Medi-Cal vs Covered CA subsidies

Advance Payments of the Premium Tax Credit APTC

ARPA American Rescue Plan Act

 How to get & qualify for Subsidies

 

Introduction to Subsidies – Premium Tax Credit

I’ve got to say that Obamacare and tax subsidies are one of the most confusing things I’ve ever come across.   The simplest thing to do is just get an Instant quote.  Enter your projected AGI Adjusted Gross Income, line 11 of your tax return, note that MAGI has a few other things,  your date of birth, zip code  and then we can set a Zoom Meeting to go over all of it.

How do you get the premium tax credit?

Check out our quote engine, to get a preliminary indication of the amount of subsidies you’ll qualify for.  There is no extra charge for our services,

In a lot of ways subsidies are hocus pocus smoke & mirrors as you have to file Form 8962, Premium Tax Credit, with your tax return at the end of the year.  So, at the end of the year if you make too much $$$ you might have to give it back.  If you make less, you get money back on your taxes.

Failing to file your tax return will prevent you from receiving advance credit payments in future years and can cause MAJOR PROBLEMS and coverage CANCELLATION!

The premium tax credit is refundable so even if you hardly pay any taxes, you still benefit.  The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums. IRS Website on “The Basics

FAQ’s, Links & Resources 

Calculate your  Covered CA MAGI Income

take #Line8b 11 Adjusted Gross income then add line 2a, 6a &   8 (Foreign Income)

 

MAGI Income from 1040

Federal Poverty Level &
Program Chart

Medi-Cal?  Covered CA Subsidies?  Enhanced Silver?
MAGI Income Chart

Federal IRS  #Form8962 Instructions Premium Tax Credit

Reconciliation Form for Covered CA Subsidies attaches to 1040
Subsidy is IMHO hocus pocus - smoke & mirrors
it all comes out when you file taxes!

 

8962 goes by MAGI

 

 

Covered CA Certified Agent

#Covered CA Certified Agent  

No extra charge for complementary assistance 

I'm in Sonia

 

Technical Links for

Premium Tax #Credits §136 B

CFR 136 B 3 – How is Tax Credit #Calculated 
cfr 136 b subsidies

Kaiser Foundation Subsidy Explanation

Premium Problems if ARPA isn’t renewed

July 12, 2022 VIDEO will ARPA be renewed for January 2022?

#COVID19 Bill

The American Rescue Plan Act  ARPA

2021 Federal Stimulus Package
March 2021

VIDEO Introduction to ARPA  by Steve 

ARPA Provides:

  • Those enrolled in  Covered California health plans will not have to pay more than 8.5% of their household income for the second lowest cost silver plan – Get Quotes
  • If you are not in Covered CA, there is a special enrollment period to apply.  If you stay with the same insurance company, your deductibles & co pays will transfer over!
  • Any person in 2021 who received unemployment insurance for one week or more, and their total income qualifies for coverage through Covered California, will receive federal premium tax credit available for 138% of FPL  Silver 94? for the duration of the Public Health Emergency in 2021.
  •  In California, individuals making between 138 percent and 150 percent of the federal poverty level — between $17,776 and $19,140 per year — will see their already-low premiums eliminated. San Diego Union *  Covered CA FAQ for Brokers *
  • 100% federal premium subsidy for COBRA coverage Blue Shield *
  • Despite What the White House Says, Obamacare Is Deeply Troubled PRI Center for Economics & Innovation
  • Get quotes to see how ARPA would work for you.
  • ARPA is funded to the tune of $34 Billion for only two years and would change the formulas for health insurance tax credits to make them more generous for most people, and also allow a wider number of individuals to qualify.
  • ARPA follows President Biden’s strategy of getting all Americans covered.  Modern Health Care 3.8.2021 * NPR *
  • Covered CA will automatically check if clients get more subsidies.  BUT! your consent to allow Covered CA to check your finances in the Federal Hub, etc.  must be up to date.  Here’s their quick guide on how to do that.
  • ARPA is comprehensive and there are several provisions that we are watching closely that would affect how people pay for their health insurance coverage:
  • Removing the cap on subsidies for people earning more than 400% [600% in CA] of the Federal Poverty Level (FPL) –Currently those with a Modified Adjusted Gross Income (MAGI) of more than 400% of the FPL are not generally eligible for Advance Premium Tax Credits (APTC).  Additionally, there is legislation that would make the removal of the 400% cap permanent.²
  • Lower the maximum a person has to pay for the Benchmark Plan from 9.83% of MAGI to 8.5% of MAGI – This provision would drop the amount the insured person has to pay for insurance from 9.83% of his MAGI to 8.5%.
  • Provide no-cost Silver Plans for people receiving unemployment insurance – Americans on unemployment insurance during 2021 would receive the Benchmark Silver Plan in their market for a $0 premium contribution while they are receiving unemployment insurance.⁴
  • APRA COVID Stimulus bill will also pay your COBRA and  Cal COBRA  premium.
  • All ages will be affected, but this bill will have the greatest impact on near-seniors, or those aged 55-64 because of the cost of their ACA coverage. Stephens Mathews Email 3.11.2021 *

