California Exchange

The California Exchange, named Covered California, was conditionally approved by the US Department of Health and Human Services in January of 2013.

Eligibility for Subsidies from Covered California

HCR Home » California Exchange » Eligibility for Subsidies from Covered California

Starting in 2014, health insurance coverage for individuals may be more affordable based on two types of subsidies available through Covered California.  Premium tax credits reduce an individual’s monthly premiums while cost-sharing subsidies reduce the amount of out-of-pocket costs, such as co-pays, co-insurance and deductibles.

Premium Tax Credits

Premium tax credits are available for individuals and families who meet certain income requirements and who do not have access to affordable health insurance that provides minimum value through their employer.  Eligibility is based on the federal poverty level and the size of the credit is based on a sliding scale so that those making less money may get more financial assistance.  Individuals and families making between 138 percent and 400 percent of the federal poverty level may be eligible for a tax credit.

Eligibility for a certain year is based on the most recently published set of poverty guidelines available as of the first day of the annual open enrollment period.  In other words, the tax credit for 2016 will be based on the 2015 guidelines, which means that an individual making up to $47,080 and a family of four earning up to $97,000 may be eligible for a premium tax credit for 2016.

Premium tax credits are only available for coverage purchased through Covered California.  Individuals may choose to receive the credits in advance each month to lower the monthly cost or may claim the credits at the end of the year on their tax return.

Cost-Sharing Subsidies

Cost-sharing subsidies reduce the amount of out-of-pocket expenses an individual or family must pay.  Individuals and families who are eligible for premium tax credits and whose household income is between 138 percent and 250 percent of the federal poverty level may receive cost-sharing subsidies if they enroll in a Silver plan.

 

Additional Information
Covered California Website – Health Care Costs and Getting Help Paying for Coverage
Information on premium assistance from Covered California.