Covered California’s Income Verification and Appeals Process

These FAQs answer frequently asked questions about Covered California’s and the Health Insurance Marketplace’s verification and appeals process.

I expect my income to be less next year.  Do I have to provide documentation?

Covered California may ask for documentation about your projected income.   Covered California will compare your estimated 2014 income to other data they access on your most recent income, such as your tax returns.   If you estimate next year’s income will be substantially less than you claimed in previous years, Covered CA may ask you to provide documentation to support your income projection.   This can include a a pay stub from your new job, a letter from your employer and in some cases a letter explaining your change in circumstances may be accepted.

How does Covered CA verify income?  

Covered CA will check the income you provide against IRS, Social Security and other databases.  If the income you provide is much different from the information in these databases, they may request you provide additional documentation.

Covered CA sent me a letter requesting additional documentation within 90 days.  What happens if I can’t make or I missed the deadline?

Call Covered CA at 1-800-300-1506 and explain your situation.

How do I appeal Covered California’s decision?

Complete the Request for a State Fair Hearing to Appeal a Covered California Determination to ask for a hearing with an Administrative Law Judge.  You have 90 days from from the date Covered CA mailed you the eligibility decision, however, you may be able to file an appeal after the 90 days if you have a good reason for filing late.

Covered CA states the following reasons for filing an appeal:

   I was denied enrollment into a Covered California health plan

   The amount of Premium Assistance (tax credits that help pay my monthly premium) is not correct

   The level of Cost Sharing Reduction (help paying my out of pocket expenses) is not correct

   I was denied eligibility for an exemption from the individual responsibility

  Covered California did not process my information in a timely manner

  Covered California stated that I am not a US Citizen or US National or a lawfully present individual living in the United States

  Covered California stated that my application was incomplete

  I do not have other health coverage (such as free Medi-Cal or employer sponsored insurance) that prevents me from qualifying for insurance through Covered California

 Covered California stated that I am not a California Resident

 Covered California stated that I did not pay my premiums by my due date

 Covered California stated that my income is too low to qualify for Covered California

Source: and Covered California







AUTHOR - Ali Nagy