This enforcement action is a result of 21 cases involving 63 consumer grievance violations that occurred during 2014 through 2017. In these cases, L.A. Care deprived enrollees of their rights to medical care. The plan has acknowledged its failure to comply with the law, and the Department has determined that an administrative penalty and Corrective Action Plan are warranted. The corrective actions include employee training and increased oversight of the grievance and appeals system.
Millions of people have been enrolled into expanded Medi-Cal through Covered California based solely on their lack of income. Thousands of those same Medi-Cal beneficiaries went on to get jobs or other insurance and forgot to report this to their county Medi-Cal eligibility department. Many of these people fear they will have to repay Medi-Cal for the months they were really ineligible for the no cost health insurance. Do you have to repay Medi-Cal after your income increases and you were no longer eligible? The short answer is usually not.
Some individuals and families who purchased their health insurance through a government exchange like Healthcare.gov or Covered California may be subject to the Penalty for Underpayment of Estimated Tax. The underpayment penalty is triggered when the federal income tax due is less than 90% of the previous year’s tax liability. If a tax household received thousands of dollars of the monthly Advance Premium Tax Credit (APTC) subsidy to lower their health insurance premiums, but earned too much taxable income to actually qualify for the Premium Tax Credit, the tax payer has to repay the entire subsidy. This repayment amount could easily trigger the underpayment penalty.
Since the beginning of 2015 through April 17th, the Centers for Medicare and Medicaid Services (CMS) have issued over $2 million in penalties on Medicare Advantage plans across the United States. Of the twelve Medicare Advantage plans cited for non-compliance, one had their enrollment activities suspended while the rest were issued civil money penalty. All […]
The IRS has issued additional guidance on ACA Advanced Premium Tax Credits and relief from certain penalties associated with the taxpayer receiving excess tax credits from a health insurance Marketplace. IRS Notice 2015-9 Penalty Relief Related to Advance Payments of the Premium Tax Credit for 2014 outlines how some taxpayers may not be subject to the penalties […]
The IRS has released a variety of documents related to reporting Affordable Care Act Advance Premium Tax Credit reconcilation, exemptions from the mandate to have health insurance coverage, and directions for caculating the Shared Responsibility Payment. Before taxpayers can crunch the numbers on their tax refund or liability they will have to either either a […]
Anyone who did not have health insurance for a period of more than three months during 2014 will have to pay a penalty on their IRS federal tax return. This penalty is also known as Affordable Care Act Shared Responsibility Payment. The ACA has given taxpayers who went without having health insurance for a period during […]
The Individual Mandate of the Affordable Care Act psychologically chafes folks who don’t appreciate the government telling them what they have to purchase. Count me in that segment. If one of the goals of the Individual Mandate is to make people take responsibility for expensive health care, an alternative might be an unforgivable tax liability on those people who have chosen to forego health insurance and incur large medical expanses that go unpaid.
The cost of going without health insurance will be any penalty assessed plus the cost of medical services that might be needed. A truly debilitating disease will force him to liquidate his assets and enter the MediCal system.