How and when to report changes to Covered CA and/or Medi Cal

It’s mandated that you report to Covered CA and/or Medi-Cal any changes, higher or lower in:

Changes in Circumstances and Advance Premium Tax Credits

Reporting these changes will help individuals avoid large differences between the advance credit payments and the amount of the premium tax credit allowed on their tax return, which may affect their refund or balance due.

Covered CA has asked agents not to give tax advice.  Here’s their suggestions.

Pros – Cons – Complicated FAQ’s Research on staying with under 65 plan?  Covered CA? vs Medicare

Medi-Cal process to handle reported changes.

FAQ on urgency to report changes in income

Be CAREFUL when you update income…  It could cause your coverage to be cancelled!!! detailed Analysis

9.15.2017 Job Aid  (Instructions) written by Covered CA  on how to make changes— Including Income 

When you are changing the income, please select the event as “None of the above.” Changing the income is not a  qualifying event.

***IMHO it can be – See Special Enrollment – Change in Silver Level...

Since you selected “Other qualifying event” it sends the case to review. Email dated 5.18.2017 9:36 AM

#Form8962 Premium Tax Credit
Reconciliation Form attaches to 1040
Subsidy is IMHO hocus pocus - smoke & mirrors
it all comes out when you file taxes!

8962 Subsidy Reconciliation

Mandate to File Tax Return 

& Form 8962

Etc. Copied from Covered CA ONLINE application 11.26.2014 – Paper Application  Rights & Responsibilities Page 16

I agree to file a  tax return before (April 15, ) to claim the Premium Tax Credit. I understand that I am required to submit changes that affect my eligibility, including income, dependency changes, address, and incarceration. These changes could affect the plans I can be enrolled.

I cannot change plans unless I have a life triggering event. Life Events include lost or will soon lose my health insurance, permanently moved to/within California, had a baby or adopted a child, got married or entered into domestic partnership, returned from active duty military service, gained citizenship/lawful presence, Federally recognized American Indian/ Alaska Native, released from jail, and other qualifying life events.

#Withholding W 4
IRS Withholding Calculator 

IRS Tax Withholding Calculator

Here’s tools to make sure the right amount is withheld, either for tax refund purposes or to avoid an unexpected tax bill next year.

“It’s a personal choice if you want to have extra money withheld to get a bigger tax refund, but you have options available if you prefer to have a smaller refund next year and more take-home money now.”  Advance Premium Tax Credit now or later?

By adjusting your  Form W-4, Employee’s Withholding Allowance Certificate, taxpayers can ensure that the right amount is taken out of their pay throughout the year so that they don’t pay too much tax and have to wait until they file their tax return to get any refund. Employers use the form to figure the amount of federal income tax to be withheld from pay.  IRS Tax Withholding Calculator

People Working in the Shared Economy  

Covered CA Consent for Verification – Income, etc. 


Review the Consent for Verification Notice that Covered California sent to consumers last week and the Consent for Verification Quick Guide for more information.

Also, watch the How to Update Consent VIDEO for instructions on updating consumer consent.

Consumers  are at risk of losing their Advanced Premium Tax Credit (APTC) and/or cost-sharing reductions for health insurance coverage if their consent form is out of date.

A consumer’s financial assistance may end because of one or more of the following reasons:

  • The consumer’s consent to allow Covered California to use computer sources to check their income and family size, including information from tax returns, has expired.
  • The consumer may not have filed afederal income tax return for their household to reconcile the Advanced Premium Tax Credit (APTC) used to lower plan premium costs
  • The consumer’s household income may be too high.

Covered CA 
Right to change plans when a change in Income changes your
Enhanced Silver Level..


One way to to make a change in your Covered CA coverage when it’s not Annual Open Enrollment is if your income changes, so that you qualify for a new or different level of Enhanced Silver Subsidies or income change makes you newly eligible for subsidies. Covered CA’s interpretation of the law is that you must already have coverage through Covered CA, to do thisFN 1 

CA CCR Code of Regulations (7)

An enrollee Definition, or his or her dependent enrolled in the same QHP – Qualified Health Plan, is determined newly eligible or ineligible for APTC (Subsidies) or has a change in eligibility for CSR. [Cost Sharing Reductions – Enhanced Silver]

See more detail and discussion in footnotes below.

