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.
Understanding Income Limits: The Affordable Care Act (ACA) introduced premium subsidies to ensure that health insurance remains accessible to a broad spectrum of individuals and families. The key factor in determining your eligibility for these subsidies is your annual income, measured as a percentage of the Federal Poverty Level (FPL).
For 2024, let's break down the income limits and what they mean:
Why You Should Check Your Eligibility: Checking your eligibility for premium subsidies is crucial because it can significantly impact your healthcare costs. By leveraging these subsidies, you can access quality health coverage without breaking the bank.
A few key points to keep in mind:
Feel free to reach us in case you have questions or are unsure how to interpret the above information.
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 $20,121/year then you qualify for Medi-Cal (this is how Medicaid is called in California).
If your income is above $20,122/year but less than $58320/year (or higher depending on age!) then you qualify for the APTC (advance premium tax credits) or subsidy that will help you pay less for health insurance. If your income is higher, I encourage you to still check for the subsidy. Based on the American Rescue Plan, you should not have to pay more than 8.5 percent of your income for health insurance premiums even if your income is higher than 400% of the PFL. So, I highly advise that you check the subsidy before you make a decision to enroll in a health insurance plan!
It will allow you to determine if your household income qualifies for certain programs and assistance with lower health insurance premiums, copays, and coinsurance.
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:
Medical for adults- income should be less than 138% of the FPL
Medical for children- household income should be up to 266% of the FPL
MCAP: over 213% — 322% FPL
CCHIP program in Santa Clara County, San Francisco, and San Mateo: over 266% — but less than 322% FPL
CoveredCa private plan income limits:
Premium Assistance 138% — 600% FPL
Enhanced Silver Plans 138% — 250% FPL
• Silver 94 138% — 150% FPL
• Silver 87 over 150% — 200% FPL
• Silver 73 over 200% — 250% FPL
The 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
Importance of Income Limits:
Covered California, the state's health insurance marketplace, uses income limits to determine eligibility for premium subsidies.
Affordable Care Act (ACA): The ACA introduced premium subsidies to ensure health coverage remains accessible for a wide range of individuals and families.
Income Determination: Your eligibility for these subsidies is based on your annual income, measured as a percentage of the Federal Poverty Level (FPL).
CoveredCA Eligibility: To qualify for CoveredCA, your income must be above 138% of the FPL. For a single individual, this equates to an annual income below $20,122.
Medi-Cal Eligibility: To qualify for Medi-Cal, California's Medicaid program, your income must be below 138% of the FPL. For a single individual, this equates to an annual income below $20,121.
Household Size and Income: Eligibility depends on your household size and income. You can easily determine what program you qualify for using these criteria.
APTC Eligibility: If your income exceeds Medi-Cal limits but falls within specific thresholds, you may qualify for Advance Premium Tax Credits (APTC). These subsidies reduce your monthly health insurance premiums through Covered California.
Income Ranges: For example, a single individual with an income between $20,122 and $58,320 may qualify for APTC. Extra discounts may be available for those with higher incomes, so it's advisable to use the subsidy calculator for accurate assessments.
Generous Subsidies: Thanks to the Inflation Reduction Act and state financial support, 2024's subsidies are more generous. Some individuals may see no change in monthly premiums, while others might have deductibles eliminated for certain plans.
Significant Impact: Checking eligibility for premium subsidies is crucial, as it can greatly affect healthcare costs. These subsidies make quality health coverage more affordable.
Annual Adjustments: Income limits are adjusted annually, so it's important to stay updated. What might not have made you eligible one year could change the next.
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 ZIP CODE: 94105, SELECT 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.
All the assistance is offered at no cost to you!
Insurance agents typically do not charge a fee for their services to customers. Instead, they earn a commission from the insurance company when they sell an insurance policy. This commission is built into the cost of the insurance policy, so customers do not pay extra for using an agent's services.
The commission structure can vary depending on the type of insurance and the specific insurance company. For example, agents may receive a higher commission for selling certain types of insurance, like life insurance, compared to others. This commission system incentivizes agents to help customers find insurance policies that meet their needs.
It's essential to understand that when you work with an insurance agent, their goal is to help you find the right insurance coverage, and they are compensated by the insurance company, not by charging you a direct fee for their services.
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)
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