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Frequently Asked Questions:
Frequently Asked Questions about health insurance:
(we have all of these questions answered on our YouTube Channel and more resources. Please visit us & Subscribe to us on YouTube and stay up to date on this information)
- What is health insurance? - Health insurance is a type of coverage that helps individuals pay for medical expenses and services.
- How does health insurance work? - Health insurance works by individuals paying premiums to an insurance company in exchange for coverage of medical expenses, subject to certain deductibles, copayments, and limits.
- Why do I need health insurance? - Health insurance provides financial protection against unexpected medical expenses and ensures access to necessary healthcare services.
- What types of health insurance plans are available in California? - Common types include HMO, PPO, EPO, and POS plans, each with different networks and coverage options.
- How do I choose the right health insurance plan for me? - Consider your healthcare needs, budget, preferred providers, and coverage options when selecting a plan.
- Can I get health insurance if I have pre-existing conditions? - Yes, under the Affordable Care Act, insurance companies cannot deny coverage or charge higher premiums based on pre-existing conditions.
- How much does health insurance cost in California? - Costs vary based on factors like plan type, coverage level, age, and location. It's best to obtain personalized quotes to determine specific costs.
- Can I get financial assistance to help pay for health insurance? - Yes, individuals with certain income levels may qualify for subsidies or tax credits through programs like Covered California.
- What is the difference between HMO and PPO plans? - HMO plans require referrals and have a primary care physician, while PPO plans offer more flexibility in choosing providers.
- What does "deductible" mean in health insurance? - The deductible is the amount individuals must pay out-of-pocket for covered services before the insurance company starts contributing.
- How does copayment work? - Copayment is a fixed fee individuals pay at the time of receiving specific healthcare services.
- What is an out-of-pocket maximum? - The out-of-pocket maximum is the limit individuals pay for covered services in a policy year, after which the insurance company pays 100%.
- Are preventive services covered by health insurance? - Yes, most health insurance plans are required to cover preventive services without cost-sharing, such as vaccinations and screenings.
- What is the open enrollment period for health insurance in California? - Open enrollment is a specific period during which individuals can enroll in or make changes to their health insurance plans. (typically from November 1 - January 31).
- Can I get health insurance outside of the open enrollment period? - You may qualify for a Special Enrollment Period if you experience a qualifying life event, such as marriage or loss of job-based coverage.
- How do I apply for health insurance in California? - You can apply through Covered California, directly with insurance companies (Kaiser, Blue Shield, Anthem Blue Cross, VSP, etc ) or with the help of a licensed insurance agent or broker.
- What is Covered California? - Covered California is California's health insurance marketplace, where individuals can shop for and enroll in health insurance plans.
- Can I keep my doctor with my health insurance plan? - It depends on the specific plan and provider network. Check if your doctor is in-network before choosing a plan.
- What is a network in health insurance? - A network is a group of healthcare providers (doctors, hospitals, clinics) that have contracted with an insurance company to provide services at discounted rates.
- How do referrals work in HMO plans? - HMO plans often require a referral from a primary care physician to see a specialist.
- Is dental included in the medical insurance? For adults, dental insurance is a separate policy. Dental plan rates are as low as $8/month for HMO plans and $50/month for PPO plans.
- Is vision care included in the medical insurance? For adults vision insurance is a separate policy. There are plans available for as low as $15/month (annual contract is required for vision plans)
- What is Medicare? Medicare is a federal health insurance program in the United States primarily designed for individuals aged 65 and older. It also provides coverage for certain younger individuals with disabilities or end-stage renal disease. Medicare is divided into different parts, including Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage).
- What is Medi-Cal? Medi-Cal is California's Medicaid program, a joint federal and state health insurance program that provides free or low-cost medical coverage to individuals and families with low income.
- Is travel insurance covered by regular medical insurance? Typically for travel outside of US it's best to get a separate international travel insurance as it provides financial protection against unexpected events such as trip cancellations, medical emergencies abroad, lost baggage, or travel delays, giving travelers peace of mind and potentially saving them from significant expenses. For visitors and tourist to the US it's also advisable to apply for a visitor insurance while travelling. The rates are affordable and short term coverage is available for as low as 6 days!
What is the maximum income to qualify for CoveredCA?
Can legal immigrants receive Medi-Cal benefits or apply for a CoveredCA health plan?
What is Covered by Dental Insurance?
Do I have to pay a penalty if I don’t have health insurance in 2018 or 2019? do i need form 1095-A?
What are exemptions from health insurance tax penalty and who qualifies for exemption?
What are 1095 Tax Forms for Health Care 1095 A, 1095 B, 1095 C?
Why is Health Insurance expensive?
How to find a health insurance broker?
What is the difference of PPO and HMO?
What do you need to know about dental insurance?
What do you need to know about vision insurance?
How to save money on doctor’s visits?
What is covered by Kaiser plan?
What is covered by BlueShield plan?
What is covered by Valley Health PLan?
My Blog
Health Insurance Income Limits for 2023 to receive ACA premium s
October 12, 2022|Health Insurance
This post will help you answer some of the following questions:
What is the affordability threshold for 2023?
