Getting Help With Health Care Costs - Covered California. As a CoveredCA Certified Insurance Agent we can help you compare different health insurance plans, as well as show you whether you qualify for financial help, such as federal tax credits to reduce your monthly premium costs.
To make it easy, look at your household size and income to determine what program you can qualify for.
For example, if your household size is 1 person (just you) and your income is below $18,755/year then you qualify for Medi-Cal (this is how Medicaid is called in California).
If your income is above $18,755/year but less than $54,360/year then you qualify for the APTC (advance premium tax credits ) or subsidy that will help you pay less for health insurance.
Covered California uses FPL (federal poverty level) limits from the prior year to determine eligibility for its programs as required by regulation.
Here are the columns associated with Covered California eligibility ranges:
Premium Assistance 138% - 600% FPL - If your income is within this limit, it means you can get a subsidized private health insurance plan in the CoveredCA
Enhanced Silver Plans 138% - 250% FPL - If your income is within this limit, then you can qualify for an enhanced silver plan! (lower copays, coinsurance, and deductible for silver plans)
• Silver 94 138% - 150% FPL
• Silver 87 over 150% - 200% FPL
• Silver 73 over 200% - 250% FPL
2022 FPL values as published by the Department of Health and Human Services.
Note: Feel free to reach us in case you have questions or are unsure how to interpret the above information. Also, if you've entered the income incorrectly while completing your CoveredCa application, the subsidy might show incorrectly or you might have incorrect eligibility. Feel free to delegate me as your agent in CoveredCa and I can fix it!
Here is how you can delegate an agent in CoveredCa: https://insurancecenterhelpline.com/our-blog/f/how-to-designate-a-certified-insurance-agent-in-coveredca
Medi-Cal uses FPL limits of the current year to determine eligibility for its programs.
The column headings shaded in purple are associated with eligibility ranges for Medi-Cal programs:
• Medi-Cal for Adults up to 138% FPL
• Medi-Cal for Children up to 266% FPL
• MCAP: over 213% - 322% FPL
• CCHIP: over 266% - 322% FPL
So, what is the income limit for 1 person to qualify for Medi-Cal?
If you look at the table, you can see that the income limit for 1 person to qualify for Medi-Cal in California shall be less than $18,755/year
Got questions? please feel free to reach out to us. We will be glad to assist.
Covered California is a California health insurance marketplace. It is the official exchange where Californians can get brand-name health insurance under the Patient Protection and Affordable Care Act or apply for Medi-Cal. It’s the only place to get federal premium assistance to help you buy health insurance from the insurance carriers like: BlueShield of California, Kaiser, HealthNet, Oscar, Anthem Blue Cross, Valley Health Plan, CCHP, etc.
This means you may qualify for a discount on a health plan through Covered California, or get health insurance through the state’s Medi-Cal program.
We are a CoveredCA Certified Insurance Agency! This means, that you can contact us directly with any questions you might have about your existing CoveredCA account or coverage, or any other questions your might have including: Getting the Form 1095-A, Help with a Health or Dental plan selection, help with your account. We have been contracted with CoveredCA since day 1, and know in depth all the aspects of the coverage and are great at solving issues!
If you need help with your CoveredCa account, need to access form 1095-A, have an issue, or need to file an appeal, please feel free to reach out to us! We are CoveredCA Certified Insurance Agent. Please delegate us to your account and we will help at no cost to you. Here is how you can delegate us:
Here is how you can delegate us:
1. go to www.CoveredCA.com web page
2. Log in with your username and password
3. Go to “Need Help” tab (the upper right corner)
- select "Find Local Help"
4. Select “Find an Agent” or “Agents”
5. Search by name: Type in: Diana Polyakov -
6. You will be asked to agree to the disclosures
7. Please sign your/her name and click continue or agree.
8. From that point, we will be able to verify the application for completeness or errors, submit additional information on your behalf, etc.
Find Out the details by watching our video:
It can be overwhelming to select a health insurance plan from the many options available. Before getting started, it is important to understand the big changes that have happened in health insurance recently:
· Coverage Levels: Most health insurance newly sold to individuals and small businesses must now be classified as one of four levels of coverage: Bronze, Silver, Gold or Platinum. In addition to those four levels of coverage, a minimum coverage plan is available to those who are younger than 30 or can provide certification that they are without affordable coverage or are experiencing hardship.
