Covered CA:  FAQ’s to keep you sane through open enrollment!

It’s hard to believe, but the state of California is at the leading edge of our nation’s quest to implement the Afordable Care Act. Having said this, things are far from perfect, with many enrollees scratching their heads on a few key issues.

Take a look at the following 9 KEY questions that EVERYONE should know before enrolling in coverage through Covered California.


Q:  I’m currently covered with Covered CA, and am current on my bill… Do I need to do anything to keep my coverage?

A:  You’re in good shape. Although we advise being very aware of any communications from Covered CA, as requirments are always changing… As long as you are current on your bill, and are ok with the plan that you currently have, we have been told by Covered CA that your plan will automatically renew for 2015.


Q:  What if I lose my coverage? (Non payment, etc…) Can I re-enroll?

A:  NO… (For this reason, we offer alternatives, such as Short Term Medical. Call us for more information @ 661-702-1010)


Q: How does Covered CA calculate my subsidy amount?

A:  Covered CA awards subsidy assistance based on your Household AGI vs. the Federal Poverty Level.

Example: For coverage starting on Jan 1, 2015, your “anticipated” 2015 AGI will be used. If your income falls between 133% to 400% of the FPL, you will likely receive assistance with your premiums.

For more help on this, see our Subsidy Guideline Spreadsheet, or call us at 661-702-1010.


Q:  Who is part of my “Household” for the purpose of coverage with Covered CA?

A:  Your household includes all members of your household for tax purposes…


Q: My spouse qualifies for coverage with their employer. Can I still qualify as an individual with Covered California?

A: If your spouse is provided coverage that meets Minimum Essential Coverage standards, and is deemed affordable (less than 9.5% of gross income for the employee), the rest of your household will not be able to qualify for subsidy assistance. They can, however, choose to apply for coverage without receiving a subsidy. In this case, we recommend staying away from Covered California’s exchange, as it presents unnecessary time and headache for those not receiving subsidy money.


Q:  Do I need to report income made by my dependants?

A:  YES: Changes in income must be made within 30 days of the change

**Failure to report this increase in earnings can result in substantial subsidy paybacks at the end of the year.


Q:  The system is telling me that my children will be put in Medi-Cal… What’s up with this?

A:  Depending on your income, children 18 and under in your household may be placed into Medi-Cal.

Example: In this scenario, you can either accept the Medi-Cal coverage for your children, or elect to enroll them in a            separate plan with one of the carriers. Please contact us if you would like to pursue this option.


Q:  What happens if my income changes throughout the year?

A: Income changes must be reported to Covered CA within 30 days of realizing the change

Example: You start the year making 2000 per month… In march, you receive a raise of $1000 a month… This raise must be reported to Covered CA within 30 days, and your subsidy will be adjusted accordingly


For even more FAQ’s regarding your Covered CA, we advise using the following link:

>> http://www.coveredca.com/faqs/

For assistance on your coverage, please call SCI & Associates @ 661-702-1010, or email us @ support@sciandassocates.com

About the author: Nolan Waterfall
Nolan serves as a consultant, both to SCI, and within his own brokerage, Campfire Health, where he enjoys educating owners, C-level executives, and HR managers, on the in's and out's of all things compliance, technology, and benefits strategy. Nolan loves reading, anything outdoors, and spending time with his wife Joanna.

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