7 On Your Side and panel of experts answer your Covered California questions

ByRandall Yip KGO logo
Saturday, December 14, 2019
7 On Your Side answers Covered California questions
7 On Your Side's Michael Finney and a team of experts hosted a hotline to answer all your Covered California questions as we near the deadline for registration.

SAN FRANCISCO (KGO) -- 7 On Your Side's Michael Finney and a panel of experts are hosted a hotline on Wednesday to answer all your Covered California questions.

They took calls and questions via social media and email about getting government subsidized health coverage in time for the New Year.

Enrollment experts from Asian Health Services, California Certified African American Insurance Roundtable, Covered California, Lifelong Medical Care, LifeMoves , Tiburcio Vasquez Health Center and Tri-City Health Center will be on hand to take your calls and answer your questions.

Go here to enroll in Covered California.


Take a look at more stories and videos by Michael Finney and 7 On Your Side here.


1. From Twitter:

Question: 4 the subsidy, it says that household income is aggregated on your tax return. is this the state tax return or the federal? Whereas my residence is California, my husband's is Florida, I appear alone on my California return, we appear together on the federal so ? .#AskFinney

Answer: It sounds like you have a household of two. Yes, you need to count both your incomes when projecting your 2020 household income. If your joint household income is between about $24,000 and about $67,000, you should be eligible for federal tax credits, provided you file a joint federal tax return, which you do.

In 2020 California is offering tax credits for households of two making between about $67,000 and about $101,000. If your income is in that range, however, I'm pretty sure you would not be eligible because you don't file a joint California tax return. I suggest calling Covered California at 800-300-1506 to confirm that. --Bob

2. From Facebook:

Question: When is the deadline?

Answer: The deadline for enrolling for coverage starting January 1st, 2020 is December 15th. The deadline for enrolling for coverage starting February 1st, 2020 is January 15th. The deadline for enrolling for coverage starting February st, 2020 is January 31st. Unlike the federal health exchange, Covered California's open enrollment period lasts until January 31, 2020.

Only those with a qualifying life event (such as leaving a job and thereby losing employer-provided coverage) can enroll outside of open enrollment. --Bob

3. From the hotline:

Question: Am I required to have health insurance in 2020?

Answer: New state mandates taking effect on Jan. 1 now require Californians to have health insurance in 2020 or face costly penalties unless you qualify for an exemption. In general, the penalty will be at least $695 for individuals and about $2,000 for a family of four or 2.5 percent of your gross annual income, whichever is greater. These penalties will be applied by the California Franchise Tax Board when you file your state tax return. For more information on potential penalties for being uninsured and exemptions, see the state's Franchise Tax Board's webpage here: https://www.ftb.ca.gov/about-ftb/newsroom/news-articles/health-care-mandate.html?WT.ac=Healthcare

4. From the hotline:

Question: If I don't have an income, am I still eligible for Covered California?

Answer: An individual with no income will qualify for Medi-Cal and can apply through Covered CA. A household size of one with no income will NOT qualify for other health plans offered by Covered CA. -- Hela

5. From the hotline:

Question: How should I get started?

Answer: The first recommended step is to go to Shop and Compare on our CoveredCA.com website: https://apply.coveredca.com/lw-shopandcompare/. Enter some information about yourself to get a quick estimate of what you would pay for health insurance and which plans are available in your area, and to find out if you qualify for financial help. The second suggested step is to connect with a local certified enrollers that you can find here: https://www.coveredca.com/find-help/ . Certified insurance agents and enrollment counselors will be able to assist you in finding a plan that best meets your needs. Their services are free and they are trained and certified to provide in-person assistance to consumers applying for health plans through Covered California. You can also call our Service Center toll free at (800) 300-1506. If you don't need assistance to enroll, you can apply directly online at http://www.coveredca.com/apply/ and go through the process yourself. You'll need your income information, ID, proof of citizenship or lawful presence, Social Security number and ZIP code. --Bob

6. From the hotline:

Question: Who qualifies for Medi-Cal?

