I don’t have any solid information on the software the counties use for eligibility determinations. I’ve heard conflicting reports that some counties use different systems. There is MEDS, SAWS, and CalHEERS (Covered California) systems. What is apparent is that there are issues. I’ve encountered numerous situations where Covered California enrollments had their subsidy (APTC) terminated because the CalHEERS system detected Medi-Cal enrollment or eligibility in one of the other systems. To the best of my knowledge, these were false positive detections. In other words, the individuals in question may have had Medi-Cal at one time, but had been determined ineligible. These individuals had been receiving the subsidy for in prior years with no issues. This leads me to believe that something changed. Either lifting of the Public Health Emergency (where all Medi-Cal cases were put on hold) somehow changed the aid code of those past Medi-Cal enrollments or the CalHEERS software became more sensitive to any Medi-Cal aid code. The result is that the CalHEERS system concluded the individual had ‘other’ insurance and was ineligible for the subsidies. The individuals then had to spend hours tracking down which county the Medi-Cal past enrollment occurred and request the county to update or fix the aid code. After the fix, we reported a change in the Covered California account and the subsidies were returned. I doubt that anyone at the Department of Health Care Services or Covered California will ever explain the issue. They get to hide behind their bureaucracy and never apologize for the stress and waste of time they inflicted on people, OR explain why it all happened.
I work for DHCS, so while I'm not familiar with the actual CalSAWS program, I do speak with countless people every day encountering the horrible, all too common problem of being stuck between CCA and Medi-Cal and it's usually due to 1. the County only updating case/application information in their own database, not CalSAWS, which is what relays the information over to CalHEERS (and MEDS)...if they don't pay attention to/update CalSAWS, CCA will never get that updated/corrected information and be able to do their part; or 2. unfortunately, when the County DOES update everything correctly, CalSAWS is flawed - that information doesn't always get relayed over to CalHEERS as it should and it's not exactly either sides fault - it's glitches in the system... For that second scenario, there is a Covered CA Ombuds that can look into the CalHEERS issue after their Consumer has verified with the County CalSAWS has been updated and the situation has been escalated with the CCA Helpline several times unsuccessfully...
I know when medi-cal clients go through the Covered California website to renew their medi-cal when it’s not due they can create another Duplicate CCID or new application number. Why does Covered California allow this? Does Covered California get money for each application submitted? This is an issue for Eligibility workers who have to close out the duplicate application number.
I worked for a county agency for 32 year and retired 2018. Out premiums from the county have doubled since retirement as they moved the retirees from the active pool of workers, thus it went up. I found a way of taking my wife off my county retirement medical and I put her on Bueshield gold. So i pay 640 a month for Kaiser and she pays 728 for blueshield. Our income is high so we did not qualify for a subsidy but my splitting it we are saving over 450 a month. I need to stay with the county plan as when i get to Medicare ago i can put around 500 a month towards part B and supplement, so basically it will be free. Just wish they could use her income alone because it would be so much lower. She is also a full Cherokee indian and I noticed on Blueshield by being native American she can move from plan to plan each month and also has zero cost on deductibles on everything. What were not sure about is those zero deductible are for using Indian Health Services which would not help us, as the closest clinic is in north San Diego. So if we cant access a clinic can we still get the zero cost using a local doctor.
The $0 cost Native American plans are based on household income. She may not qualify for the $0 cost plan with your household income. As I understand, the $0 cost-share is not limited to Native American health center providers, but applies to all doctors in the network. We are waiting to see if there will be a change to federal rules address the ‘family glitch’ that prevents some spouses and dependents from getting subsidies when offered employer group coverage. I’m not sure if it would necessarily help in your situation or not. We are suppose to hear something before the end of 2022.
When qualifying, does it matter the reason why one might have no income? (Example I quit my job and am taking some months to travel, was not fired, do they take that into consideration for my eligibility?)
No, eligibility is based solely on your stated income, regardless of the reason for any decrease of income such changing jobs or leaving the job market altogether.
