Medi-Cal Eligibility and Covered California – Frequently Asked Questions

Medi-Cal Health Coverage

1. What is Medi-Cal?

Medi-Cal offers free or low-cost health coverage for California residents who meet eligibility requirements.  Most applicants who apply through Covered California and enroll in Medi-Cal will receive care through managed health plans.

Medi-Cal has always covered low-income children, pregnant women and families.  On January 1, 2014, California expanded
Medi-Cal eligibility to include low-income adults.  When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined.  You can apply for Medi-Cal benefits regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability, or veteran status.

2. How much does Medi-Cal cost?

For many individuals who enroll in Medi-Cal, there is no premium, no co-payment, and no out of pocket cost.  Some households will see affordable costs, such as a low monthly premium.  For some Medi-Cal children, the monthly premiums are $13 per child up to a family maximum of $39 per month.  In general, individuals in Medi-Cal will get the same health benefits available through Covered California at a lower cost.

3. What is the difference in coverage between Medi-Cal and Covered California?

Medi-Cal is health coverage, just like the coverage offered through Covered California.  Medi-Cal provides benefits similar to the coverage options available through Covered California, but often at lower or no cost to you or your family.  All of the health plans offered through Covered California or by Medi-Cal include the same comprehensive set of benefits known as “essential health benefits.” Essential health benefits consist of:

  • Outpatient (Ambulatory) services
  • Emergency services
  • Hospitalization
  • Maternity and Newborn care
  • Mental Health and Substance Use Disorder Services, including Behavioral Health Treatment
  • Prescription Drugs
  • Programs such as physical and occupational therapy (known as Rehabilitative & Habilitative Services) and devices
  • Laboratory services
  • Preventive and wellness services & chronic disease management
  • Children’s (Pediatric) services, including oral and vision care.
A recent survey of Medi-Cal members by the California Healthcare Foundation (CHCF) found that 90% of respondents rate Medi-Cal as a good or very good program.  Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure members receive the right care at the right time.

4. How is the state and/or counties reaching out to the homeless population to sign them up for health care?

Outreach and Enrollment Grants for Targeted Populations:

Individuals who are homeless are one of the target populations for $25 million ($12.5 million in The California Endowment funds plus $12.5 million in federal funds) for grants to counties under AB 82, trailer bill language enacted as a part of the 2013-14 budget (see excerpt attached). The Department of Health Care Services (DHCS) has released guidance to the counties about these funds (attached) and held a webinar (attached) to date, with the goal of distributing grants to counties by February 1, 2014.  For more information on Outreach and Enrollment efforts click on the link Outreach and Enrollment.

California Policy Academy to Reduce Chronic Homelessness Workgroup:

California is one of four states that recently participated in a federal Substance Abuse and Mental Health Services Administration (SAMHSA) Policy Academy to Reduce Chronic Homelessness. With the expansion of Medi-Cal eligibility, many people who are experiencing chronic homelessness will be able to enroll in Medi-Cal. The Policy Academy state team and consultant are currently engaging homelessness subject matter experts in a Medi-Cal Outreach and Enrollment workgroup to explore preparing a toolkit of best practices for outreach and enrollment of the chronically homeless population that DHCS could then share with Outreach and Enrollment grantees. This will build upon best practices from the Low-Income Health Program (LIHP) as well as recent philanthropic funding efforts to enroll the chronically homeless population.

5. What health plans are available through Medi-Cal?

Medi-Cal managed care offers a selection of 21 health plans. Your health plan options will vary depending upon the county in which you live.  Most counties offer commercial plans, which also operate in Covered California including Anthem Blue Cross, Kaiser, Health Net, and Molina. Other plans are public plans administered by the community. Every county’s Medi-Cal plans provide the same high quality care at the same low or no cost to Californians, no matter where you live.  The directory of health plans available through Medi-Cal managed care is available online at: Medi-Cal Managed Care: Health Plan Directory.

