Kevin Knauss: Health, History, Travel, Insurance
The federal ACA subsidy is more generous limiting the household health insurance responsibility for health insurance premiums to 9.8 percent of household income. While the California Premium Subsidy may add a few dollars of subsidy below 400 percent of the FPL, it is really focused at upper income households. The California subsidy limits the household responsibility to between 14 and 18 percent of the household income.
The ACA states that if a married couple apply for the premium tax credit subsidy through Covered California, they must agree to a Married Filing Joint federal tax return status. If you are the victim of domestic abuse or your spouse leaves you, there is little interest in working with that person to file taxes jointly.
The big unknown is how you will use health care services in the next year. If you historically visit a doctor for the occasional sports injury, allergies, or to have wax removed from your ears, even if you visit the doctor more than 3 times (the Bronze 60 limit), you may still be money ahead with the Bronze plan.
You use the Attestation of Income form after you have diligently reported your MAGI using the Covered California income section of the application. The most difficult part of the Covered California application is the income section. Take your time and make sure the entries are correct and ensure that the start and stop dates of the income streams are also correct.
Pay no attention to any reports of increasing or decreasing health insurance premiums for 2021 when it comes to subsidized Covered California enrollment. First, your rate will increase because you, and everybody in your household is another year older. Rates are based on age. Second, the subsidy is based on the Second Lowest Cost Silver Plan.
California policy states that Disaster and Emergency assistance payments received from federal, state, or local government agencies is exempt from both Modified Adjusted Gross Income (MAGI) and non-MAGI Medi-Cal programs. Consequently, county Welfare Directors have been directed to disregard the LWA when making income eligibility determinations. However, for Covered California, the LWA money is counted as taxable income for eligibility and calculation of the monthly Advance Premium Tax Credit subsidy (federal) and the California Premium subsidy.
Covered California doesn’t administer or enroll you into a MAGI Medi-Cal health plan. Through the Covered California income section where you enter you monthly income, the Covered California application system determines if you or your dependents are eligible for MAGI Medi-Cal. If your income indicates you are eligible for MAGI Medi-Cal in the Covered California system, that information is pushed over to the Department of Health Care Services and your county social services office.
You cannot be enrolled in Medicare and a subsidized Covered California health plan. If you are eligible for Part A of Original Medicare, you are ineligible for the federal and state health insurance premium subsidies. If you don’t terminate your Covered California subsidized plan when your Medicare becomes active, you may have to repay all the subsidy amount you received for those months when Medicare became effective.
Part of the confusion has been generated by the fact that Covered California added a special income field for reporting the federal Pandemic Unemployment Compensation (PUC) amount after many people had already enrolled. Some people enrolling shortly after they lost their jobs and employer-based health insurance due to the Covid-19 shut down, only entered their California unemployment insurance. Other households included both State and PUC amounts in one weekly amount or separate entries in the old Covered California income section.
The failure on the part of Covered California is that they waited two weeks before generating a letter to the consumer explaining the situation. While the letter apologizes for the error, they never really spell out how or why it happened. It is sad the family had to learn from their health plan that their monthly bill was being adjusted.