The Modified Adjusted Gross Income is line 11 of the 1040: Adjusted Gross Income + Social Security retirement and disability benefits + tax exempt interest + foreign earned income. All applicable deductions and adjustments to the Adjusted Gross Income will be included on one of the schedules that feed into the AGI. For example, making a contribution to an IRA or a health savings account will reduce the AGI.
My husband and I are both retired, I collect a monthly amount from my 401(k) IRA, he gets a monthly annuity, and we both collect social security. Question number 1: does all of that count as income? We are currently on COBRA, my old employer was paying us a $1000.00 a month reimbursement that has now ended. We will no longer be able to afford our COBRA. Question number 2: can we drop our COBRA? And, then collect Covered California?
The Social Security definitely counts toward the income for the subsidies, even if it is not taxed. If the other retirement income must be declared as taxable income, then those income streams would also count toward the MAGI. It does not sound as if you have a qualifying life event for a Special Enrollment Period to purchase health insurance through Covered California. Your health insurance becoming unaffordable is not a qualifying life event in itself. But there may be other issues that I am not aware of that might trigger a SEP to enroll in a subsidized health plan outside of open enrollment. The worst case scenario is that you must wait until November 2022 for open enrollment to be a less expensive plan in January 2023.
Hi Kevin your videos have been a God Send. I have a burning question. Next year my wife will be fulltime stay at home Mom to our 15 month old while I work as an Independent Contractor. I am currently getting health issurance from my 2nd job but I will work fully self-employed next year which will mean I will need to cover the 3 of us under Covered California. 1st is thier a wage cap/requirement for Covered California. And would we have to show taxes from 2021. We file as married but seperate. Hopefully this is not too much of a loaded question. Thanks in advance!
There is no wage or household income cap for 2022. The subsidy is based on making the second lowest cost Silver plan no more than 8.5% of your household income. In order to qualify for the subsidies you will have to state that you will be filing Married Filing Joint. If you subsequently file your taxes in 2022 as Married Filing Separate, you will have to repay the subsidies you received during the year. The subsidy is based on your 2022 estimated income, not your 2021 income. Covered California has an income attestation form you can submit if income verification triggered. Finally, be aware that dependents under 19 years of age, when the household income is under 266% of the federal poverty level for the household size, will be determined eligible for Medi-Cal.
@@Nikowazi Being self-employed can be one of the most complicated household situations when applying through Covered California. All of the necessary conditions must be met, along with correctly estimating the income, in order for the the household to receive the correct subsidies and not have a rat’s nest when they go to file their tax return the next year.
@@KevinKnauss Thank you Thank you Kevin! I should elaborate more on my self employment I will be a fulltime Independent Contractor for a small government contract next year. They donot provide health insurance and also God willing will be a Realtor later in the year once pass my RE exam. Not sure if that will make the application process a little easier for covered California. My wife and I will file our 2021 taxes later in the year before April hopefully that not impede when apply for covered california in January. Your advice is Golden sir⭐️
@@Nikowazi Your 2021 tax filing status and return have little relevance upon the 2022 application. You are estimating your income and tax filing status for 2022, that's what is important for the application. In terms of future income, you can always change it during the year. But if you anticipate a significant increase in taxable income in the future, you might want to consider hedging your income a little high to account for the later increase.
if my job stops in July do i put the income up to that point? or do i use last year? it keeps saying calculated annual income is 13600 a year even though i estimate 30k after finding a new job
You are estimating your income for the current year. However, it is assumed that you will be listing your current income streams. If your job stops in July and there is nothing else lined up, you would end the income stream in July. Just be aware that the Covered California system screens for Medi-Cal based on monthly income. Even if you earned $100,000 in the previous 6 months, if your current monthly income is $0, you are Medi-Cal eligible.
Medicare Part A is considered minimum essential coverage and makes those individuals entitled to Part A ineligible for the subsidies through Covered California.