Resources & Links

#Native Americans Heath Insurance subsidies, etc

 

No Health Care Expenses, Depending on Income

Federally recognized American Indians and Alaska Natives who earn less than 300 percent of the federal poverty level (see chart) will not have to pay certain out-of-pocket medical costs, such as copays and deductibles, if they purchase health insurance coverage through Covered California, no extra charge for use to help you.  Get Quote

No Cost-Sharing for Covered Services Provided by an American Indian Health Provider or Clinic, Regardless of Income

There are no copays or deductibles for any covered services received directly through the federal Indian Health Service, tribes, tribal organizations or urban American Indian organizations.

Ability to Buy Insurance Anytime

American Indians and Alaska Natives can buy or change health insurance plans once a month through Covered California and are not subject to open-enrollment periods.   Our webpage on special enrollment

Exemption from the Shared Responsibility Payment

All members of federally recognized tribes and all American Indians and Alaska Natives who are eligible for services through an Indian Health Service provider are eligible from an exemption from the shared responsibility payment (the tax penalty consumers pay if they do not have minimum essential health coverage).

 more exemption information

Our webpage on CA Penalty  * 

Exemptions from CA Mandate Penalty

covered ca.com/documents-to-confirm-eligibility/american-indian-or-alaskan-native  

Additional information that may be of interest to American Indians and Alaska Natives is available below:

More Links

Southern CA

Tongva Territory

 

FAQ's  #Negative MAGI Income – Qualification for Medi Cal? Subsidies?”

 

  • Question  If your MAGI Income is negative, can you still qualify for Covered CA subsidies APTC even if you have some income, before you get to line 11 of your 1040?
    .
  • Answer - NO!  See the income chart.  Your MAGI Income - AGI needs to be over 138% of FPL Federal Poverty Level
  • Question If your carry over net operating loss (from prior years) is allowed to be taken into account, is it part of the Federal Modified Adjusted Gross Income number ) or does California specifically require you to take it out of the equation?
  • MAGI details from a Higher Up at Medi Cal

    • Medi Cal agrees that MAGI can be negative and will educate the Counties...
    • Good afternoon Steve,Thank you for raising this issue with DHCS. Without a signed Medi-Cal Authorized Representative form MC 382 on file with the county or provided to DHCS, I cannot speak to any specifics surrounding a Medi-Cal case.However, speaking in general terms, when a case is escalated to DHCS typically we will do direct outreach with the county involved and Covered California (if needed). If training issues are identified such as incorrect information being provided, then training and resources will be provided.

      Additionally, DHCS has flagged “negative” reported loss income as a policy clarification area to provide further guidance on in future for counties, since it is not uncommon but can be a confusing area to make sure the information is captured correctly in the systems and the policy is clear.

      Thank you for raising this and helping identify this opportunity for improvement, and have a wonderful rest of your day!

    • Kathryn Floto, MPA | Health Program Specialist II
      Medi-Cal Eligibility Division
      California Department of Health Care Services
    • Good morning,

      For Modified Adjusted Gross Income (MAGI) Medi-Cal income and deductions policy, DHCS published All County Welfare Director’s Letter (ACWDL 21-04).

      Page 2, Section 1 provides guidance on policy for countable income for MAGI program calculation, which is federal taxable income minus any allowable (post-tax) deductions under federal code. Page 3 links to an Income and Deductions chart tool to determine if a post-tax deduction can be used for MAGI-based Medi-Cal and for Covered California eligibility. Please note that the chart and the Covered California website deductions are post-tax deductions, and pre-tax deductions are already included when calculating AGI.

      Tax loss is not considered an acceptable post-deduction for MAGI Medi-Cal or Covered California per federal code.  The Centers for Medicare and Medicaid Services (CMS) has also published a document detailing MAGI rules with deduction information on page 7.

      If the tax loss is considered as more of a capital gains/loss, or other loss such as real estate reported on Schedule E, then this amount should be entered into the system as an income with a negative (for example: -819,988).  This will tell the system the income is actually at a loss and will reduce the income.

      I would be happy to research your client’s case specifically if you can provide identifying information for me to look her up (name, DOB, SSN).  Please let me know if you or your client are interested and I can initiate a secure e-mail and send over appropriate documents to share private information for your client to fill out in order for me to share back any results.

      Thank you, and please let us know if you have any further questions.

      Kathryn Floto, MPA | Health Program Specialist II
      Medi-Cal Eligibility Division
      California Department of Health Care Services

 

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