May I apply anytime for health insurance through Covered California?
“No” would be the answer for the majority of individuals. They may only apply during the Open Enrollment Period … November 15th of one year through February 15th of the next year. There are a couple of exceptions:
- Medi-Cal: Individuals who have limited income may enroll in Medi-Cal year-round. You may be eligible for Medi-Cal depending on the number of people in your household and your household income. You may use the “Shop and Compare” tool at http://coveredcalifornia.com or schedule an appointment with one of our two Covered California enrollment counselors and we can help you determine if you are eligible.
- Special Enrollment: To qualify for special enrollment (February 16th through November 14th), you must have a qualifying life event and enroll within 60 days from the date of that event. Following is a list of some of the more common “qualifying life events”
- You get married or enter into a domestic partnership
- You have or adopt a child
- You lose your health coverage
- You change where you permanently live or move to another region of California where plan options are different
- You have exhausted your COBRA coverage (Note: you may not terminate your COBRA coverage prior to its expiration and apply for coverage through Covered California. This applies to both the enrollment and special enrollment periods.)
- You are already enrolled in a Covered California plan and you become newly eligible or ineligible for tax credits based on your income
- You turn 26 and can no longer be covered by your parents’ plan
- You return from active duty military service
- You become a citizen, national or lawfully present individual
- Covered California determines you experienced an exceptional circumstance
Who is eligible for Covered California?
All U.S. citizens, U.S. nationals and non-citizens lawfully present in California may apply for health care through Covered California.
Who is not eligible for Covered California?
If you are not lawfully present in California, you are not eligible for a Covered California plan. However, you can still apply through Covered California to find out if you are eligible for Medi-Cal or to find coverage for family members who are lawfully present. For example, if your child is a U.S. citizen, you can apply on his or her behalf. You only need to provide information on immigrant status for family members applying for coverage.
What does it mean if I am ineligible for Covered California but eligible for Medi-Cal coverage?
Medi-Cal is free or low-cost health coverage for children and adults with limited income. Medi-Cal is health coverage, just like the coverage from Covered California health plans. If you are determined eligible for Medi-Cal, your local Department of Social Services will send to you a packet of available health plans from which to choose. You will also receive a benefits identification card (BIC) in the mail. If you have not received a BIC or been contacted by your human services agency within a couple of weeks of your application, you may contact them directly … check your local listings for the office nearest to you.
What is the Premium Tax Credit?
The premium tax credit helps pay for health insurance coverage and is available to eligible individuals and families with low or moderate income. If you are entitled to this financial assistance, you may choose to have the credit paid directly to your insurance company to lower your monthly premiums (advance payments) or you may claim the credit when you file your tax return for that year.
For any year in which you receive a premium tax credit, you must file a federal income tax return for that year. Covered California will send to you by January 31 of the year following the year of coverage, an information statement showing the amount of your premiums and advance credit payments. Form 8962 will be used to reconcile the difference between the premium tax credit that you received and the actual amount of the credit that you may claim. This is the reason that it is very important to immediately report any changes in income or family size that may reduce the amount of the tax credit. It is easier to work with an adjustment as it occurs rather than wait until the end of the year and find that you may owe back some of the advance payments.
This is a refundable tax credit which means that if the amount of the credit is more than the amount of your tax liability, you will receive the difference as a refund. If you owe no tax, you can get the full amount of the credit as a refund. However, if you receive advance payments as part of your monthly insurance premium payments, you will reconcile these payments with the amount of the actual premium tax credit that you calculate on your tax return. If your actual allowable credit on your return is less than your advance credit payments, the difference, subject to certain caps, will be subtracted from your refund or added to your balance due. If your actual allowable credit is more than your advance credit payments, the difference will be added to your refund or subtracted from your balance due.
When you are ready to file your taxes, call Bay Wide Tax Service for an appointment. Having two staff members operating under the dual roles of certified Covered California enrollment counselors and certified tax preparers is a “win-win” for you.
What is the Individual Shared Responsibility Fee (or Penalty)?
The shared responsibility provision of the Affordable Care Act is an individual shared responsibility fee (or penalty) that is charged every month that you do not have insurance or have not obtained an exemption. If you have coverage for at least one day in a month, then you do not owe the payment for that month.
To avoid the fee, you will need to have minimum essential coverage. All of the Covered California health insurance providers meet this requirement as well as most private major medical plans outside of Covered California, Medicare, Medi-Cal, most employer-based coverage and more. You need to obtain and maintain this coverage throughout the year; however, you may have a “short coverage gap” exemption each year. As long as the gap in coverage is less than three consecutive months, you will not be charged the fee. Beginning with the 2015 tax year, insurers will be required to provide everyone that they cover each year with information that will help them demonstrate that they had coverage.
The penalties for not having health coverage are being phased in over three years as follows:
You will pay the greater of a percentage of family income above your tax filing threshold (standard deduction plus exemptions) or a set dollar amount as follows:
- 2014: 1% or $95 per adult, $47.50 per child (up to $285 per family)
- 2015: 2% or $325 per adult, $162.50 per child (up to $975 per family)
- 2016: 2.5% or $695 per adult, $347.50 per child ($2,085 per family)
It is important to note that the size of your penalty is based on the number of months in which you (and your family) lacked coverage. If you had coverage for part of the year, the size of the penalty for being uninsured is adjusted to reflect only the number of months without insurance. And remember that you are allowed one brief period (less than 3 months) without coverage each year.