What if I underestimated my income for the year?

by | May 9, 2023

Covered California Subsidy Payback

Understanding Covered California Subsidy Payback: What to Do When Your Income increases or decreases

Life can be unpredictable. Incomes increase and decrease, careers change, and financial surprises can appear out of nowhere. One area where these surprises can have significant implications is in the case of health insurance tax credits.

For our clients at our Covered California Enrollment Center, it’s extremely important to understand the implications of these changes, especially when it comes to federal tax credits.

Let’s explore the story of Steve as a case study.

Steve’s Journey with the Silver Plan

Steve started his year by enrolling in a subsidized health insurance plan through Covered California. Midway through the year, Steve’s financial fortunes rose, but he missed a crucial step: notifying Covered California of this change.

Why Reporting Income Changes Matters

Subsidies are financial aids extended by the government, helping eligible individuals offset their health insurance premiums. These subsidies are calculated based on one’s Modified Adjusted Gross Income (MAGI). they are directly linked to one’s annual income. Therefore, ensuring that assistance is provided in accordance with an individual’s financial capacity. Falling below the federal poverty level might even qualify you for Medi-Cal, California’s version of Medicaid.

But what happens if, like Steve, your income shifts during the year?

  1. Income Increases: If your actual earnings surpass your estimates, you may need to return a portion or all the subsidy you were granted.
  2. Income Decreases: On the flip side, a drop in income can make you eligible for further financial assistance.

Notably, if someone with a Covered California Subsidized Plan experiences a significant income surge, they might need to repay some or all of the received subsidy. However, there’s a silver lining: a repayment cap. For those with earnings below 400% of the federal poverty level, the repayment amounts range from $325 to $1,400 for single tax filers and $650 to $2,800 for families. The exact repayment depends on your income. Please refer to the repayment schedule below for detailed information.

The Importance of Prompt Reporting

It’s crucial for all Covered California enrollees to be aware of the implications of income changes on their health insurance coverage. If you experience a change in income, it’s imperative to report it promptly to Covered California. An income decrease might have two notable benefits:

  1. Reduction in Monthly Premiums: By promptly reporting a decrease in income, you could be eligible for a higher subsidy, effectively lowering your monthly health insurance costs.
  2. Enhanced Plan Benefits: With a decreased income, you may also qualify for (Cost-Sharing Reduction Plans).  CSR plans are designed to reduce your out-of-pocket healthcare expenses for individuals and families that qualify based on hoesehold income.

Failing to report income changes in a timely manner may have a negative impact on your taxes if you are receiving a tax credit. When you file your income tax return you may end up with an unfortunate tax liability. Additionally, there is a possibility you may have to repay the full amount of the subsidy you received. By staying informed and proactive you can avoid any unnecessary surprise at tax time and maximize your healthcare benefits.

Tax Filing Status and Covered California Subsidy Repayment

It is extremely important to immediately report income changes to Covered California. Additionally, it is valuable to understand how your tax filing status can affect your federal tax credit repayment. Alongside the risk of having to return your advanced tax credit due to an income increase that wasn’t reported, this obligation also applies if you  file as ‘Married Filing Separately.’

In this scenario, you’ll need to return the entire advanced tax credit you received, a requirement that complies with both state and federal rules. The implications can be financially substantial, so it’s key to factor in this aspect when making healthcare and tax-related decisions. As always, seeking personalized advice from a tax professional can help you navigate these complexities effectively.

 

Understanding Subsidy Paybacks Through Real-Life Scenarios

Navigating the nuances of Covered California’s subsidy payback system can be a bit challenging, especially when tax season approaches. Let’s dive into some real-life scenarios of our clients to help clarify how these rules apply:

  1. Mary’s Fortunate Miscalculation:
    • Initial Estimate: Mary started her year estimating her annual household income at $42,000.
    • Actual Earnings: By year’s end, she only earned $25,000.
    • Monthly Subsidy Reality: Mary received a monthly subsidy of $533.00 based on her initial estimate.
    • What Could Have Been: If she had estimated accurately, Mary would have been entitled to a monthly subsidy of $742. Additionally, She would have qualified for an Enhanced Plan with lower out-of-pocket cost.
    • Tax Season Outcome: Due to her overestimation, Mary received a tax refund of $2,508 (the difference of $209 for each month she was under the health plan).
  2. Jeff’s Fortunate Break:
    • Initial Estimate: Jeff anticipated his yearly income to be around $29,000.
    • Actual Earnings: By the close of the year, he amassed earnings of $40,500.
    • Subsidy Implications: Jeff’s miscalculation would have resulted in a repayment of $1,656. However, thanks to the subsidy payback cap and his income landing within the 200%-300% FPL range, he was only obligated to return $825.
  3. Miguel and Maria’s Pricey Oversight:
    • Initial Estimate: This couple began their year with an estimated household income of $65,000.
    • Actual Earnings: When tax season arrived, their reported income jumped to $98,000.
    • The Costly Oversight: Since Miguel and Maria did not report their income increase to us, they were ineligible for the subsidy at tax time. Additionally, with their income exceeding the 400% FPL threshold, they were obligated to return the full subsidy amount, totaling $5,492.

It’s essential to note the importance of promptly updating income changes with Covered California. While some like Mary might walk away with an unexpected refund, others, like Miguel and Maria, might face substantial repayments. Always stay informed to avoid financial surprises.

Additional Resources

For a detailed look at the limits on repayment amounts and Federal Poverty Levels based on household size, refer to the  “Subsidy-Repayment Limits below” and “Federal Poverty Level-2024” tables, respectively.

Did your income change this year? Don’t wait. Reach out to us now to update your details and ensure you’re receiving the correct subsidies.

For more in-depth information and resources, we welcome you to visit our website or contact us at (888) 280-0763.

Subsidy Repayment Cap (2023)

Income as a % of FPL
Repayment Limit (Single Filers)
Repayment Limit (Families)
Up to 200%
$325
$650
201% - 300%
$825
$1,650
301% - 400%
$1,400
$2,800
Over 400%
Full Amount of Subsidy
Full Amount of Subsidy

Federal Poverty Level Chart (2024)

Household Size
138% FPL
200% FPL
300% FPL
400% FPL
1
$20,121
$29,160
$43,740
$58,320
2
$27,214
$39,440
$59,160
$78,880
3
$34,307
$49,720
$74,580
$99,440
4
$41,400
$60,000
$90,000
$120,000
5
$48,494
$70,280
$105,420
$140,560
6
$55,587
$80,560
$120,840
$161,120
7
$62,680
$90,840
$136,260
$181,680
8
$69,773
$101,120
$151,680
$202,240

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