It just doesn’t seem “Fair” that if someone makes $100k as a single and then loses his job, can’t enroll when that happens.

Yes, I’ve been told that if you want Fair, you have to go to Pomona.

Response By Email (Argelia) (03/26/2018 11:57 AM) Good day Steve Shorr, Thank you for contacting Covered California™. A change in income is not a Qualifying life event. If you select “other qualifying life event,” it puts a hold on the account.  In the future, for income changes you need to select “none of the above.” 

 FAQs / Ask Us a Question

CFR §156.425 Changes in eligibility for cost-sharing reductions. (Enhanced Silver)

Please start your research into Special Enrollment Periods by reviewing our main page of California Code of Regulations on Qualifying Events

 See Full FPL Federal Poverty Level Chart – Income vs Plan and Program you and your family qualify for

(a) Effective date of change in assignment. If the Exchange notifies a QHP issuer of a change in an enrollee’s def eligibility for cost-sharing reductions (including a change in the individual’s eligibility under the special rule for family policies set forth in §155.305(g)(3) of this subchapter due to a change in eligibility of another individual on the same policy), then the QHP issuer must change the individual’s assignment such that the individual is assigned to the applicable standard plan or plan variation of the QHP as required under §156.410(b) as of the effective date of eligibility required by the Exchange.

(b) Continuity of deductible and out-of-pocket amounts. In the case of a change in assignment to a different plan variation (or standard plan without cost-sharing reductions) of the same QHP in the course of a benefit year under this section, the QHP issuer must ensure that any cost sharing paid by the applicable individual under previous plan variations (or standard plan without cost-sharing reductions) for that benefit year is taken into account in the new plan variation (or standard plan without cost-sharing reductions) for purposes of calculating cost sharing based on aggregate spending by the individual, such as for deductibles or for the annual limitations on cost sharing ECFR.Gov

(6) Newly eligible or ineligible for advance payments of the premium tax credit, or change in eligibility for cost-sharing reductions.

(i) The enrollee is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions; [Enhanced-Silver]

advance payments of the premium tax credit (subsidies) or is experiencing a change in eligibility for Enhanced Silver – cost-sharing reductions CA Agent Training Page 9  or premiums become unaffordable 155.420  156.425   156.410

premium tax credit

determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions [enhanced silver],

Special enrollment periods no longer will be available for:

Consumers who had signed up for exchange plans with too much in advance payments of tax credits because of redundant or duplicate coverage;

Consumers who were affected by Social Security income tax errors;    (Counihan, CMS blog, 1/19).  Learn More ⇒CA Health Line – Health 1.20.2016

(ii) The enrollee’s dependent enrolled in the same QHP is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions; or

(iii) A qualified individual or his or her dependent who is enrolled in an eligible employer-sponsored plan is determined newly eligible for advance payments of the premium tax credit based in part on a finding that such individual is ineligible for qualifying coverage in an eligible-employer sponsored plan in accordance with 26 CFR 1.36B-2(c)(3), including as a result of his or her employer discontinuing or changing available coverage within the next 60 days, provided that such individual is allowed to terminate existing coverage.

affordable or provide minimum value [bronze plan] for his or her employer’s upcoming plan year to access this special enrollment period prior to the end of his or her coverage through such eligible employer-sponsored plan;  Learn More⇒Change Enhanced Silver

(iv) A qualified individual in a non-Medicaid expansion State who was previously ineligible for advance payments of the premium tax credit solely because of a household income below 100 percent of the FPL, who was ineligible for Medicaid during that same timeframe, and who has experienced a change in household income that makes the qualified individual newly eligible for advance payments of the premium tax credit.