How is ACA affordability 2023 calculated?
Will there be ACA subsidies in 2023?
What is the ACA threshold for 2023?
What is the highest income to qualify for Medicaid 2023?
What is the income threshold for Covered California 2023?
What is the income limit for Medi-Cal 2023 family of 3?
What is the highest income to qualify for Medi-Cal?
What is the lowest income to qualify for Obamacare 2023?
Who qualifies for subsidies under the Affordable Care Act?
What happens if I underestimate my income for Obamacare 2023?
What is the most you can make for Marketplace insurance?
If you are shopping for health insurance and wonder what is the income limit for Marketplace Insurance 2023 and if you are eligible for Covered California subsidy this article will help you figure out if you qualify for lower premiums and save money on your health insurance for year 2023!
You may be eligible for federal assistance when you buy a health plan through your state’s marketplace. This assistance could lower the premiums you pay and reduce how much money you must pay out of your own pocket when you seek medical care.
It is very important to check in advance if you qualify and avoid paying more for your health insurance. The program eligibility by federal poverty level for 2023 will help you navigate the qualification for the premium tax credits.
.png/:/cr=t:0%25,l:0%25,w:100%25,h:100%25/rs=w:1280 "What is the affordability threshold for 2023? How is ACA affordability 2023 calculated? Will there be ACA subsidies in 2023? What is the ACA threshold for 2022? What is the highest income to qualify for Medicaid 2022? What is the income threshold for Covered California 2022? What is the income limit for Medi-Cal 2022 family of 3? What is the highest income to qualify for Medi-Cal? What is the lowest income to qualify for Obamacare 2022? Who qualifies for subsidies under the Affordable Care Act? What happens if I underestimate my income for Obamacare 2022? What is the most you can make for Marketplace insurance?")
It is very easy to use this chart!
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 $20,121/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. 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.
What Do The FPL Levels Mean?
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 Eligibility
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
Although premiums for marketplace plans generally increase each year, if you qualify for premium tax credits, the tax credit should cover most or nearly all of the cost increase. In general, you may be eligible for tax credits to lower your premium if you are single and your annual 2023 income is between $20,121 to $54,360 or if your household income is between $38,295 and $111,000 for a family of four.
However, please check if you qualify for subsidies even if your income is higher because as I mentioned earlier Consumers at 400% FPL or higher may receive a federal premium tax credit to lower their premium to a maximum of 8.5 percent of their income based on the second-lowest-cost Silver plan in their area.
Don't forget to apply for health insurance during the open enrollment.
.png/:/cr=t:0%25,l:0%25,w:100%25,h:100%25/rs=w:1280 "health insurance open enrollment 2023 Is Obamacare available in 2023? How often do open enrollment periods usually occur? What is the open enrollment period for Covered California? Is Obamacare still in effect for 2023? Does Covered California have open enrollment? How early should I apply for Covered California? How long will Covered California last? What is the open enrollment period for Covered California 2023?")
If you reside in California, mark your calendar and evaluate your healthcare options available in California from November 1, 2022 through January 31, 2023. During this time you can purchase a health insurance plan, switch to a new plan (upgrade, downgrade), add family members, or apply for subsidies to help pay for health insurance.
Once the Open Enrollment ends, you will no longer be able to add, upgrade/downgrade your health insurance plan, unless you experience a qualifying life event such as moving, getting married, having a baby, or leaving a job. You’ll have a 60-day Special Enrollment period to choose a new plan if you qualify under these special circumstances.
How to correctly estimate the income when calculating the subsidy?
Correct income reporting determines the eligibility for certain subsidies, or advance premium tax credits, or discounts whatever you want to call it.
Why this is important, is – because if you don’t estimate correctly your income or if you don’t report certain income or you report the income that you are not required… this will result in incorrect subsidy calculation and you can either have to pay back the APTC (or the subsidy) at the tax time or you end up overpaying for your health insurance. That is why it’s very, very important to calculate and estimate it correctly in order to avoid surprises at the tax time.
You can look at your tax return, form 1040, and find the AGI – adjusted gross income! This is the most accurate income that would need to be reported on your health insurance application; but keep in mind, that at the time of application you don’t know your AGI, since you will be doing the taxes 1 year from now, so do your best estimate to project this income!
