Kevin Knauss: Health, History, Travel, Insurance
Posts related to the Covered California application, consumer account, estimating income, household size, monthly subsidies, health plans, Medi-Cal, and terminations.
There is a situation where Covered California will adjust your income. It happens if you fail to submit the income verification documents. In this case, because you have not verified your stated income, Covered California drops the income to $0 and you then become Medi-Cal eligible. Once you are determined Medi-Cal eligible, ONLY your county Medi-Cal office can adjust your income upwards to make you eligible for a private plan with the subsidies.
The new California Franchise Tax Board (FTB) 3895 is a close mirror image of the federal 1095A. The FTB 3895 statement reports important data regarding your health insurance through Covered California such as the monthly premiums, Second Lowest Cost Silver Plan, and how much Covered California paid to your health insurance company to lower your premiums.
The Shop and Compare Tool calculated the subsidized rates for each Silver 70 health plan for 2021. When compared to 2020, the monthly health insurance premium for the 55-year-old individual increased between 25 and 160 percent. Kaiser, the least expensive Silver plan, had the largest dollar increase of $175 per month. Without the Oscar expansion, the Blue Shield HMO Silver 70 would have been the SLCSP, but the much less expensive Oscar Silver plan came in second, $139 lower after the subsidy.
The confusion lies in the statement that the consumer is not eligible for the California Premium Subsidy. The California Premium Subsidy program is completely separate from the federal Premium Tax Credit subsidy. You can be eligible for the federal subsidy but not the State subsidy. If your income is over 400 percent of the federal poverty level, you are not eligible for the federal Premium Tax Credit subsidy, but you may be eligible for the State subsidy.
I will note that when selecting the UCLA Medical Group from the drop-down list on the L. A. Care website, it will specify that limited enrollment is available. I don’t know if that means only the participating primary care physicians will accept a limited number of L. A. Care members or if the entire UCLA Medical Group is limited.
The only way you can ever receive the Premium Tax Credit subsidy to lower your health insurance premium, either on a monthly basis or when you file your federal or state tax return, is to enroll in a health plan through Covered California. The subsidy can be a form of income protection. In the event that the household has a sudden drop of income in the middle of the year, the Covered California application can be updated with the lower income amount and trigger the subsidy to lower the health insurance premium.
Upon renewing Covered California coverage or applying for new health insurance, new questions will pop up if your income is listed as alimony. Specifically, Covered California wants to know the date of the divorce or modification of the decree. This is all to determine if the specified alimony payments can be considered as income for the Covered California premium tax credit subsidies.
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.
