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Individuals enrolled in an employer-sponsored plan, including retiree coverage, are not eligible for the premium tax credit, even if the employer plan is unaffordable or fails to provide minimum value. The individual may be eligible for a premium tax credit for another family member who enrolls in Marketplace coverage and is not enrolled in the employer plan
The individual may be eligible for the premium tax credit if the individual declines the coverage from a former employer, such as COBRA or retiree coverage, even if it is affordable and provides minimum value.
If the individual declines the COBRA coverage, even if it is affordable and provides minimum value, the individual may be eligible for the premium tax credit.
If a tax filing unit’s income changes, and the filer should have received a higher amount, this additional credit would be included in their tax refund for the year. On the other hand, any excess amount that was overpaid in premium credits would have to be repaid to the federal government as a tax payment. However, there are limits on the excess amount to be repaid for those below 400% of the Federal Poverty Level.
Consumers are required to self-report changes in income to Covered California within 30 calendar days from the date of the change. Consumers can report these changes via the online application or by calling the Covered California Service Center.
If an individual’s income changes, any excess amount that was overpaid in premium assistance would have to be repaid to the federal government as a tax payment. However, there are limits on the excess amounts to repaid and is as follows:
|If Household Income Is:||The Dollar Limit for Single Filers Is:||The Dollar Limit for Joint Filers Is:|
|Less than 200% of the FPL||$300||$600|
|At Least 200% of the FPL but less than 300% of the FPL||$750||$1,500|
|At Least 300% of the FPL but less than 400% of the FPL||$1,250||$2,500|
Premium tax credits are calculated based on an individual’s “fair share” of premium. “Fair share” increases with income, and ranges from 3.5% of income at 139% of FPL to 9.5% of income at 400% of FPL.
Individuals will pay their “fair share” of premium, or the total premium, whichever is less.
Yes, an individual can cancel their Grandfathered plan and enroll in Covered California. Subsidy eligibility will be determined by the regular criteria, and not related to any previous enrollment in an (individual) Grandfathered plan.
The employee and family can enroll in a Covered California plan at full cost. If the employer-sponsored coverage is of minimum value, and is affordable to the employee, then the employee will not be eligible for subsidies. If the dependents are eligible for the employer coverage, and the coverage is of minimum value, and is affordable to the employee, then the dependents will not be eligible for subsidies.
Yes. You can find a table of eligibility by FPL here:
Firstly, Covered California recommends that individuals with mixed eligibility situations such as this use the online calculator at www.coveredca.com.
The husband is ineligible for Covered California if he is on Medicare.
In order for either a husband or wife to be eligible for subsidies, they must file taxes jointly. The wife’s eligibility for subsidies will be determined by the household income (MAGI).