 FAQs / Ask Us a Question


1.  Covered CA cites their webpage and says change in income is only if you are already enrolled in a Covered CA plan. Email dated 11.14.2016 3:35 PM 45 CFR §155.420(d)(6); 10 CCR – CA Code of Regulations – Special Enrollment Periods  § 6504(a)(6). Note that Covered California interprets this to only allow for changes in plan, not to newly enroll based on language in the state and federal regulations referring to the enrollee rather than the individual as in other sections. Thus, if you are already in a plan you can change to a new plan but you can’t newly enroll in a plan when your income decreasesWestern Poverty Page 5.215

45 CFR §155.420(d)(6) Newly eligible or ineligible for advance payments of the premium tax credit, or change in eligibility for cost-sharing reductions.

(i) The enrollee is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions;

(ii) The enrollee‘s dependent enrolled in the same QHP is determined newly eligible or newly ineligible for advance payments of the premium tax credit or has a change in eligibility for cost-sharing reductions; or

(iii) A qualified individual or his or her dependent who is enrolled in an eligible employer-sponsored plan is determined newly eligible for advance payments of the premium tax credit based in part on a finding that such individual is ineligible for qualifying coverage in an eligible-employer sponsored plan in accordance with 26 CFR 1.36B-2(c)(3), including as a result of his or her employer discontinuing or changing available coverage within the next 60 days, provided that such individual is allowed to terminate existing coverage.

(iv) A qualified individual who was previously ineligible for advance payments of the premium tax credit solely because of a household income below 100 percent of the FPL and who, during the same timeframe, was ineligible for Medicaid because he or she was living in a non-Medicaid expansion State, who either experiences a change in household income or moves to a different State resulting in the qualified individual becoming newly eligible for advance payments of the premium tax credit;

Enrollee means a qualified individual

or qualified employee enrolled in a QHP. Enrollee also means the dependent of a qualified employee enrolled in a QHP through the SHOP, and any other person who is enrolled in a QHP through the SHOP, consistent with applicable law and the terms of the group health plan. Provided that at least one employee enrolls in a QHP through the SHOP, enrollee also means a business owner enrolled in a QHP through the SHOP, or the dependent of a business owner enrolled in a QHP through the SHOP. Qualified individual means, with respect to an Exchange, an individual who has been determined eligible to enroll through the Exchange in a QHP in the individual market.    Definitions  155.20   You can completely forget about what federal law has to say when it comes to Covered CA.  Since Day 1, they have been making up their own rules without regard to the law when it suits their fancy.  So, to Covered CA, decrease in income only allows a change of health plan if already enrolled through Covered CA despite the fact that in just about any other state, it triggers an SEP.  MAX Herr   Response from Covered CA   Income changes so much that a current Covered California enrollee becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.

This is what it states in you’re enrolled in a Marketplace plan and your income or household change, you should report the changes as soon as possible. These changes — like higher or lower income, adding or losing household members, or getting offers of other health coverage — may affect the coverage or savings you’re eligible for.

Why it’s important to update your application immediately

If your income estimate goes up or you lose a household member: You may qualify for less savings than you’re getting now. If you don’t report the change, you could have to pay money back when you file your federal tax return. If your income estimate goes down or you gain a household member: You could qualify for more savings than you’re getting now. This could lower what you pay in monthly premiums. You could qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP).

More Info

• Income and Reconciliation Notice 

• APTC & Income Talking Points

• APTC & Income FAQs

If you haven’t given Covered CA permission to verify income, you will be renewed, but without the advance premium tax credit and risk cancellation  Insure Me

45 comments on “Report a Change – How & When – Especially Income

  1. I was just approved to covered california.

    However, the address on my file is completely wrong (completely different area of Cali).

    I cannot figure out how to fix this on the website and their number doesnt work until Tuesday, which is another month!

    What am I missing?

  2. We had to adjust our income again on the covered ca website as we have apparently a very unique (compared to other folks getting insurance through covered ca) income situation.

    We spent several hours/days on the phone with them. It was extremely complicated and I’m not sure any insurance expert would even have expected or understood the insanity of covered ca’s process.

    I believe/hope we have it sorted out for now.

    Thank you for your help again.



