Affordable Health Coverage - If I still cannot afford it, are there financial assistance programs available to me?

Many people know they need health insurance but are concerned about the price. Luckily, there are options built into the Affordable Care Act (ACA) to provide for those who may need financial assistance.

What is Covered California?

California is the first state to create a health benefit exchange following the passage of federal health care reform.  Covered California is charged with creating a new insurance marketplace that allows individuals and small businesses to purchase competitively priced health plans using federal tax subsidies and credits.

How will Covered California work with my finances?

Covered California will help people find out if they qualify for federal financial assistance that will lower their costs.  If they qualify, the only way one can take advantage of the subsidy is by going through Covered California either directly, by your Certified insurance broker or agent or another Certified agency. There are three financial assistance programs to help make sure everyone can afford health care. These programs are available to individuals and families who meet certain income requirements and do not have affordable health insurance with minimum coverage standards from an employer or another government program.

To be eligible for financial support, consumers must purchase plans from Covered California’s marketplace. The State of California is leading the health care innovation process by requiring that all carriers offer these same standard designs to all individuals and small businesses – whether inside or outside of Covered California.  While higher income individuals choosing one of these plans would not be eligible for financial help, they would be assured that the plan contains the same essential health benefits offered, and the exact same benefit design so they can make true comparisons.

1. Tax credits:  Tax credits are available to help lower the cost of your insurance premium, which is the amount you pay to buy health insurance, usually each month. When you enroll in a health plan through Covered California or a certified broker or agency, tax credits can be immediately applied to the insurance premium, which reduces the amount you pay each month.

2. Cost-sharing subsidies:  Cost-sharing subsidies reduce the amount of health care expenses an individual or family has to pay when you get care. These expenses might include copayments or other costs incurred when you receive medical care.

3. Medi-Cal assistance:  Medi-Cal is free health coverage for those who qualify, including people with disabilities, and those with incomes of less than $15,000 for a single individual and $31,180 for a family of four.

This chart summarizes the individuals and families eligability for certain federal programs provided for the Affordable Care Act

What if my income changes?

Any eligible Californian without insurance can shop through Covered California for coverage, regardless of income. Your income level helps determine your eligibility for Medi-Cal coverage or a financial assistance program, such as a tax credit, to help pay your health care costs. If your income changes over the year, your tax credit will be adjusted. If your income increases, you will have to pay the difference at tax time if you have not adjusted your tax credit.

If you have Medi-Cal coverage and your income increases to more than $15,415 a year for an individual or $31,810 for a family of four, you would no longer qualify for this no-cost government insurance plan.  However, through Covered California, you could find affordable coverage and tax credits to help pay the premiums.