6. Will I be able to stay with my doctor?

More than 400 hospitals and approximately 130,000 doctors, pharmacists, dentists, and other health care providers participate in the Medi-Cal program to provide medically necessary services to members. Most Medi-Cal members who participated in the CHCF study said it is easy to find a primary care physician nearby.  You can search for a managed care provider on the Department of Health Care Services website atHealth Care Options.

7. Is it possible for the members of the same family to qualify for different coverage at the same time?

The Covered California application is a single application for multiple health coverage programs. It is common that members of the same family or tax household are eligible for different programs. For example, both parents could be eligible for tax credits through Covered California, while the children are eligible for Medi-Cal. This is because the eligibility rules for Medi-Cal kids are different than for adults, which ensures that no child lacks affordable coverage. In other cases, one parent may be eligible for Covered California without subsidies because they have access to affordable coverage through their job, while their spouse is eligible for premium assistance tax credits through Covered California and the children are eligible for Medi-Cal.

8. What do I do if I have questions about medications, accessing doctors, or specialists?

If you have questions about your coverage under Medi-Cal managed care, you can call your health plan’s customer service representatives directly, just as you would under any other health coverage plan.  To access the Medi-Cal managed care health plan directory, please log on to:  Medi-Cal Managed Care: Health Plan Directory.

9. Can I decline Medi-Cal and enroll in a Covered California health plan and receive the federal premium assistance?

Under federal law, if you are currently enrolled in or are eligible for Medi-Cal, you are ineligible to purchase subsidized coverage through Covered California.  If you are eligible for Medi-Cal, you can still purchase a health coverage plan through Covered California, but you cannot receive premium assistance to reduce its cost and will have to pay the full cost of the Covered California health care plan’s premium.

10. Is there a deadline to enroll in Medi-Cal?

No.  There is no deadline to enroll in Medi-Cal. You can apply at any time during the year.  When you are determined eligible for Medi-Cal, your eligibility goes back to the month of your application.  In some cases, you may be able to receive Medi-Cal coverage right away.  Contact your county human services agency at County Offices for more information.  However, enrollment in Covered California only occurs during an open enrollment paper, so if you are trying to enroll some household members in Medi-Cal and others in Covered California, be sure to enroll in time for the households seeking coverage through Covered California.

11. If someone’s Medi-Cal coverage is cancelled due to increased income or decreased household size, does that person qualify for special enrollment into Covered California?

Yes, losing health coverage such as Medi-Cal is considered a qualifying event that would trigger a special enrollment period.  Other qualifying events include:

  • Permanently moved to/within California
  • Lost or will soon lose their health insurance, including Medi-Cal eligibility (also known as loss of Minimal Essential Coverage (MEC)
  • Had a baby or adopted a child
  • Got married or entered into a domestic partnership
  • Domestic violence survivors  (If married, abuser’s income not counted if survivor lives apart and is unable to file joint tax return.)
  • Returned from active duty military service
  • Released from jail or prison
  • Gained citizenship/lawful presence
  • Federally Recognized American Indian/ Alaska Native
  • Other qualifying events as identified on the Covered California portal

In the event that one of these life events does occur, you would be eligible to enroll within 60 days of that event.  During that period you could not be denied coverage by a health plan in Covered California or in the individual market if you are otherwise eligible, and you could be eligible for the premium assistance that is only available through Covered California.

12. My Medi-Cal has been discontinued and I am now able to enroll in Covered California during a Special Enrollment Period (SEP), how can I avoid a gap in my health coverage?

If your Medi-Cal will be or has been discontinued, in order to avoid a gap in your health coverage, you should pick a Covered California plan before the date your Medi-Cal ends.  If you do not select a Covered California plan in the same month your Medi-Cal ends, you will not have health care coverage for at least a month.  You must also pay your Covered California premium by the due date when you are billed in order to be covered.  If your request for enrollment is completed within 60 days of the qualifying life event date, the soonest your Covered California health plan can start will be the 1st of the month following your Covered California plan.selection.  If you wait more than 60 days after your Medi-Cal ends to pick a Covered California plan, you may not be able to enroll until Covered California’s next Open Enrollment Period. You may contact Covered California online at CoveredCA.com or call 800-300-1506 or contact your County Eligibility Worker for assistance in selecting your Covered California plan.  You may reach your County Eligibility Worker at the county social services agency via http://www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx.