  3. Our son has obtained a Anthem policy through his employer with an 11/01 effective date. Seems as if it does not make sense to keep him on our policy and pay both premiums for next two months.

    However, you never know with Covered CA-they may charge more with my son off and just my wife on the policy.

    Are you able to check this without making a change?

  4. Hi,

    I have been on the Covered California insurance (HealthNet) for the last several years.

    However, my income level has increased some. So, the premium amounts forecasted through them for 2021 all appear quite high.

    Is it less expensive to separate out from Covered California and just find health insurance directly?

    Going from paying $187 per month to paying over $400 per month sounds a little steep.

    I am not sure that my budget can afford it.

  5. I went on the Covered CA website the other day and tried to update things, but it would not let me.

    My husband who was covered by Medicare passed away in April. Should I keep him on still because of tax filing for 2020? 2021,

    I will be filing single vs. married, filing jointly.

    If he should be removed because of a “qualifying event” and it might change my premium for 2021 for the better, please tell me how to remove him, and I will.

    Also, my MAGI for 2020 will be significantly less (probably around $35,000 or maybe less) when I file taxes.

    Whatever you think is best.
    Thank you again,

  6. I changed employers, can I switch from Bronze to Silver?


    Only if there is a change in income, that changes subsidies or silver level. See explanation above and the main special enrollment page.

  7. I have lost my job at the ,,, Club, and am unemployed for now.

    What can I do regarding my health insurance?

  8. One of the issues with Obamacare APTC Advance Premium Tax Subsidy is it does not look at income in arrears, because that would be too simple.

    Instead it relies on enrollee’s to guess what they will make in same – future year and oh by the way how much they will have in deductions or if an adult son who’s listed on the plan will find a job or not. Who knows?

    The premium assistance relies on MAGI Modified Adjusted Gross Income, do you have a complete list of acceptable deductions allowed for 2018 and for 2019?

    • Enrollee’s Duty to Report Changes in Circumstances

      An enrollee, or application filer on behalf of an enrollee, must report any change of circumstances with respect to the eligibility standards within 30 days of such change. An enrollee, however, who has a change in income that does not impact the amount of the enrollee’s Advance Payments of Premium Tax Credit (APTC) or the level of Cost-Sharing Reduction (CSR) is not required to report such a change.

      (45 C.F.R. § 155.330(b);

      10 CCR California Code of Regulations § 6496
      § 6496. Eligibility Redetermination During a Benefit Year.

      (a) The Exchange shall redetermine the eligibility of an enrollee in a QHP through the Exchange during the benefit year if it receives and verifies new information reported by an enrollee or identifies updated information through the data matching described in subdivision (g) of this section.

      (b) Except as specified in subdivisions (c) and (d) of this section, an enrollee, or an application filer on behalf of the enrollee, shall report any change of circumstances with respect to the eligibility standards specified in Sections 6472 and 6474 within 30 days of such change. Changes shall be reported through any of the channels available for the submission of an application, as described in Section 6470(j).

      (c) An enrollee who has not requested an eligibility determination for IAPs shall not be required to report changes that affect eligibility for IAPs.

      (d) An enrollee who experiences a change in income that does not impact the amount of the enrollee’s APTC or the level of CSR for which he or she is eligible shall not be required to report such a change.

      (e) The Exchange shall verify any reported changes in accordance with the process specified in Sections 6478 through 6492 before using such information in an eligibility determination.

      Cal. Code Regs., tit. 10, § 6496, subds. (b), (d).)


      Definition of change (Entry 1 of 2)
      transitive verb

      1a : to make different in some particular : ALTER
      never bothered to change the will
      b : to make radically different : TRANSFORM
      can’t change human nature
      c : to give a different position, course, or direction to
      changed his residence from Ohio to California
      2a : to replace with another
      let’s change the subject
      b : to make a shift from one to another : SWITCH
      always changes sides in an argument
      c : to exchange for an equivalent sum of money (as in smaller denominations or in a foreign currency)
      change a 20-dollar bill
      d : to undergo a modification of foliage changing color
      e : to put fresh clothes or covering on change a bed
      intransitive verb