· Essential Health Benefits: All health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits. These benefits fit into 10 categories, and include services like prescription drugs, mental health care, and emergency services.
· Dental Coverage: All Covered California health insurance plans offer embedded pediatric dental coverage. This means that dental insurance for children is included in the price of all health plans purchased in the exchange. In addition, Covered California now offers supplemental dental coverage for adults, through optional family dental plans.
· Vision Coverage: Covered California offers consumers a pathway to quality vision care. Vision care benefits for children are included in all health plans purchased through the exchange. Vision care for adults is not offered in Covered California health plans, but Covered California works with certain vision insurance companies to offer vision coverage directly to consumers.
What is SEP?
A. SEP is the special enrollment period- it allows anyone to apply for health insurance outside of the open enrollment. Here are the SEP reasons:
- 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
- Member of a Federally Recognized American Indian or Alaska Native Tribe
Is Covered California the same as MediCal?
Is Covered California a health plan?
No. Covered California (aka the Exchange) is an online marketplace where people can shop, compare and purchase health insurance for individuals/families and small businesses.
How does Coveredca verify income?
How much money can you have in the bank and still qualify for Covered California?
Can you make too much money for Covered California?
What income is counted for Covered California?
What is Covered California™? What is “Obamacare”? Are they the same?
What is the Medi-Cal program?
Who can buy health insurance through Covered California?
When will I be able to get coverage through Covered California?
What kind of health insurance can I buy through Covered California?
What does Covered California health insurance cover?
What are the coverage levels?
How much will it cost me to purchase health insurance through Covered California, and will I be eligible for financial assistance?
What kind of help is available to reduce the cost of insurance?
Am I eligible for premium assistance?
How much financial assistance can I get?
Can I decline Medi-Cal and enroll in a Covered California health insurance plan and receive the federal premium assistance?
I have health insurance through my employer, but coverage for my spouse and child are too expensive. Would I be eligible for premium assistance for a plan for my child?
Why should I buy health insurance?
Do I have to buy health insurance? What are the penalties for not having health coverage?
How will Covered California help me find health insurance I can afford?
What if I already have health insurance?
Am I eligible for cost-sharing subsidies?
What is considered annual income?
What if my income changes?
What if I have a pre-existing health condition?
What if I need help choosing health insurance?
How do I apply for Covered California coverage or Medi-Cal?
What documents will be verified for enrollment into Covered California?
I’m pregnant and do not have insurance. What health coverage is available for me?
I live in California but spend months out of California for work. Will Covered California health insurance plans cover me while I am traveling?
Will I be able to purchase a dental plan and a vision plan through Covered California?
How much are the premiums if I have pre-existing conditions?
How can you use Covered California in conjunction with Medicare parts A, B and D?
If someone’s Medi-Cal coverage is cancelled because of increased income, does that person qualify for special enrollment into Covered California?
Will patients be able to keep their same doctor when they purchase health insurance through Covered California?
if you have any of the above questions, please reach out to us! We would love to help!
Forms to confirm CoveredCA status - If you need to confirm your identity, please reach out to us!
Covered California’s mission to expand coverage by making health care more affordable is based on Californians getting the health insurance they need at an affordable price. Many people get health insurance through their job but could not afford it if they needed to pay the full premium themselves, just as many households can only afford their premium because of the financial assistance that is available from the federal government. This assistance reduces the amount paid for health insurance depending on the individual’s or family’s income. Premium assistance is calculated based on where the person falls on the federal poverty level scale. The above table depicts incomes and federal poverty level percentages. Those making 138 percent of the federal poverty level or less may qualify for Medi-Cal, the low-cost or no-cost health insurance program in California.
If you are confused or need help calculating/estimating your premium assistance or have other questions related to your CoveredCA account, feel free to reach out- we can help! (You can find us using "Find Local Help" tool on CoveredCA - and type the agent's name: Diana Polyakov lic. #0I21751)
Check out this great video
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