Here are various income types that are required to be included when completing the CoveredCa application:
EMPLOYMENT & SELF-EMPLOYMENT INCOME
Employment Income
Tips, wages, pay, salary, bonuses
Self-Employment Income
Own business, freelance, contract, trade work
Foreign Earned Income
Taxable and nontaxable, see IRS Form 2555
Farming or Fishing
Income from farming or fishing
GOVERNMENT & ASSISTANCE INCOME
Social Security Retirement
Benefits paid to people 62 years and older
Social Security Disability
Benefits paid to disabled people under 65 years old
Social Security Survivors
Benefits paid to surviving family of a deceased worker
Unemployment
Federal or state government unemployment income, and State Disability Insurance (SDI) you get in place of unemployment benefits
Jury Duty Pay
Money earned serving on a jury
INVESTMENT & INTEREST INCOME
Capital Gains
Income from the sale of property or an investment
Interest Income
Taxable and nontaxable, see IRS Form 1099-INT
Ordinary or Qualified Dividends
Regular income from owning stocks, see IRS Form 1099-DIV
Other Gains or Losses
From the sale of property or other investments, see IRS Form 4797
RETIREMENT INCOME
Retirement or Pension
Income you get from retirement plans including 401k, 457, 509, Taxable IRA and Keogh
Railroad Retirement Benefits
Taxable and nontaxable, see IRS Form RRB-1099
EDUCATION SCHOLARSHIPS, AWARDS & GRANTS
AmeriCorps State/National Stipend & Education Award
AmeriCorps National Civilian Community Corps Stipend & Education Award
AmeriCorps Vista Stipend & Educational Award
Scholarships, Awards & Fellowship Grants
OTHER TAXABLE INCOME
Rentals / Royalties
Income from real estate or other property / Income from the sale or use of your work
Cancelled Debts
Debt forgiven without asking for anything in return
Court Awards
Income awarded by a court ruling
Taxable Refunds / Credits / Offsets
State or local tax refunds, credits or offsets, not your federal tax return
Alimony
If you get alimony payments from a spouse or former spouse, enter that income here. For more information, see IRS PUB 504
Other Taxable Income
If you have taxable income we haven't asked about, enter it here
You may choose to estimate your income on a monthly or annual basis. What is important is that you carefully and correctly include all countable income that I’ve mentioned in this video. Making errors could prevent you from receiving all the financial help you are eligible for. Or, it could cause you to receive more financial help than you are eligible for, requiring you to repay the financial help when you file your taxes.
Covered California eligibility is based on annual income, and the system will calculate an annual income if a consumer enters their income on a monthly basis.
On the other hand- MediCal eligibility is based on monthly income, and the system will calculate a monthly income;
I hope this information was helpful for you! If you have a general question, please feel free to comment below! If you have an issue with your CoveredCa account or have a specific question, please feel free to reach out directly or you can delegate me as your agent and I’ll do my best and help you solve the issues. I am a CoveredCA Certified Insurance Agent and I am familiar with most issues and have successfully helped many consumers in the past!
Online information: www.InsuranceCenterHelpline.com
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We love helping people! We are an independent insurance agency in California helping individuals, families and small businesses find affordable health insurance plans that would work best for them and allow them to save money!
Feel free to reach out if you have questions or need help with finding the best health insurance plan and compare it with other companies!
Frequently Asked Questions:
Health Insurance Open Enrollment 2022
What is the income limit to qualify for Obamacare health insurance in 2023?
What is the income limit to get a subsidy in CoveredCA?
Can I get a health insurance stipend if I drive for Uber, Doordash and other apps?
Where can I get IRS form 1095-A and FTB 3895?
Cobra health insurance or CoveredCA?
When is the open enrollment to get health insurance for 2021?
What is Covered by Dental Insurance?
Is mental health covered by health insurance?
Do I have to pay a penalty if I don’t have health insurance in 2018 or 2019? do i need form 1095-A?
What are exemptions from health insurance tax penalty and who qualifies for exemption?
What are 1095 Tax Forms for Health Care 1095 A, 1095 B, 1095 C?
Why is Health Insurance expensive?
How to choose the best health insurance plan?
How to choose the best dental insurance plan?
Can new immigrants get Medicaid/Medi-Cal or Obamacare subsidized health insurance plans?
How to find a health insurance broker?
What is the difference of PPO and HMO?
How to delegate a Certified Insurance Agent in CoveredCA?
What do you need to know about dental insurance?
What do you need to know about vision insurance?
Emergency room vs. Urgent care cost
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About Us
Our Commitment to Quality
Insurance Center Helpline, Inc. is an insurance agency located in the San Francisco Bay Area with clients throughout California. The agency was established in 2013 (rebranded in 2018) for one purpose - To service the local community with understanding of their health insurance coverage options. We completely realize that shopping for health insurance can be confusing, frustrating, and most importantly it can be a complicated process - especially now, with changes brought by The Affordable Care Act (ACA). We will work with you, one-on-one, to educate you on how health insurance works - from acquiring a plan to understanding your plans benefits, and to how it can be used to pay for medical expenses. In the end, we hope to educate you on the current marketplace and to provide you with the information needed to choose a plan of insurance that best meets your financial and medical needs.
What makes the Insurance Center Helpline, Inc. unique is that we focus solely on the needs of our clients. We listen. We talk. We choose a health insurance product that works and best fits your individual, family or small business needs.
We recognize that no two individuals, families or businesses are alike – and the type and level of coverage needed will be equally unique. We will help you obtain the best possible plan at the best possible price for the most comprehensive coverage.
How We Can Help You
We will help you find a health insurance plan that will allow you to have access to top doctors, clinics and hospitals
See the Difference
We work with all the insurance carriers in California, so we can shop and Compare various options. We also work with CoveredCa and will be glad to assist with your enrollment, renewals & issues.