      1 : to become different some things never change
      2 : to undergo transformation, transition, or substitution winter changed to spring
      neither liked his seat so they changed with each other
      4 : to put on different clothes need a few minutes to change for dinner
      5 : to shift one’s means of conveyance : TRANSFER
      on the bus trip he had to change twice
      6 of the voice : to shift to lower register : BREAK
      His voice started to change when he turned 13.
      7 of the moon : to pass from one phase (see PHASE entry 1 sense 1) to another change hands
      : to pass from the possession of one owner to that of another money changes hands many times
      change noun
      Definition of change (Entry 2 of 2)
      1 : the act, process, or result of changing: such as
      a : ALTERATION
      a change in the weather
      a time of vast social change going through changes
      a change of scenery
      d : the passage of the moon from one monthly revolution (see REVOLUTION sense 1a) to another also : the passage of the moon from one phase (see PHASE entry 1 sense 1) to another
      e : MENOPAUSE
      2a : money in small denominations received in exchange for an equivalent sum in larger denominations
      b : money returned when a payment exceeds the amount due
      a cashier quick at making change
      c : coins especially of low denominations
      a pocketful of change
      d : a negligible additional amount only six minutes and change left in the game
      e : MONEY sense 1
      cost a large chunk of change
      3 : a fresh set of clothes
      4 British : EXCHANGE sense 5a
      5 : CHANGEUP
      6 : an order in which a set of bells is struck in change ringing

  9. Last month I left my job and now I am freelancing.

    Not sure what to do about reporting my income since I really don’t know what it will be – I am transitioning to 1099 project work.

    I can continue to cover my premium if best option is to leave as is and settle up at tax time.

  10. I’m not clear as to when and how to update/verify my income for this year based upon my last year’s tax return.

    Can you please advise?

    • 1040 Income – Line 37 + Foreign Income + Tax Exempt Interest + Social Security

      The question is NOT what you earned last year. It’s what do you expect to earn in 2018. That’s what form 8962 is, to reconcile your taxes and what was advanced to you as a subsidy.

      In a private email, we sent you your 2016 tax return. Please advise how you think your numbers will look for 2018.

      If your estimate changes, see above, on our webpage about reporting that within 30 days.

  11. I will qualify for Health Insurance through my employer and don’t need my Covered CA coverage anymore.

    How do I cancel coverage?

    Do I need proof of new coverage?

    What is the deadline so that I don’t have to pay for two policies?

  12. 1. I went through you to get assistance with the subsidies. Which you told me I was unable to qualify for due to projected income in 2018.

    2. I have since spoke with other agents that have assured me that I could have qualified.

    • 1. As I recollect, you said you were disabled and would not have any income for 2018 or if you did it would be below the amount the IRS needs to get subsidies. See our Covered CA income chart or use our instant calculator and proposal quote engine.

      While past income might be accepted as an indicator of future income, it’s what you file on your taxes at the end of the year for 2018 that counts. See forms 8962 Premium Tax Credit and 1040.

      Even if you were to get on board with Covered CA and got advance subsidies, you are mandated to report any change in income within 30 days. See above for details. The application is under penalty of perjury. If you get subsidies you are not entitled to, you have to pay them back, when you file your taxes.

      Our agent contract, CA Law and Federal Law – Tax Code prohibits us from helping people obtain tax benefits they are not legally entitled to.

      If you want to submit and application to Covered CA, you are welcome to do so. The main problem I told you was that they would put you into Medi-Cal and you said you didn’t want that.

      2. It’s nice that you spoke to someone, but I don’t see any citations for why they think you can get subsidies with zero income. We do not pay attention to hearsay.

      Don’t forget – President Trump said health care is very complicated and President Obama didn’t even know ACA changed employer plans too.

      One advantage to applying for Medi-Cal either direct or through Covered CA would be that if you do get a job that qualifies for subsidies, you could use a special enrollment event at that time, as you would be losing coverage.

      If I recollect, you said if you did get a job, you would have Health Coverage there, thus no point.

      Open Enrollment lasts till 1.31.2018

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