Covered California: Tax Filing Requirement for Consumers Receiving Premium Assistance

Some Californians, individuals, and families enrolled in Covered California (Covered CA) plans are eligible for financial assistance to lower the cost of their health insurance.  Anyone who receives financial assistance with Covered CA is required to file a federal tax return as a condition of eligibility.

Covered CA offers two main ways to get assistance with health care coverage costs:

  • Premium Assistance (formally called the Advanced Premium Tax Credit or APTC) is a tax credit to reduce an individual’s monthly premium.
  • Cost-Sharing Reductions is a subsidy to reduce an individual’s out-of-pocket costs (their copay’s, coinsurance, deductible and out-of-pocket maximum).

Important Information Regarding Premium Assistance and Tax Filing

All Covered CA consumers who receive Premium Assistance/APTC, must file federal taxes for each calendar year they receive the assistance. If they fail to file their taxes, they will lose their eligibility for Premium Assistance/APTC. The consumer will then be responsible for paying the full premium amount and will have a higher cost-sharing for health care services.

Warning Notices

Covered CA has mailed warning notices to those who are at risk of losing their Premium Assistance/APTC. These notices were sent to consumers who in 2017:

  • Received Premium Assistance/APTC in the calendar year but did not file a federal tax return for that year;
  • Filed a federal tax return but did not include IRS Form 8962; or
  • Requested an extension to file a federal tax return but did not end up filing the return.

Covered CA consumers who fall within any of these categories will have until May 15, 2019, to preserve their Premium Assistance/APTC by reconciling their premium assistance and contacting Covered California to attest to having done so.

If consumers fail to take these steps, they will receive another notice, in a pink envelope, that tells them when their financial assistance will end if no action is taken. Covered CA consumers who fail to take corrective action will lose their current financial help starting July 1, 2019.

Open Enrollment Is Here!

This year’s health insurance enrollment cycle began on October 15, 2018, and ends on January 15, 2019. Enrolling is easy and may be done a number of ways:

Covered CA Basics

Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.

Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including outpatient care, hospitalization, prescription drugs, laboratory tests, mental health care, and emergency services. There are five health carriers who offer a variety of plans in the County of San Francisco: Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, and Oscar.

Sign Up and Renewal Dates

  • Sign up by December 15, 2018, for coverage starting January 1, 2019
  • Sign up by January 15, 2019, for coverage starting February 1, 2019

Need Help Paying For Health Insurance Costs?

Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The AIDS Drug Assistance Program (ADAP)  and Office of AIDS Health Insurance Premium Payment Program (OA-HIPP)  help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.

Get Help

Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident who needs assistance in exploring your options and/or enrolling in healthcare you can contact PRC for additional help and information:  415-777-0333.

It Is Tax Time Again

With all the recent tax reform changes, many people have many questions. Intuit has created a nice article that explains how the changes affect 2017 taxes (taxes you actually file in 2018) and changes that take effect next year during the 2018-tax filing season (taxes you file in 2019).  Below are some highlights, important dates, and resources to help you file your taxes.

Tax Penalty for Not Having Health Insurance

Individuals without qualifying health coverage for all or part of 2017 may still have to pay a tax penalty for the tax year 2017. A tax preparer or tax prep software may assist in calculating any penalty for not having health insurance.

For the tax year 2017, the penalty is the greater of 1) 2.5% of total household adjusted gross income, OR 2) $695 per adult and $347.50 per child, up to a maximum of $2,085 per family. The penalty amounts have not been set for the 2018 tax year and beyond.

In limited situations, some individuals may be exempt from the tax penalty.

Medical Expenses

If you itemize deductions in 2017, you may be able to deduct qualifying medical expenses to the extent they exceed 7.5% of your Adjusted Gross Income. See the IRS Publication for a full list of qualified medical expenses.

Deadline to File 2017 Taxes is April 7, 2018

The deadline to file your personal tax return for the tax year 2017 is Tuesday, April 17, 2018. (Why the change? Because April 15 falls on a Sunday, and Monday is Emancipation Day, observed in Washington D.C., the home of the IRS.) If you are not ready to prepare and file your return by the deadline, you may request a six-month extension with the IRS.

Free Tax Filing Assistance in San Francisco

Mission Economic Development Agency (MEDA)

Provides free tax services in English and Spanish. Call 2-1-1 (available 24/7 in 150 languages) to make an appointment.

Volunteer Income Tax Assistance (VITA)

Provides free tax return preparation for qualifying taxpayers. Visit the hyperlink above to locate a VITA or Tax Counseling for the Elderly (TCE) program near you.

Earn it! Keep it! Save it! A program of the United Way

Provides free tax services to qualifying taxpayers. Visit the hyperlink to find out about eligibility, what to bring to your meeting and the program sites near you.

AARP Foundation Tax-Aide

Offers free, individualized tax preparation for low to moderate-income taxpayers – especially those 50 and older – at more than 5,000 locations nationwide. Find a location near you by searching the link.