How and when to report changes to Covered CA

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

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

Here’s the 9.15.2017 Job Aid  (Instructions) written by Covered CA  on how to do it — 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

Mandate to File Tax Return – 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.

Covered CA  Income Reconciliation Notice #8962

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

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.

For an introduction – See our parent pages of how to report income change and income – application questions and of course the general explanation of subsidies and how they work.

If you  received premium assistance you MUST file taxes.

When you file, the IRS will check to see if the amount of income you  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 or us as your agent, no extra can work with these enrollees to reduce their current premium assistance to minimize this consequence.  Just use the button above to get a quote.

Subsidy might have to be paid back at tax time,   if new income not reported.  LA Times 9.9.2013


CNN 4.27.2015 reports that H & R Block reports average refund lowered by $729 due to under reporting MAGI income.

1.12.2015 CA Health Line on ACA and tax issues if there is a change in income.

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

When you complete the application, it’s under perjury and you promise to notify Covered CA of any changes.

This is also a reason we don’t do business for competent adults through 3rd parties.  Here’s where we wrote someone up with Covered CA and then the person was all mad at us and said we were money hungry, etc. as we didn’t put them in Medi-Cal.  Read this ladies comments about how messed up Medi-Cal is.   

Promise to tell Covered CA of any changes in income, family situation, etc.
Promise to tell Covered CA of any changes in income, family situation, etc. Click to enlarge & View actual application

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Report Changes as they happen # 5152

Report Changes as they happen

Changes should be reported within 30 days. Here's instructions.  If you've appointed us - instructions - as your broker, no extra charge, we can do it for you. 

Video Importance of Reporting Changes - Covered CA Video

IRS Video


Denial of benefits and possible criminal charges if you don't report changes in income!  

Steve Shorr - Covered CA Certified Agent

Steve Shorr - Covered CA Certified Agent -
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instant proposal including APTC Subsidy Calculation 

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Instructions to appoint us as your broker with Covered CA – no additional charge!

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

  1. 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. Source *

      (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

  2. 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.

  3. 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.

  4. 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?

  5. 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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