13. I previously was denied Medi-Cal due to owning a car. Do I qualify now?

The Affordable Care Act simplified financial eligibility requirements for Medi-Cal program eligibility.  Under these simplifications, “property” such as a car, is no longer counted.  You should apply through Covered California for health coverage even if you previously were determined to be ineligible for Medi-Cal coverage and even though you may think your financial situation has not changed.

14. If I sign up for Medi-Cal, will anything happen to my assets?

Medi-Cal only tries to recover its costs for medical assistance after your death when a recipient is over age 55, or when a member of any age is cared for at an institution, such as a nursing home.  Medi-Cal does not seek payment during your lifetime or the lifetimes of your surviving spouse, disabled son or daughter, or while your child is under 21 years of age.  If you are under 55, you can sign up for Medi-Cal knowing that nothing will happen to your assets unless you are institutionalized.  For those over age 55 or in an institution, the Department of Health Care Services may present a claim for the cost of your care.  It would be paid from your estate at the time of your death.  For more information, please visit Third Party Liability.

Family

1. Will my family and I qualify for the same program?

Depending on your household size or family income, you or your family may qualify for different programs. For example, you may qualify for affordable private health insurance available through Covered California. However, your child may qualify for free Medi-Cal. We will tell you which health insurance you and other members qualify for.

2. I just found out I am pregnant. Can I apply for health insurance that will cover me during my pregnancy?

Yes. Make sure to answer yes to the application question “Are you pregnant?” or tell the person helping you to fill out your application. You can apply for health insurance that can cover pre-natal care, labor and delivery, and postpartum care. Health insurance plans can no longer deny health insurance if you are pregnant.

3. I just had a new baby. What should I do about health insurance?

If you did not have Medi-Cal or the Medi-Cal Access Program at the time of delivery, fill out this application for your newborn. If you did have Medi-Cal or the Medi-Cal Access Program during your pregnancy, you do not need to fill out this application. Call your county worker to make sure your baby is covered from birth, or fill out a newborn referral form. Print the MC 330 form. If you had coverage under the Medi-Cal Access Program call, 1-800-433-2611, or go to http://mcap.dhcs.ca.gov to register your baby.

Citizenship/Immigration

1. What eligibility requirements will an undocumented person have to meet come 2014?

An undocumented person must meet the same eligibility requirements as any other beneficiary such as income limits and California residency in 2014.

2. Does everyone on the application have to be a U.S. citizen or U.S. national?

No. You may qualify for health insurance through Medi-Cal even if you are not a U.S. citizen or a U.S. national.

3. Will I qualify for health insurance if I am not a citizen or do not have satisfactory immigration status?

You do not have to be a citizen or have satisfactory immigration status to qualify for Medi-Cal.  You may qualify for Medi-Cal coverage of emergency and pregnancy-related services if you meet all of the eligibility requirements but do not have a satisfactory immigration status. Immigrants who have a satisfactory immigration status and meet all eligibility requirements can qualify for full Medi-Cal coverage.

4. Will undocumented immigrants be eligible for full-scope Medi-Cal?

An immigrant who meets all eligibility requirements, but is not in a satisfactory immigration status for full scope Medi-Cal is entitled to emergency and pregnancy-related services and, when needed, state-funded long-term care.

5. Where can I get information about becoming registered to vote?

If you are not registered to vote where you live now and would like to apply to register to vote today please visit this website or call 1-800-345-VOTE (8683).