Hello. I’ve been watching your TH-cam videos all day. Im super anxious and nervous because I’ve never had health insurance before so I decided to apply today. I only estimated the income I told to covered California cause I still don’t know what would be my income for 2022. I am self employed by the way. Now they are asking for proof of income and I still haven’t filed taxes for 2022. They gave me until April 4th to send the proof of income but in the next few days, I’m going to receive mails from Anthem blue cross for payment information and billing. My question is, do I have to wait till I file taxes and send them the proof before I pay for the Anthem? I would really appreciate your help. Thank you
You can use your 2021 tax return to verify your income, but was 2021 normal? You are estimating your 2022 income. Your past tax returns are only a guide. Your income may be higher or lower than what you earned for 2021, hence, the estimate. Pay the health plan immediately. It is not dependent on the income verification with CC.
I’m super confused. Thanks so much for answering my questions. My last question is do I have to wait to file for my 2021 taxes and then send them my documents after? I’m afraid if I’ll send them my 2020 tax returns I won’t be eligible or they’re going to ask me to pay penalties or something cause it’s too much smaller that my estimated amount I gave them.
@@ge408 You should consider filing an income attestation. A link for the form should be displayed on the page in your account about uploading eligibility documents. I'm not a fan of sending tax return information.
If you underestimated your income for 2022, then you may have to repay a portion or all of the difference. For example, you estimate your income for 2022 at $30,000. But when you do your taxes, your income is $40,000. You received subsidies on $30,000, which would be a higher amount than $40,000. Consequently, you would have to repay the difference between what you received and what you were entitled to. If you received subsidies at $30k of $12,000, but at $40k you were only entitled to subsidies of $10,000, you may have to repay the $2,000 difference.
I appreciate your videos, Kevin. Thank you. I feel more educated and less fearful of the process. Thank you so much.
You are welcome, the underlying process of the Covered California application is not widely discussed by CC.
This video helped me very much. Than you for the information
That is wonderful good news. Glad to hear it!
Kevin what do you think about the CalSAWS software all counties are using to process CalFresh and Medi-Cal cases?
I don’t have any solid information on the software the counties use for eligibility determinations. I’ve heard conflicting reports that some counties use different systems. There is MEDS, SAWS, and CalHEERS (Covered California) systems.
What is apparent is that there are issues. I’ve encountered numerous situations where Covered California enrollments had their subsidy (APTC) terminated because the CalHEERS system detected Medi-Cal enrollment or eligibility in one of the other systems.
To the best of my knowledge, these were false positive detections. In other words, the individuals in question may have had Medi-Cal at one time, but had been determined ineligible. These individuals had been receiving the subsidy for in prior years with no issues.
This leads me to believe that something changed. Either lifting of the Public Health Emergency (where all Medi-Cal cases were put on hold) somehow changed the aid code of those past Medi-Cal enrollments or the CalHEERS software became more sensitive to any Medi-Cal aid code.
The result is that the CalHEERS system concluded the individual had ‘other’ insurance and was ineligible for the subsidies. The individuals then had to spend hours tracking down which county the Medi-Cal past enrollment occurred and request the county to update or fix the aid code. After the fix, we reported a change in the Covered California account and the subsidies were returned.
I doubt that anyone at the Department of Health Care Services or Covered California will ever explain the issue. They get to hide behind their bureaucracy and never apologize for the stress and waste of time they inflicted on people, OR explain why it all happened.
Thank you for your time!!
I work for DHCS, so while I'm not familiar with the actual CalSAWS program, I do speak with countless people every day encountering the horrible, all too common problem of being stuck between CCA and Medi-Cal and it's usually due to 1. the County only updating case/application information in their own database, not CalSAWS, which is what relays the information over to CalHEERS (and MEDS)...if they don't pay attention to/update CalSAWS, CCA will never get that updated/corrected information and be able to do their part; or 2. unfortunately, when the County DOES update everything correctly, CalSAWS is flawed - that information doesn't always get relayed over to CalHEERS as it should and it's not exactly either sides fault - it's glitches in the system...
For that second scenario, there is a Covered CA Ombuds that can look into the CalHEERS issue after their Consumer has verified with the County CalSAWS has been updated and the situation has been escalated with the CCA Helpline several times unsuccessfully...