Answer: Children residing in California regardless of immigration status through age 18 in households making up to 266% of the Federal Poverty Level (FPL - about $68,000 for a family of four) are eligible for Medi-Cal. Resident adults regardless of immigration status aged 19 through 25 making up to 138% of the FPL (about $35,000 for a family of four) are eligible for Medi-Cal. Legal resident adults aged 26 through 64 making up to 138% of the FPL are eligible for Medi-Cal. Finally, resident adults aged 26 through 64 making up to 138% of the FPL who cannot establish legal residency are eligible for a limited version of Medi-Cal, referred to as Restricted Medi-Cal. --Bob

7. From the hotline:

Question: I'm NOT over 65 years old -- but my wife is. Does that change our eligibility?

Answer: Presumably you and your wife are a household of two, and your wife is eligible for Medicare. When you enroll at coveredca.com, you will list both you and your wife, as well as your joint projected 2020 income. Indicate that you want health coverage, but your wife does not. For Medicare enrollment questions, you can contact HICAP - https://cahealthadvocates.org/hicap/. --Bob

8. From the hotline:

Question: Can I get a plan in Covered California if I have "B" in Medicare? (Or any Medicare plan?)

Answer: No, you cannot.

9. From the hotline:

Question: How can I get a plan in Covered California because I don't want to be in Medicare?

Answer: If you are enrolled in Medicare, or are eligible for Medicare Part A at no cost, no, you can't get a plan through Covered California. Most people 65 years old and over are not eligible to enroll in plans through Covered California. --Bob

10. From the hotline:

Question: How much is the tax penalty?

Answer: The penalty will be at least $695 for individuals and about $2,000 for a family of four or 2.5 percent of your gross annual income, whichever is greater.

11. From the hotline:

Question: Can I get insurance through my job with a subsidy?

Answer: Some employers do offer subsidized health insurance for their employees. Check with your employer. If you're offered affordable health insurance through your employer, you're not eligible for tax credits at Covered California. --Bob

12. From the hotline:

Question: Our son is turning 26. He will no longer be a dependent on our insurance plan. When he applies, does he need to add mom and dad as part of the household when he files his own taxes and has a job?

Answer: No; Mom and Dad are not considered part of your son's household. --Bob

13. From the hotline:

Question: My son has zero income. Is it possible for him to qualify for a PPO plan?

Answer: Your son's household size will help determine his eligibility. If his household size is 1 and he has no income, he will qualify for Medi-Cal and NOT a PPO plan or any other plan through Covered CA.

14. From the hotline:

Question: Do stocks and investments count toward income?

Answer: No, but capital gains and distributions from an IRA would could as income. --Bob

15. From the hotline:

Question: Has art that has value (not sure of how much) be included in assets? Is there a limit?

Answer: There's no asset test for enrolling in plans through Covered California. The only thing that matters is income (which would include capital gains on the sale of valuable art). Outside of Covered California there are some programs that do have asset tests, such as certain low income residents enrolled in Medicare who are also eligible for Medi-Cal. --Bob

16. From the hotline:

Question: Can you change (upgrade or downgrade) during the year?

Answer: Consumers can renew or make changes during open enrollment and during the special enrollment period if there is a qualifying life event such as recently getting married or moving to another county. Changes in income must be reported to Covered CA within 30 days. --Hela

17. From the hotline:

Question: I don't know how to estimate my income for the next year. Any advice?

Answer: Some people, particularly freelancers, have a challenging time projecting what their 2020 income will be. It may be prudent to seek help at https://www.coveredca.com/find-help/. Many enrollment counselors have helped others in similar situations.

One option is to estimate your 2020 income, but ask that you not receive in advance all the tax credits you would be eligible for at that income level. Then, if your income is higher than expected, you won't owe as much back when you file your tax return. Of course, if your actual 2020 income is less than what you projected, you would get a larger tax refund. --Bob

18. From the hotline:

Question: Are you still qualified for Covered California if you travel out of the country for an extended period of time?

Answer: As long as you maintain your California residency, you're qualified for plans through Covered California. However, the plan would likely not pay for medical expenses incurred outside the country. --Bob

19. From the hotline:

Question: My income fluctuates throughout the year. At times I really can't afford my premium. What can I do?

Answer: I would recommend to find a certified enrollment counselor near you for assistance in regards to this matter. They will be able to help you determine your options. Go to coveredca.com and click find help to search for a counselor near you. -- Hela

20. From the hotline:

Question: What happens if I am eligible for Medi-Cal?

