If you live in California and have a household income within certain parameters, you may be eligible for help paying for health insurance from the federal government and the State of California. The assistance may be offered in the form of Medi-Cal or in the form of a federal “tax credit” that lowers the cost of your health insurance. Read on to figure out if you could be eligible for either.

First understand the FPL

To calculate your eligibility, it’s first important to know what the Federal Poverty Limit (FPL) is. As of May 2021, the FPL is $12,420. Knowing this, you can calculate everything else.

How do I know if I am eligible?

There is a limit to the household income you can have in order to qualify for health insurance assistance. The federal government will look at your Modified Adjusted Gross Income (MAGI). As you calculate your MAGI, keep in mind that tax deductions can lower it, so take advantage of them. Common tax deductions include things like child and dependent care, earned income tax credits, and charitable donation deductions.

This chart from Covered California will help you calculate your MAGI. You’ll notice that your MAGI must be between 0% and 600% of the FPL to receive any sort of health insurance assistance.

Depending on where your income falls, you may be eligible for one of these two options:

• If you make up to 138% of the FPL, you will likely qualify for Medi-Cal. If you make over 138% of the FPL, you are unlikely to qualify for it, unless you’re pregnant or have special medical needs. Medi-Cal has unique programs for pregnant women earning between 138% and 322% of FPL, as well as children whose families earn 266% or less of FPL.
• If you make between 138% and 400% of the FPL, federal tax credits will help you and you will be eligible to purchase a California Silver Plan. The Silver Plan is lower-cost health insurance with affordable monthly premiums, mid-sized deductibles, and lower fees for medical services. Being eligible for a California Silver Plan means that a large portion of the annual cost of health care is covered for you (between 73% and 94%). In addition, if you are an American Indian or an Alaskan Native and make up to 600% of the FPL, you will typically qualify for even better pricing or pay nothing for the plan. The California Silver Plan is great to consider if you are fairly healthy, visit the doctor primarily for check-ups, and take generic drugs.

Connecting Californians with health insurance

Covered California connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well-known companies. That means when you apply, you may qualify for a discount on a health plan through Covered California or get health insurance through the state’s Medi-Cal program. Either way, you’ll have great health coverage.

From April 12, 2021 through the end of this year, Covered California is holding a special enrollment period to give uninsured and unsubsidized Californians time to sign up for coverage on the exchange.

More assistance as of March 18, 2021

On March 18, 2021, Covered California announced that it will be finding ways of getting new government subsidies (which were part of the recently-enacted federal American Rescue Plan Act (ARPA)) into the hands of qualified people. Covered California estimates that more than three million Californians will be eligible for the new ARPA subsidies and nearly a million more will become eligible for Medicare. Another result of ARPA is that the overall price of health care plans has gone down and is now capped at 8.5% of a person’s annual income through the end of 2022. If you’re already enrolled in health insurance through Covered California, it is necessary to take action because your premium payments will automatically be lowered starting May 2021.

Covered California estimates that most of its currently enrolled customers will see an average of $119 per household in premium savings. And, if you receive unemployment compensation in 2021, you will likely be entitled to free coverage.

Who can help me get started?

KeenanDirect knows that any form of assistance is welcome relief as you strive to keep you and your family healthy. If you think you may be eligible for the above programs, we are ready to help you calculate your MAGI, discover your eligibility, weigh your options, and apply. To talk to a helpful KeenanDirect specialist free of charge, please click here. We look forward to helping you receive the health insurance benefits that are rightly yours.