6. Will the information I provide for health coverage be used to verify my immigration status?

Immigration status is verified for documented immigrants who want Medi-Cal and claim to be in a satisfactory immigration status for full scope Medi-Cal.  This information is only used to verify status for Medi-Cal eligibility purposes.

7. Can people on H-1 visas, including those who have lived legally in the country for fewer than 5 years, enroll in Medi-Cal?

Yes. In general, anyone can apply for Medi-cal.  A person on an H1 visa is a temporary worker or trainee.  As long as they are living and working in California and provide evidence of that, they can meet California residency.  If they meet all other eligibility requirements, they will be eligible for restricted scope Medi-Cal limited to emergency and pregnancy related services.  It does not matter how long they have lived in the United States.  If they meet all eligibility requirements they will be eligible for restricted scope Medi-Cal.

8. Can green card holders, including those who have lived legally in the US for fewer than 5 years, enroll in Medi-Cal?

Yes. A lawful permanent resident (green card holder) is eligible for Medi-Cal regardless of their date of entry if they meet all other eligibility requirements.  Under current Medi-Cal policy, eligible green card holders get full scope Medi-Cal in California even if they have been in the United States for less than 5 years.

Other

1. Do I need health insurance now that health reform has started?

Starting in January 2014, most people over 18 years old will be required to have health insurance or pay a tax penalty. Coverage may include insurance through your job, coverage you buy on your own, Medicare, or Medi-Cal.

But, some people are exempt from having health insurance. Those people include, but are not limited to, people whose religious beliefs are opposed to accepting benefits from a health insurance plan, people who are incarcerated, people who are members of a federally recognized American Indian tribe, and those people who have to pay more than 8% of their income for health insurance, after taking into account any employer contributions or premium assistance.

In 2014, the penalty will be 1% of your yearly income or $95, whichever is higher. The penalty will go up each year. By 2016, the penalty will be 2.5% of your yearly income or $695, whichever is higher. After 2016, the tax penalty will increase each year based on a cost-of-living adjustment.

For more information about penalties, visit www.CoveredCA.com or call your local county social services office or Covered California.

2. What if I already have health insurance through my employer?

If you already have affordable health insurance from your employer, you do not need to do anything. But you can still apply anyway to find out if you or your family members qualify for free or low-cost free health insurance. If you apply, be sure to complete Attachment B and send it in with your application.

3. What does “self-employed” mean?

People who are self-employed earn a living directly from their own business or services. They do not earn money from a company that pays them.

Covered California

1. What is Covered California?

Covered California is the new marketplace that makes it possible for individuals and families to get free or low- cost health insurance through Medi-Cal, or to get help paying for private health insurance.

Our goal is to make it simple and affordable for Californians to get health insurance. Covered California is a partnership of the California Health Benefit Exchange and the California Department of Health Care Services.

2. How can Covered California help me?

Covered California can help you choose a private insurance plan that meets your health needs and budget. We offer some of the state’s best known health plans, and some regional or local plans too.

We can explain the costs and benefits of health insurance plans clearly, so you can compare the different choices available to you. You will know exactly what you’re getting and how much you have to pay before you choose your plan.

3. I am a federally recognized American Indian or an Alaska Native. How can Covered California help me?

If you are a federally recognized American Indian or an Alaska Native, you may be eligible for:

  • Free or low-cost insurance
  • Premium assistance
  • Reduced out-of-pocket expenses
  • Special monthly enrollment periods

You can also get services from Indian Health Services’ funded tribal health programs or Indian health programs.

Be sure to complete Attachment A and send it to it with your proof of Native American or Alaska Native heritage document. You may use the following documents to provide proof of your Native American Indian or Native Alaskan heritage:

  • Tribal enrollment card or
  • Certificate of degree of Indian blood (CDIB) from the Bureau of Indian Affairs

4. Can I get health insurance through Covered California?

Any Californian can get health insurance through Covered California if he or she is a state resident and cannot get affordable health insurance through a job.

