Affordable Care Act

All About the Covered California Income Limits

Published on January 29, 2020

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Based on your income you may qualify for tax credits when you enroll in health insurance in the state of California. According to Covered California.com, if your annual household income is somewhere between 0 and 600% of the Federal Poverty Line (FPL), you may qualify for some government assistance in affording your health insurance.

Can anyone get Covered California?

No. In order to be eligible for assistance through Covered California, you must meet an income requirement. In order to qualify for federal tax credits or a subsidy in California, you must make between 0-600% of the FPL.

If you make 601% of the FPL, you will be ineligible for any subsidies. Keep in mind that Tax deductions can lower your income level and may help you qualify for government assistance.

Source: Covered California

It’s important to know that your eligibility for subsidies and government assistance is dependent on your Modified Adjusted Gross Income (MAGI). Refer to the graphic below to calculate your MAGI.

How to calculate modified adjusted gross income

If you make between 138 and 400% of the FPL are eligible for premium tax credits. In addition to qualifying for a subsidy, you will also qualify for a California Silver Plan.

  • If you make >138 to 150% of the FPL, you will qualify for the Silver Enhanced 94 Plan, which covers 94% of the average annual cost of health care.
  • If you make >150 to 200% of the FPL, you will qualify for the Silver Enhanced 87 Plan, which covers 87% of the average annual cost of health care.
  • If you make >200 to 250% of the FPL, you will qualify for the Silver Enhanced 73 Plan, which covers 73% of the average annual cost of health care.

The California Silver Plans are a popular choice in that they tend to have affordable monthly premiums and mid-sized deductibles. They also have discounted fees for common medical services. The California Silver Plans may be best suited for those who are relatively healthy, mainly need routine doctor visits, and take generic drugs.

If you are an American Indian or an Alaskan Native and make between 0-600% of the FPL, you will typically qualify for either American Indian / Alaskan Native (AIAN) Zero Cost Share or AIAN Limited Cost Share.

What is the max income you can have and still qualify for Medi-Cal?

Source: Covered California

Typically, if you make between 0 and 138% of the FPL you will qualify for Medi-Cal. If you make over 138% of the FPL, you are unlikely to qualify for Medi-Cal unless you’re pregnant or otherwise medically needy.

Medi-Cal for Pregnant Women

The Medi-Cal program has been expanded to provide pregnant women with government assistance affording with their health insurance. If you’re pregnant and have a household income from >138% to 213%, you may qualify for MAGI Medi-Cal. If you are pregnant and have a household income of >213% to 322%, you may be eligible for assistance through the Medi-Cal Access Program (MCAP).

Government Programs for Children

In order to qualify for Medi-Cal adults must have a household income of less than 138% of the FPL. However, Children qualify for Medi-Cal when their family has a household income of 266% or less. In order to qualify, children must be under 19 years old.

If your household income is >266% to 322% of the FPL, the County Children’s Health Initiative Program (C-CHIP) offers health care coverage.

Make sure to report any mid-year income changes

If you or anyone in your household experiences any significant income changes throughout the coverage year, make sure to report them as soon as possible. You may become eligible or ineligible for subsidies depending on how your income changes.

If you experience a significant increase in your yearly income and become ineligible for subsidies, you may have to pay your subsidies back during tax season the following year. This is why it’s important to try to be as accurate as possible when reporting your income when you apply for subsidies at the start of the year.

Make sure to report any income changes as soon as possible to avoid missing out on coverage or owing money at the end of the year.

What if I don’t qualify for a subsidy?

If you do not qualify for a subsidy, you may have to pay for your health insurance on your own. Many people who make just over the subsidy cut off have a difficult time affording their coverage. This – which is referred to as The Subsidy Cliff – mostly affects middle-income individuals and families.

Additionally, California has passed an individual mandate law at the state level. This means that if you don’t qualify for an exemption and go without health insurance for the 2020 coverage year you may have to pay a tax penalty at the end of the year. This tax penalty is $696 per adult (this number will rise with inflation every year) or 2.5% of household income, whichever is larger. You can learn more about the penalty in our breakdown of the changes to California health insurance.

However, with eHealth you can use our free online tools to help compare government plans to private health insurance plans to see if private health insurance is more affordable option for you. Even if you don’t qualify for subsidies, eHealth has affordable options that are right for both your health insurance coverage and budgetary needs.

To start comparing health insurance options online with eHealth, enter your zip code below.

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