I know when medi-cal clients go through the Covered California website to renew their medi-cal when it’s not due they can create another Duplicate CCID or new application number. Why does Covered California allow this? Does Covered California get money for each application submitted? This is an issue for Eligibility workers who have to close out the duplicate application number.
I worked for a county agency for 32 year and retired 2018. Out premiums from the county have doubled since retirement as they moved the retirees from the active pool of workers, thus it went up. I found a way of taking my wife off my county retirement medical and I put her on Bueshield gold. So i pay 640 a month for Kaiser and she pays 728 for blueshield. Our income is high so we did not qualify for a subsidy but my splitting it we are saving over 450 a month. I need to stay with the county plan as when i get to Medicare ago i can put around 500 a month towards part B and supplement, so basically it will be free. Just wish they could use her income alone because it would be so much lower. She is also a full Cherokee indian and I noticed on Blueshield by being native American she can move from plan to plan each month and also has zero cost on deductibles on everything. What were not sure about is those zero deductible are for using Indian Health Services which would not help us, as the closest clinic is in north San Diego. So if we cant access a clinic can we still get the zero cost using a local doctor.
The $0 cost Native American plans are based on household income. She may not qualify for the $0 cost plan with your household income. As I understand, the $0 cost-share is not limited to Native American health center providers, but applies to all doctors in the network. We are waiting to see if there will be a change to federal rules address the ‘family glitch’ that prevents some spouses and dependents from getting subsidies when offered employer group coverage. I’m not sure if it would necessarily help in your situation or not. We are suppose to hear something before the end of 2022.
Thank you for this video, Kevin! Very helpful as always👍👏👌🙌
Great! I achieved my goal.
When qualifying, does it matter the reason why one might have no income? (Example I quit my job and am taking some months to travel, was not fired, do they take that into consideration for my eligibility?)
No, eligibility is based solely on your stated income, regardless of the reason for any decrease of income such changing jobs or leaving the job market altogether.
hi Kevin, should I include federal standard deduction (which is $12,950 for single) in deduction section of Covered California application?
The Modified Adjusted Gross Income is line 11 of the 1040: Adjusted Gross Income + Social Security retirement and disability benefits + tax exempt interest + foreign earned income. All applicable deductions and adjustments to the Adjusted Gross Income will be included on one of the schedules that feed into the AGI. For example, making a contribution to an IRA or a health savings account will reduce the AGI.
My husband and I are both retired, I collect a monthly amount from my 401(k) IRA, he gets a monthly annuity, and we both collect social security. Question number 1: does all of that count as income? We are currently on COBRA, my old employer was paying us a $1000.00 a month reimbursement that has now ended. We will no longer be able to afford our COBRA. Question number 2: can we drop our COBRA? And, then collect Covered California?
The Social Security definitely counts toward the income for the subsidies, even if it is not taxed. If the other retirement income must be declared as taxable income, then those income streams would also count toward the MAGI.
It does not sound as if you have a qualifying life event for a Special Enrollment Period to purchase health insurance through Covered California. Your health insurance becoming unaffordable is not a qualifying life event in itself. But there may be other issues that I am not aware of that might trigger a SEP to enroll in a subsidized health plan outside of open enrollment.
The worst case scenario is that you must wait until November 2022 for open enrollment to be a less expensive plan in January 2023.
Hi Kevin your videos have been a God Send. I have a burning question. Next year my wife will be fulltime stay at home Mom to our 15 month old while I work as an Independent Contractor. I am currently getting health issurance from my 2nd job but I will work fully self-employed next year which will mean I will need to cover the 3 of us under Covered California. 1st is thier a wage cap/requirement for Covered California. And would we have to show taxes from 2021. We file as married but seperate. Hopefully this is not too much of a loaded question. Thanks in advance!
There is no wage or household income cap for 2022. The subsidy is based on making the second lowest cost Silver plan no more than 8.5% of your household income. In order to qualify for the subsidies you will have to state that you will be filing Married Filing Joint. If you subsequently file your taxes in 2022 as Married Filing Separate, you will have to repay the subsidies you received during the year.
