In this post, I am going to break it down to the basics for you- the main things you need to know.
What is Covered California?
Covered California is a state-run marketplace where Californians can shop for health insurance plan, including private plans, and they may qualify for financial assistance through tax credits and other subsidies to help pay their monthly premium.
Is this the same as Medi-Cal or considered "welfare" insurance?
No to both! Medi-Cal offers low-cost or free health insurance to eligible Californian residents with limited incomes. Medi-Cal is a state and federal funded program that is part of the broader social welfare system that aims to support people in need.
Covered California is not considered to be "welfare" insurance, but simply a means to help blue collar working class families afford their insurance premiums.
Where does the money to pay for Covered California come from?
Premium tax credits, also known as subsidies, come primarily from the federal government. The government offers advanced premium tax credits (also known as APTC) to individuals or families who qualify and need help paying for their premiums. These credits are applied directly to the monthly premium cost, which in turn reduces the consumers cost on their monthly premium.
How do I find out if I qualify?
Eligibility for Covered California is based on a few things. You must reside in California, you cannot be enrolled in Medicare, have access to affordable health coverage through an employer*, you must be a lawfully present immigrant, and your household income will determine your eligibility for financial assistance.
Medicare: If you are eligible for Medicare, you cannot be on Covered California. Typically your health insurance agent will remove you when the time comes. But, it is your responsibility to make sure you don't slip through the crack! Covered California can come back at tax time and take back anything they gave you that you shouldn't have earned.
Employer insurance: This is a little tricky, because what you deem to be "unaffordable" might be classified as "affordable" through Covered California. Typically if you are offered work insurance through your employer, you will not qualify. It is possible your family would qualify, but this can be quite complicated. You want to make sure you are not enrolling your family in something they truly shouldn't have, otherwise Covered California can take the money back at tax time. If you think you or your family might qualify, reach out to me and I am happy to do a review for you!
Lawfully Present Immigrant: A non-citizen who is permitted to live and/or work in the country, typically with permission from the U.S. Government. You will need to provide proof of this when you apply for Covered California.
Household Income: This is the one that people most often get hung up on. The income you report to Covered California must be the taxable total of income for your entire household. It doesn't matter if your spouse has their own insurance and they aren't applying. When you apply, it is based on the entire households income. if you fall within the limits of the federal poverty level chart, you might qualify for help! This is very important to remember. If you underreport your income, at tax time (say it with me!) Covered California can take back the overpayments they provided.
What is the federal poverty level (FPL) chart?
The FPL chart is used to determine eligibility for various programs like Medi-Cal and Covered California. This is derived from the annual FPL figures published in the Federal Register by the U.S. Department of Health and Human Services (HHS). These guidelines are update annually and are used to determine income thresholds for eligibility in state and federal programs. This is our most recent FPL chart, as of todays date.
How do I apply?
You can do this yourself by going to www.coveredca.com . However, due to the complexity of Covered California and all of its nuances, I do strongly suggest using a health insurance agent. Agents undergo training in order to be licensed to sell health insurance, as well as additional training yearly to sell Covered California. Each time we renew our health insurance license, we are required to have 27 hours of continuing education.
What will you need to help me?
I will make a copy of your driver's license and have you fill out a short intake form. I will process your application, upload a copy of your driver's license to Covered California, report your household income and then submit the application. Once that has been completed, I will help you choose the plan that best suits your needs.
Will it cost me extra to use you?
Absolutely not! In fact, it is illegal for a health insurance agent to charge you for a sale. I am paid through the carrier, a small portion each month. Your premium will not be higher because you used a health insurance agent- your premium is based on the qualifying factors listed above, as well as your age, the number of people on your plan and the number of people in your tax household.
Are you ready? Reach out to me today!
