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                                                                        Covered CA FAQ’s

 

If I don’t qualify for premium assistance, do I have to get coverage through Covered CA?

Coverage is available outside of the exchange (Covered CA). They may have larger networks of doctors. You can call our agents and we can discuss your options.

Do I qualify for a premium assistance on Covered CA?

Your estimated Modified Adjusted Gross Income (MAGI) for 2015 income is used to determine eligibility.  (Usually line 37 of your taxes will give you a good idea, but remember the subsidy is based on future estimated income)

Number of People in Household

If your income is

LESS THAN….

If your Income is BETWEEN………

1

$16,105

$16,106 - $29,175

2

$21,708

$21,709 - $39,325

3

$27,311

$27,312 - $49,475

4

$32,913

$32,914 - $59,625

5

$38,516

$38,517 - $69,775

You may qualify for:

Medi-Cal

Premium Assistance through Covered California

Some of your income, like child support, workers compensation and Veteran’s disability payment should NOT be included.

 

 

 

I think I may be eligible for Medi-Cal. Where should I go to apply?

You may go to your local County Offices or go online to www.c4yourself.com.

My spouse’s employer offers coverage, am I still eligible for a subsidy on Covered CA?

Chances are, no you are not eligible. In 2013, the IRS issued a ruling that if the employee was paying less than 9.5% for coverage for themselves (self only), it is deemed “affordable” even though coverage to add on the family could be as high as $1000 a month. We know that this is a huge problem, we will keep you posted on any changes in this ruling.

My children are on Medi-Cal or my spouse is on Medicare, why do I have do give their date of birth and social security info?

If they are part of your household and you report them on your taxes, we need everyone’s information whether or not they are enrolling. As you can see above, on the income grid, your subsidy is based on your total income and the number of people in the household.

If I over-estimated my income in 2014 and took too much subsidy, what will happen?

This will be worked out when you do your taxes for 2014. If you owe back part of the subsidy, you will have to pay the difference on your taxes.

If I under-estimated my income in 2014 and should have taken more subsidy, will I ever see that money?

Same as above, but you will receive a credit on your 2014 taxes.

I am self-employed. How do I calculate the income that I should report?

Calculate your taxable income. Total income minus the cost of doing business.

What if I get a raise or a new job in 2015?

Call your agent or log into your account with Covered CA and report the income change. You will most likely pay more in premium, because you now have more income coming in. But, it is better than getting a big tax bill the next year.

Ultimately, the responsibility lies on you to report any income changes.

What are enhanced benefits?

If your income falls under 250% of Federal Poverty Level, you may qualify for Enhanced Benefits. These benefits lower your co-pays, deductibles and out of pocket maximums and help you with out of pocket expenses.

 

Does my doctor take plans through Covered CA?

One of the most frequent questions that we get at Armstrong Fairway. We can look them up for you and see if they take any of the plans under Covered CA, but we always recommend that you call the doctor yourself and ask as well. The reason for this is, we can’t tell from the online sites when their contracts are ending or if they are planning to terminate. If you are purchasing a PPO plan, it is very important to ask them if they are a “Preferred Provider” under that plan. Every doctor will say yes if asked if they take a PPO plan, because they all do. But, it makes a big difference if they are contracted as a Preferred Provider or not.

What are the deadlines to get coverage for 2015?

December 15…………for coverage beginning on January 1

January 15……………for coverage beginning on February 1

February 15…………..for coverage beginning on March 1

If you apply for a March 1 deadline, you will avoid any penalties in 2015.

What is the penalty for not getting coverage in 2015?

2% of your yearly household income. The maximum penalty will not be above the national average premium for a bronze plan. 



www.coveredca.com
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