The subsidy is based on your 2022 estimated income, not your 2021 income. Covered California has an income attestation form you can submit if income verification triggered.
Finally, be aware that dependents under 19 years of age, when the household income is under 266% of the federal poverty level for the household size, will be determined eligible for Medi-Cal.
@@KevinKnauss Thanks a billion! That eases the tension. I will reachout once more when we apply next year in January! Appreciated.
@@Nikowazi Being self-employed can be one of the most complicated household situations when applying through Covered California. All of the necessary conditions must be met, along with correctly estimating the income, in order for the the household to receive the correct subsidies and not have a rat’s nest when they go to file their tax return the next year.
@@KevinKnauss Thank you Thank you Kevin! I should elaborate more on my self employment I will be a fulltime Independent Contractor for a small government contract next year. They donot provide health insurance and also God willing will be a Realtor later in the year once pass my RE exam. Not sure if that will make the application process a little easier for covered California. My wife and I will file our 2021 taxes later in the year before April hopefully that not impede when apply for covered california in January. Your advice is Golden sir⭐️
@@Nikowazi Your 2021 tax filing status and return have little relevance upon the 2022 application. You are estimating your income and tax filing status for 2022, that's what is important for the application. In terms of future income, you can always change it during the year. But if you anticipate a significant increase in taxable income in the future, you might want to consider hedging your income a little high to account for the later increase.
if my job stops in July do i put the income up to that point? or do i use last year? it keeps saying calculated annual income is 13600 a year even though i estimate 30k after finding a new job
You are estimating your income for the current year. However, it is assumed that you will be listing your current income streams. If your job stops in July and there is nothing else lined up, you would end the income stream in July. Just be aware that the Covered California system screens for Medi-Cal based on monthly income. Even if you earned $100,000 in the previous 6 months, if your current monthly income is $0, you are Medi-Cal eligible.
Is a person eligible for Covered California while on Medicare?
Medicare Part A is considered minimum essential coverage and makes those individuals entitled to Part A ineligible for the subsidies through Covered California.
Hello. I’ve been watching your TH-cam videos all day. Im super anxious and nervous because I’ve never had health insurance before so I decided to apply today. I only estimated the income I told to covered California cause I still don’t know what would be my income for 2022. I am self employed by the way. Now they are asking for proof of income and I still haven’t filed taxes for 2022. They gave me until April 4th to send the proof of income but in the next few days, I’m going to receive mails from Anthem blue cross for payment information and billing. My question is, do I have to wait till I file taxes and send them the proof before I pay for the Anthem? I would really appreciate your help. Thank you
You can use your 2021 tax return to verify your income, but was 2021 normal? You are estimating your 2022 income. Your past tax returns are only a guide. Your income may be higher or lower than what you earned for 2021, hence, the estimate. Pay the health plan immediately. It is not dependent on the income verification with CC.
@@KevinKnauss sorry for the confusion. I actually estimated my income for 2021 and not the 2022.
@@ge408 2021 income estimate will roll over into 2022 as long as the income streams don't have end dates on or before December 31, 2021.
I’m super confused. Thanks so much for answering my questions. My last question is do I have to wait to file for my 2021 taxes and then send them my documents after? I’m afraid if I’ll send them my 2020 tax returns I won’t be eligible or they’re going to ask me to pay penalties or something cause it’s too much smaller that my estimated amount I gave them.
@@ge408 You should consider filing an income attestation. A link for the form should be displayed on the page in your account about uploading eligibility documents. I'm not a fan of sending tax return information.
Thank you Kevin. Will there be penalty when my final 2022 year end earning vary?
If you underestimated your income for 2022, then you may have to repay a portion or all of the difference. For example, you estimate your income for 2022 at $30,000. But when you do your taxes, your income is $40,000. You received subsidies on $30,000, which would be a higher amount than $40,000. Consequently, you would have to repay the difference between what you received and what you were entitled to. If you received subsidies at $30k of $12,000, but at $40k you were only entitled to subsidies of $10,000, you may have to repay the $2,000 difference.