Covered California will be sending a notice next week to health plan enrollees that received APTC, or “premium assistance,” encouraging them to report any changes in income or household size since enrolling in a Covered California health plan.
Enrollees who received premium assistance this year will need to file taxes for 2014. When they file, the IRS will check to see if the amount of income they reported to Covered California is the same as the amount of income they actually made. The IRS will also check to see if their family size is the same as when they applied. The IRS will compare, or “reconcile,” the amount of premium assistance they qualify for based on their actual income and family size reported on their tax return with the premium assistance they received during the taxable year.
Enrollees who experienced a change in income or household size but have not reported this information to Covered California are at risk of having to pay more at tax time. If needed, Covered California can work with these enrollees to reduce their current premium assistance to minimize this consequence.
From COVERED CA:
Notices with Incorrect Open Enrollment Dates
In the past two weeks, about 11,000 Denial of Coverage notices were generated and sent to consumers with the incorrect Open Enrollment dates for the Individual Marketplace. These notices were sent to consumers that applied outside of Covered California’s Open Enrollment period. Although the dates indicated were correct at the time the notices were sent, a change in the law resulted in a change to the Open Enrollment period indicated.
The incorrect dates on the notice were October 15, 2014 through December 7, 2014. The 2015 Open Enrollment period is November 15, 2014 to February 15, 2015.
Please [be aware if you were] affected by this notice [and take note of] the new Open Enrollment dates. Be sure to also check whether [you] qualify for Covered California’s Special Enrollment Period.
If eligible, you can call [today for questions about enrolling in this special enrollment period].
[If you] are not eligible for Covered California’s Special Enrollment Period, [you] can apply during Open Enrollment this fall for coverage beginning January 1, 2015.
Now that Open Enrollment has ended, you must have a “Qualifying Event” to make any changes or enroll in a new plan outside of Open Enrollment. As of today’s regulations (always subject to change), the next Open Enrollment period will begin on Nov. 15th, 2014.
Examples of Qualifying Life Events:
In all state-based, federal and partnership exchanges, individuals may also enroll outside of the open enrollment window if they have a qualifying life event. The consumer and the agent should contact each specific exchange directly for their qualifying life event procedures. For your reference, qualifying life events include:
- Having a baby
- Adopting a child or placing a child for adoption or foster care
- Moving outside your insurer’s coverage area
- Losing other health coverage—due to losing job-based coverage, divorce, the end of an individual policy plan year in 2014, COBRA expiration, aging off a parent’s plan, losing eligibility for Medicaid or CHIP and similar circumstances. Important: Voluntarily ending coverage doesn’t qualify you for a special enrollment period. Neither does losing coverage that doesn’t qualify as minimum essential coverage.
- Gaining citizenship
- Leaving incarceration
- Gaining status as member of an Indian tribe. Members of federally recognized Indian tribes can sign up for or change plans once per month throughout the year.
- For people already enrolled in marketplace coverage: Having a change in income or household status that affects eligibility for premium tax credits or cost-sharing reductions