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Covered California tax credit mix-ups cause headaches for consumers

January 19, 2017
Area(s) of Interest: Health Care Reform 


Physicians should be aware that approximately 35,000 Californians insured through Covered California were in for a shock when they received their premium bills this month. The source of the problem is two-fold, both related to clerical errors by the state health exchange.

Roughly 9,600 beneficiaries have, at least temporarily, lost federal premium subsidies because Covered California was unable to verify their income. The premium subsidies that enrollees receive are determined based on income. In order to verify income against a federal database, Covered California needs consent from enrollees. In December, Covered California discovered some enrollees hadn’t provided the necessary consent and as a result have, at least temporarily, lost their subsidies as of January 1, 2017. Affected patients are now receiving bills from plans for the full, unsubsidized amounts of their premiums. Once an enrollee provides the needed consent, Covered California has pledged to recalculate the tax credits and apply them retroactively to the beginning of the year.

Another group of 25,000 Covered California policy holders are also facing higher-than-expected premium bills because the exchange initially sent incorrect tax credit information to their health plans. Covered California confirmed that it provided incorrect subsidy information for some policy holders, resulting in inaccurate premium bills. The information has been corrected, and insurers are now sending out new bills. In most cases that means higher premiums than consumers had initially been quoted, and health plans are entitled to bill them for the difference.

Patients should be aware that if their updated premiums are more than they can afford, there’s still time to switch health plans before open enrollment ends on Jan. 31.

Physicians who receive questions from their patients about either of these issues should direct them to contact Covered California directly at (800) 300-1506.

For physician practices, these two issues could result in changes to patient eligibility. Physicians are urged to be diligent in verifying patients' eligibility and benefits each time they are seen to ensure they will be paid for services rendered.

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