your coverage will not be affected by the new health care reform.
Parents on Medi-Cal
My parents are currently covered through Medi-cal. Should they enroll through the exchange or what are the benefits of doing so?
Ken Wood, CoveredCA:
If your parents are currently enrolled in Medi-Cal, their coverage will not be affected by the new health care reform.
Medi-Cal to Covered Californa plan
I qualify for Medi-cal but would like the platinum plan. Will I have to pay full price without financial assistance to upgrade?
Ken Wood, CoveredCA:
Yes. Your Medi-Cal benefits are richer than the Platinum plan so I am not sure why you are interested in the Platinum benefit plan. But if you elect not to stay enrolled in Medi-Cal, you could purchase the Platinum plan, but you would not be eligible for premium assistance.
Plan benefits and selection
The largest numbers of question on the Live Chat were about the plans and selection.
What Plan must a family select?
IF upon entering all information in the Covered California Calculator (on the website) a family is suggested to purchase a platinum plan, can they opt out of it a purchase a bronze plan?
Ken Wood, CoveredCA:
You may purchase any plan that you choose on Covered California. In certain situations for those eligible for tax credits, there are enchanged benefit plans which make the most sense.
Dental and prescriptions
If I re-enroll with Kaiser through Covered Cal, will my premium still include dental and prescriptions?
Ken Wood, CoveredCA:
Yes, all plans in Covered California cover prescription drugs pediatric dental. Kaiser is one of the plans that will be offered.
Mixing plans in a family
Can different family members select different plans? Bronze for the teenager, Silver for one parent and Gold for the other?
Ken Wood, CoveredCA:
To be considered for the premium assistance, you would need to apply with family members under the same plan from the same insurance company. If you are not eligible for the premium assistance, then each of your family members could purchase an individual plan and thus select different metal levels or even different health insurance companies.
Coverage start date
If you enroll in Covered California in Jan, when will coverage start?
Ken Wood, CoveredCA:
If you enroll before the 15th of the month, your covereage will begin the 1st of the next month. If you enroll after the 15th of a month, your coverage will begin in the month after that. For example, if you enroll on January 14th, your coverage will begin Feb 1. If you enroll on Jan 16, your coverage will begin on March 1.
Employer plans
My employer currently provides health insurance. Will they be required to choose from the Health Benefit Exchange or can they retain their current policy?
Ken Wood, CoveredCA:
Employers are not required to change their coverage because of the Affordable Care Act. Our focus is on the 5.3 million uninsured in California.
Grandfathered plans
If a person is currently on Kaiser HMO with a high deductible and no prescriptions is “grandfathered” …does that mean that prescriptions still will not be covered or are they required to start covering those?
Ken Wood, CoveredCA:
As long as you remain in a grandfathered plan, those benefits will not change. You should consider the new Covered California plans, which cover all essential benefits, including prescription drugs.
Doctor and hospital networks
Will most doctors/hospitals accept these plans?
Ken Wood, CoveredCA:
Approximately 80% of practicing physicians and 80% of acute care hospitals are included in at least one of the plans Covered California is offering.
Networks outside the exchange
Will there be a difference in the provider network inside the exchange and outside the exchange?
Ken Wood, CoveredCA:
The plans that are offered inside the exchange will be available outside of the exchange — exactly the same plan, network and price. There will be plans outside of the exchange that will offer different networks.
Married with spouse on Medicare
Is there a way to calculate a cost estimates for an individual who is married, but whose spouse is disabled and is covered under Medicare?
Ken Wood, CoveredCA:
Yes, the cost would be the same as a single individual.
Minimum coverage
If someone chooses to maintain individual coverage with a plan that does not meet minimum essential coverage & minimum value requirements, rather than purchase a plan at CoveredCA with higher monthly premiums, will (s)he be subject to the individual mandate penalty?
Ken Wood, CoveredCA:
Yes, you are required to have coverage that complies with the Affordable Care Act. If you are in a grandfathered plan, you may be able to keep the plan for a bit longer, but ultimately you will need to comply.
What if ACA is repealed?
If I drop my current coverage and go with you guys and all of this later gets repealed. Am I going to be able to get coverage with my current health insurance again? I have a pre existing condition.
Ken Wood, CoveredCA:
We do not anticipate that the Affordable Care Act will be repealed. If in the unlikely case this were to occur, I would expect there would be transition rules so that individuals would be able to maintain coverage.
Plan availability
My medical providers are in Contra Costa county (healthnet) but I live in Alameda county. Could I still enroll in healthnet? Or do I have to enroll in the plans offered in Alameda county only?
Ken Wood, CoveredCA:
You have to enroll in the plans available where you live.
Choosing an insurer
Why would you choose one insurer form the pool over another? all the monthly premiums are the same and cost for services are the same correct? Why would I choose one over the other?
Ken Wood, CoveredCA:
If the premiums are similar, there may be a difference in the physicians and hospitals in the plan. Also, so plans may offer coverage if you go outside of their network. We will be providing information about customer satisfaction and quality as well for each plan. So many other factors go into the decision other than premium.
Dropping group health plan
Does it make sense to go with this if i am not happy with the coverage i get from my employer
Ken Wood, CoveredCA:
Only you can decide. If your employer offers good coverage and is paying part of the premium, you will not be eligible for the tax credits at Covered California.
Group plans and tax credit subsidies
If my employer offers coverage, but my portion of the premium (for family) is higher than 9.5 of my income, will I be eliglble for a subsidy?
Ken Wood, CoveredCA:
The test is a little bit different — it is if the cost of individual coverage is more than 8% of your income, then you are potentially eligible for a waiver of paying the penalty if you are uninsured. The fact that your costs for famly coverage are above 9.5% would not allow you to be exempt or to have access to the indvidual subsidies.
Assisters and non-profits
There even some operational questions related the Assisters Program and nonprofits
Assister Training
When will trainings for assistors begin? What is the actual name being used to identify those individuals that have been trained to assist with enrollment? I’ve heard IPA, assistors, navigators, among other terms.
Ken Wood, CoveredCA:
Certified Enrollment Counselor training will begin in mid-July and will be complete by the end of August. The term for any assister — whether it is an in-person assister, an assister, or navigators — is Certified Enrollment Counselor. If you are interested in becoming a Certified Enrollment Counselor, please visit:http://bit.ly/16jiEW7
Large non-profits
What about “large” non-profits? Where is a resource for them to know how the new law affects them going forward? What about tax credits for non-profits, or exemptions, and employee subsidies?
Ken Wood, CoveredCA:
Large non-proftis are treated the same way as for profits under the Affordable Care Act. Your best resource would be your organization’s tax advisor.
How will premiums increase?
Are premium increases based on an overall groups, age or individuals?
Ken Wood, CoveredCA:
As of 2014, there will be a single risk pool for the individual market in California. So future rate increases will be similar for everyone. Rates do increase each year because of age in the individual market.
These questions are likely to be repeated through out California as different organizations host outreach and educational events. As much as I have studied Covered California, even I couldn’t answer all the questions posed to Ken Wood. He and his staff did a great job at chipping the mystery surrounding the new health insurance plans to be offered by Covered