Answer: When you fill out the application, the system will determine if you are eligible for Medi-Cal. When that determination is made, the application is sent to the county Medi-Cal office where you live to process the application. Your county Medi-Cal office will contact you in approximately 45 days. If you have any questions about your application, you can contact the Medi-Cal office in your county. You can find a list of those offices at this link: www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx. --Bob

21. From the hotline:

Question: I'm a recent immigrant. Can I get coverage?

Answer: Under the Affordable Care Act, most individuals who are U.S. citizens, U.S. nationals or lawfully present immigrants are required to have health coverage. Immigrants who are not lawfully present are not eligible to purchase a health plan through Covered California; however, they may be eligible for coverage through Medi-Cal. Both lawfully present and not lawfully present individuals can apply through Covered California to see if they are eligible for health plan options through Covered California or Medi-Cal. Learn more here: http://www.coveredca.com/individuals-and-families/getting-covered/immigrants/.

22. Via Facebook:

Question: When will I get my 1095-A form?

Answer: For those who had coverage through Covered California in 2019, your 1095-A form should be uploaded to your online account by the end of January. A paper copy will also be mailed to you by January 31. If you do not receive your 1095-A, please call the Covered California Service Center at (800) 300-1506.

23. Via Facebook:

Question: Michael, I am currently not covered but my Medicare kicks in, in March. I already have my card, so I'm done with the application process. My question, will I be penalized for not having coverage now?

Answer: You may be required to pay a penalty on your 2020 California state tax return for being uninsured for two months of the year. (Presumably your Medicare coverage starts March 1st, 2020.) To be safe, you can enroll now in coverage starting January 1st; after paying the premium for January and February, cancel the coverage with an ending date of February 29th. --Bob

24. From the hotline:

Question: How likely is it for an individual to receive financial help?

Answer: Nine out of 10 consumers receive financial help to pay for their Covered California health coverage. For example, an individual making about $75,000 and a family of 4 with household income of about $154,000 can now all qualify for financial help to lower health care costs with the new subsidy programs available starting in 2020 through Covered California.

25. From the hotline:

Question: How do I pay the premium for the plan I enrolled in through Covered California?

Answer: You will make the payment directly to your health plan. If you have not received an invoice, please contact them directly for help. For more information, see: http://www.coveredca.com/members/paying-your-premium/. Note: you'll need to pay the first month's premium (less, of course, whatever tax credits you are eligible for) in order to confirm the enrollment. --Bob

26. From the hotline:

Question: Do adults have dental coverage through Covered California?

Answer: Covered California offers the option to add adult dental coverage for an additional cost when enrolling in a health plan. For more information, visit http://www.coveredca.com/individuals-and-families/getting-covered/dental-coverage/

27. From the hotline:

Question: I live in Amsterdam. I am a US citizen, so I file taxes here in California. My insurance is in / from Europe. Will I be penalized?

Answer: Since you residence is outside the US, in theory you should be presumed to have health coverage and therefore should not have to pay the penalty. However, it's probably best to check with a tax preparer. See https://www.ftb.ca.gov/about-ftb/newsroom/news-articles/health-care-mandate.html : Exemptions Claimed on State Tax Return ... Certain citizens living abroad/residents of another state or U.S. territory. --Bob

28. From the hotline:

Question: My friend says I can get cheaper insurance through Covered California than what my job offers, based off what she pays. Can I drop what I have and get on Covered California?

Answer: If the insurance offered by your employer is not "affordable" based off Covered CA's guidelines, then you may opt out and purchase a plan through Covered CA. But there is a specific definition of affordability; it may be considered affordable even though you don't think it is. Talk with your employer and also with Covered California (800-300-1506).

29. From the hotline:

Question: My income will change in March. What income do I have to show?

Answer: You will need to report a change of income to Covered CA within 30 days of the change.

30. From the hotline:

Question: Will my coverage be affected if I move to a new city?

Answer: Your coverage may be affected if you move to another county within California, not necessarily another city. You will need to report your change of address to Covered CA.

31. From the hotline:

Question: Do I qualify if I make $15,600 annually?

Answer: You will qualify for Medi-Cal through Covered CA for a household size of 1.