The advent of Covered California has been changing my employment law practice — and for the better.
It used to be that a terror among clients being wrongfully terminated was what they would do about their health insurance. In fact, negotiation over their ability to maintain their insurance would sometimes end up “driving the bus” — such that they would accept less money than they might deserve overall just so they could stay insured for longer. (This was particularly a problem for older workers and those with pre-existing conditions.)
Now that’s changing.
Losing a job, especially a long-term job, is still traumatic — but in terms of personal economics it is much more survivable. At least in California, the worse you’d face is that you’d have to buy your own insurance — and it’s available, regardless of preexisting conditions! For some, it might cost more than COBRA; for many (and I’d guess most) it will cost less — often far less — and, unlike COBRA, it won’t expire.
The CoveredCA.com website — one of the best state sites in the country (although apparently Kentucky, home of Ft. Knox, is considered the gold standard) is now running smoothly. Reports keep coming in from people whose monthly insurance premiums will be under $100 — and in some cases under $10. (And, in other cases, free. Medicaid expansion, you know.) The terror of economic ruin due to health care costs is receding.
People who want insurance in effect by January 1 — whether long-term unemployed, freshly discharged, or just inclined to tell the boss to “take this job and shove it” — have to sign up through the exchanges by December 23. You can do so later — but it leaves you uninsured for a while — and why put up with that if you can avoid it?
One problem is that the message is getting out pretty well to the sorts of people who read this blog — ones who can speak English, for example — but not so much to others. If anyone out there would like to translate this post into Spanish — and Vietnamese, Korean, and Mandarin — I’d love to post them in other languages.
People need to know that the worst, when it comes to paying for health insurance coverage, is over. Go ahead and fight about Obamacare (or California’s version of it) if you want; it’s the law. Now we’re talking about whether people will get the benefits coming to them. Can we agree that letting them know what’s available is just morally right?
Yes, we should all know about it. I bet we all know someone who may not have insurance and we should be spreading the word. The thing I am coming across is that people know about it but like a lot of well intended gov’t programs…it is a pretty good sized hassle to deal with. One that is worth the benefits, but one that is frustrating in the mean time. Plus the folks working there don’t know details about the hard questions…such as, what happens if my income changes drastically in 2014 compared to what I declare now (in a year that I may not even know what my 2013 taxable income will be)? Why are you requesting W2’s and bank statements for my newborn baby?
I’ll solicit a navigator friend of mine to join this conversation and perhaps provide some answers.
That would be great Greg…one of the questions that we are really struggling with getting a straight answer is this and it has to do with income limits and Medical vs exchange insurance…if I project my income to be $XX which does not qualify me for Medical, but I end up making $YY in 2014 which pushes me down to Medical coverage, what happens? Do I get a refund of all of my premiums paid less credits? What about coverage differences between Medical and exchange insurance (Gold in this case)…how is that reconciled (coverage is different between Medical and Gold)?
The same is true for the other way around too…what if I project that I will have income that qualifies for Medical, but I end up making too much?
Seems so strange that in 2012, folks are being asked to indicate what they will make in 2014. Remember that a good chunk of people who are not W2 wage earners will not have their income known until mid-2015 or even later, almost 2 years from now.
I’ve extended the invitation and it has been accepted; I just don’t know when my CoveredCA source will show up here.
Greg, I know the navigators are busy signing everyone up, but do you know if he/she will still be checking in on the OJB?
I’ll go drop him a line.
cmon, cmon, we’re impatient here!!
Patience is a needed virtue when dealing with this area Vern.
Hi Boutwell : Your Question: what happens if my income changes drastically in 2014 compared to what I declare now (in a year that I may not even know what my 2013 taxable income will be?
For now you just apply with what you know about you income. If your income changes, you have to report the change and your premium assistance or subsidy if you qualify for any will reflect the increase of the decrease of your income.
IS THIS OR IS THIS NOT Greg’s long awaited friend? And if it is, do stay a spell.
‘Tis! ‘Tis!
Thanks…see below to your other comment. The real problem is that a lot of people may not even know what their income really is until months after year end. The problem I see is with Medical, which is explained below. Premium assistance adjustments I presume will be reflected with tax filings.
One problem I deal with in my field is people who have just gotten (or are about to get) fired, often from jobs of long-standing, and therefore don’t know if they’ll have any income beyond (one hopes at least) unemployment benefits for next year. Their prior taxes will be a poor guide to expected income!
