The 56-year-old San Mateo County resident purchased health insurance through Covered California in 2020 and 2021. The estimated income was $45,000. In 2020, after the Covered California subsidy, the individual paid $109.98 per month for the Kaiser Silver 70 plan. In 2021, the Kaiser Silver plan jumped to $285.71, a 160 percent increase over the prior year.
Household Income Levels
Posts related to eligibility for health care programs based on household income such as Covered California, Medi-Cal, Medicare usually based on federal poverty levels.
In scenario III, the income situation is reversed. The couple estimated a MAGI of $25,000, but ended up with a final MAGI of $55,000. However, they don’t have to repay all of the $4,375 excess federal Premium Tax Credit they received from the federal government because there is a repayment limitation. In their case, they only have to repay $2,700. The higher income puts the couple into the California subsidy income zone and they get to claim a $376 tax credit on their California income tax return.
Unfortunately, many of us don’t fully factor in the costs of doing business when we think of our monthly income stream. Consequently, many small self-employed individuals may have applied and received unemployment benefits greater than the actual net taxable income received during normal business operations.
The Applicable Figure is multiplied by the MAGI. The results on Line 8a (45,000 x .0877) is $3,947, rounded up. Under the ACA, the Purmt’s should pay no more than $3,947 or $329 per month for the second lowest cost Silver plan for health insurance. The subsidy advanced by the market place exchange (Covered California, Healthcare.gov) is the difference between the cost of the SLCSP and the family’s consumer responsibility.
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 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.
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.
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.