Medi-Cal Monthly vs. Covered California Annual Income Issues
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- Опубліковано 23 сер 2024
- Medi-Cal eligibility focuses on monthly income while Covered California emphasizes the household's estimated annual income. Because the two agencies look at income differently, families frequently are frustrated when their Covered California health plans are cancelled by Medi-Cal because the eligibility workers don't understand the income estimate on the Covered California application.
Also, the line 11 on tax return doesn’t paint the picture for self-employed, the AGI would be much more than the calculated monthly income (with deductions). Is that right?
Self-employed individuals use a Schedule C to calculate Profit or Loss from a business, which is fed into the AGI on line 11.
Thanks for explaining this!
It can be a little tricky when the government agencies fail to completely explain how their programs interact.
If children qualify for medi-cal, but the parents don’t, would Covered CA consider the parents as a 2-person household? Because if you put those numbers for a 4-person household, they wouldn’t qualify for covered ca either
The subsidy is calculated on the household size from the tax return. If dependents in a 4 person household are Medi-Cal, based on income, removing the dependents with the same income, the adults would continue on Covered California. The income necessary to qualify for Covered California increases with household size. This is assuming that the dependent income is not being entered for the household income. Potentially removing dependents with income could drop the adults into Medi-Cal.
Great video. After paying Jan premium on Jan 5, and maintaining current docs in CC, all coverage inactive due to County canceling blue shield without notice 12/31/22. and suddenly MRI & multiple specialist appts inJan must be canceled. If they disqualify for CC getting care in Medi cal with current docs seems impossible and standard of care suddenly implodes.
There seems to be a huge disconnect between what Medi-Cal is doing and the health care services people have lined up in the coming months. We are supposed to bow down and thank them for the no cost health insurance. However, a health plan without your current doctors is not health insurance. It is just another anxiety inducing government situation we have to negotiate to stay alive.
@@KevinKnauss your videos
Are very helpful as I navigate this from having employer sponsored care most of my life. The stress of being sick and sudden lack of control over getting care is not good and I can’t imagine how difficult it is for anyone elderly or non English speaking.
@@reghammond09 The health care is overly complicated and the mechanics are not explained very by the people who operate the system. The hospitals, medical groups, health plans, and Covered California focus on marketing (sales and enrollments) and miss the basics. They assume we are all subject matter experts. I’m glad to hear that my little videos have helped answer some questions for you.
It sounds like medi-cal is less desirable than covered California plans. Is that right?
It depends on the health care needs of the individual and their preferences. Many people have received excellent life saving care with Medi-Cal. Other people prefer the larger network of providers offered by the Covered California plans. Both cover all the same medical services.
Great video. For example, say my parents are 69 and on Medicare. If the only they have is Social Security and combined Social Security income for Married/Joint filing is $28,700. But they also took out $8000 from traditional IRA. With no other incomes. Will that disqualify their Medi-Cal eligibility?
Your parents have non-MAGI Medi-Cal that has different income limits. Usually, distributions from a retirement account would just increase the assets and not have any impact on the monthly income.
Thank you for your info, I’m currently on long term disability through insurance I paid into while I was employed. I have a 401k and have not contributed to it since going on long term disability and it will remain there until I either choose to remove it or age out. I’m making about 25,000 a year with that long term disability. My question is will that none working income count as income when tempting to apply for covered california insurance and also med i-cal? I can’t afford the cobra insurance from my past employer, I’m just so confused, please help
Typically, if the insured pays for the disability policy and receives benefits, the income received is not taxable. If the employer paid for the policy, the income is taxable. You should confer with your tax preparer to see if you are having to claim the disability benefits as taxable income.
If the answer is No, and that is your only income, you would not qualify for Covered California health insurance subsidies. You would qualify for Medi-Cal. You can also enroll in a health plan without the subsidies either through Covered California or direct with the carrier of your choice.
To confirm a one time lump sum payment scenario, a married couple over 59 1/2 and under 65 monthly income is low enough to qualify for California medi-cal
The one time lump sum payment(s) at end of the year are all in December are a large IRA-Roth conversion and/or IRA withdrawal plus a large stock sale
These multiple lump sum payments did not happen the month prior in November and will not happen again in the following month of January
The question are multiple one time lump sum payments allowed in the same month of December to retain medi-cal coverage?
Thanks and great videos.
Thus far, the situation you describe of multiple retirement distributions, has not disqualified individuals or families from MAGI Medi-Cal. It has been explained to me that the county eligibility workers are really focused on consistent monthly income.
The case worker does have the ability to use an annual budget worksheet in place of a monthly income budget worksheet. In this manner, usually when requested by the beneficiary, the multiple disbursements are combined and averaged over the months. The average income may be over the income threshold and the household members allowed to enter Covered California with the subsidies for health insurance.
What happen if you win one time in casino how do they calcúlate that income for medícal
That would most likely be considered a one-time lump sum distribution or income. Medi-Cal is really looking for consistent monthly income. If, you routinely earn money from gambling, which many people do, and you can show the net profit from the gambling endeavor, that could be considered income on a monthly basis and put you over the Medi-Cal limit.
Great info Kevin!! I got flag by medical on my Covered Cal ins due to income error input that took me below 138%. Don't want to fall into medical. What's your best advise? And if you fall into Medical how long do you have to stay before you can go back to Covered Cal ? Thank in advance,much appreciate it!
You need to communicate with the county and let them know the income entry was an error. You may need to send them proof of the income stream. A case worker may be able to flip you back to Covered Ca that day.
The problem is if your effective date for the health plan has already passed. It is near impossible to get a retroactive health plan enrollment. For example, you report a change in July that inadvertently makes you Medi-Cal. You talk to someone at the county in August. You will most likely be Medi-Cal for August as it is difficult to make a health plan enrollment effective back to the first of August.
However, if they do release you, then you can enroll in a plan for an effective date of the next month or September.
What if one is over 65 and has no income yet (plans to not draw small retirement and Social Security until 70) and will live with other family members in those family members home; must the income of the other adults in the house be reported on the Covered CA or MediCal applications? It's a situation where that over 65 person is just getting free room and board and just needs medical coverage. Also, what would be best no cost medical coverage, straight MediCal or MAGI MediCal?
You are talking about two different programs. If the person has Medicare, they ineligible for MAGI Medi-Cal. In general, both programs focus on the tax household of the individual. If they file single, regardless of their living situation, it is the income for a single adult that will be applied to an eligibility determination.
There are other programs that Medi-Cal screens for such as food stamps where the household situation could come into play. For instance, is the individual part of the communal dining and has access to food bought by other household members?
The best least expensive medical coverage is complicated to address without knowing whether the individual has Medicare benefits or not. However, for the very lowest income individual, Medi-Cal can cover most of the costs if the individual is under 65 or over 65 with Medicare.
@@KevinKnauss Many thanks Kevin! Thank you for clearing up my confusion. I appreciate you taking the time to respond to my questions.