Further, the coverage under ACA is based on Modified Adjusted Gross Income, NOT based on Assets, so they should not ask you for your bank statement. If that happens, call Covered CA to report it http://www.CoveredCA.com. Also, you can get enrolled through an insurance agent who is a “Certified Enrollment Counselor”. They should provide you with this service free of charge to you, because Covered CA pays the Certified Enrollment Counselors entities $54 per application per household. DO NOT PAY A PENNY FOR THE HELP. LET THEM DO THE WORK>
The bank statements were asked by Covered CA service rep to verify presumably that the kids do not have income. I don’t think they were asking in order to verify assets, but instead asked to determine that the kids do not have income. The kids are 3 and new born by the way…did not change their request for documents though. Strange and perplexing like so many other things with ACA…
BOUTWELL: “I project my income to be $XX which does not qualify me for Medical, but I end up making $YY in 2014 which pushes me down to Medical coverage, what happens? Do I get a refund of all of my premiums paid less credits? What about coverage differences between Medical and exchange insurance (Gold in this case)…how is that reconciled (coverage is different between Medical and Gold)?”
Use the online calculator http://www.CoveredCA.com for projections. Do not get yourself in Analysis paralysis. You qualify for what you qualify for now. Once there will be life changing events or income increase or decrease, you have 30 days for the date of change to report it. So, if now you qualify for MediCal and you start making more money that will not qualify you for MediCal, you may qualify for subsidy. I hope this answers your questions.
It is really easy to say what you just said, but it does not answer the question from a detail perspective…A lot of people will NOT KNOW what their income is until tax time. Probably pretty easy for a wage earner but not so easy for a self-employed person.
I want to know what will happen if:
1. I project that I will not qualify for Medical based on what I know, but then I actually do qualify (i.e. my income goes down), and
2. I project that I will qualify for Medical based on what I know, but then I actually d not qualify (i.e. my income goes up).
I would imagine that crossing over the Medical line would impact, the following areas, which is what we need to know about:
a. premiums…If I now qualify for Medical, do I get my premiums back (i.e. projected that I would not qualify for Medical, but I actually do). Vice versa: I now do not qualify for Medical, do I have to pay the premium now b/c I was not paying it before?
b. co-pays/services…If I now qualify for Medical, do I get any of my out of pocket expenses back or have to true up. Vice versa: I now do not qualify for Medical, do I have to true up.
I am looking for the true, black and white answer, and not something like a lot of people have told me…don’t worry about it, they will never figure it out or even know about it until it is too late.
This is real. This impacts people. Thanks for coming on and answering. i appreciate it.
Yes Vern. This is Greg LONG waited Volunteer friend.
Volunteer??? You mean you’re not paid for…any of this?
BTW: Navigators are not swimming to the ship. They are waiting for miracles to happen. Most of the money that Outreach and Education State money are not spent as it suppose to be. That is another 800lb gorilla we need to deal with later. That is one of the major mishaps of Obamacare
Here is a good resource for the application:
Vern: Volunteer as in Yes, I am not on anyone payroll. This makes the entities who got paid by the state to answer your questions. They do not respond to emails or phone calls. So, it is my civic duty to help you navigate the system
Can you help navigate my question specific question(s) above (Dec 18, 3:44pm)? Unfortunately, I have not found anyone who knows the answer to these specifics. I cannot imagine that the questions will either a) be just one person needing to know (I have a couple of people asking) or b) an area that has not been addressed by the powers that be.
Real questions need real answers…hopefully someone can assist- ObamCare Expert seems to be the best shot that we have now, since the folks on the phone are not much of any help at all.
Hi Boutwell, I work part-time in a patient advocacy agency.
According to CoveredCA Q&A page : “If your income changes over the year, your tax credit will be adjusted accordingly. If your income increases you will have to pay the difference at tax time or by notifying Covered California, we will adjust your premium assistance. If your income decreases, you can receive additional tax credit.”
http://www.coveredca.com/shopandcompare/#faq
Based on the income level, some family members such as children up to the age 19 and pregnant women may quality for no-cost insurance through Medi-Cal. Other family members may qualify for the subsidized or unsubsidized health coverage.
The non-Medi-Cal eligible will be budgeted based on the Modified Adjusted Gross Income, based on IRS tax rules.
The Medi-Cal regulations on self -employment are slightly different than the IRS. They can be found at http://www.oal.ca.gov/ccr.htm.
Self employment income is under section 50505. Net Profit from Self-Employment.: ” (a)The net profit from self-employment shall be an estimation of the annual net income for the current year based on the federal tax return filed for the previous year as limited by (c)…” Some of the deductions allowed by the IRS are not allowed.
In both situations, schedule C may be used.
I hope this in a nutshell explanation helps.
Dora…THANK YOU very much for the Medi-Cal info.