Applicants may qualify for a free or low-cost health plan, or for financial help that can lower the cost of premiums and co-pays. The amount of financial help is based on household size and family income. Applicants qualify if their income meets the income limits.

5. When will I be able to get coverage through Covered California?

Covered California will begin enrollment on Oct. 1, 2013, for coverage that will take effect Jan. 1, 2014. The open-enrollment period for coverage during 2014 will run from Oct. 1, 2013, to March 31, 2014. If you are eligible for Medi-Cal, the open enrollment period does not matter.

6. I am currently enrolled in Medi-Cal. Can I get health insurance through Covered California?

If your income changes during the year or at your annual renewal, you may qualify for other health insurance and premium assistance through Covered California.

7. How do I apply through Covered California?

You can apply for health insurance through Covered California in the following ways:

    • Online: Visit www.CoveredCA.com. We provide information about each health insurance plan, explained in clear and simple terms.
    • By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
    • By fax: Fax your application to 1-888-329-3700.
    • By mail: Mail the Covered California application to:

      Covered California
      P.O. Box 989725
      West Sacramento, CA 95798-9725

    • In person: We have trained Certified Enrollment Counselors or Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free! For a list of places near where you live or work, visit www.CoveredCA.com or call
      1-800-300-1506 (TTY: 1-888-889-4500).

8. What will happen after I apply for health coverage?

You will receive a letter within 45 days to tell you which program you and your family members qualify for. If you don’t hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).

9. What health insurance is offered through Covered California?

You will have a wide variety of health plans to choose from. Health insurance companies cannot refuse to cover you because you have been sick before or could not get coverage.

Covered California offers four groups of private health insurance plans: platinum, gold, silver, and bronze, plus a minimum coverage plan.

Each group offers a different level of coverage, from high to low. Health insurance plans that cover more of your medical expenses will usually have a higher premium but allow you to pay less when you receive medical care.

Platinum plans have the highest premium, but they pay 90% of your health care expenses. Gold plans pay pay 80% and silver plans pay 70% of your health care expenses. Bronze plans have the lowest premium but pay just 60% of covered health expenses.

If you qualify for Medi-Cal, the coverage and costs are different and may be free for you.

10. I have a pre-existing condition. Can I get health insurance through Covered California?

Yes, you can get health insurance regardless of any current or past health conditions. Starting in 2014, most health insurance plans can’t refuse to cover you or charge you more just because you have a pre-existing health condition.

11. I have a disability. Can I get health insurance through Covered California?

You cannot be denied based on a pre-existing condition. Eligibility is based on income, not health status.

12. Will I be able to use my new Covered California health insurance plan right away?

Covered California health plans start providing services on January 1, 2014.

13. When someone enrolls in a health insurance plan during open enrollment but after Jan. 1, 2014, will the effective date be Jan. 1, or is it subject to the actual enrollment date?

If you enroll in a Covered California plan before Dec. 15, 2013, you can be eligible to have coverage that starts on Jan. 1, 2014. You will also need to pay your share of the premium before January. During the last three months of the initial Covered California open-enrollment period (from Jan. 1, 2014, through March 31, 2014), an individual who submits a completed application, receives an eligibility determination and makes a plan selection by the 15th of each month will receive a coverage-effective date of the first day of the following month, as long as the person’s full premium payment is received. For example, someone who has enrolled in a Covered California health insurance plan by Jan. 15, 2014, will have coverage beginning Feb. 1, 2014 if they pay their share of premium.

14. What is the difference between Medicare and Covered California’s open enrollment?

Currently, there are two open enrollment periods happening during the same period of time, which may be causing some confusion among California residents.

Covered California

  • The Covered California exchange will permit individuals to enroll in health plan coverage or Medi-Cal during the initial enrollment period from October 1, 2013, to March 31, 2014, and thereafter during an open enrollment period that will begin on October 15 and last through December 7 annually. People who want to enroll in a health plan or find out if they are newly eligible for Medi-Cal, can call Covered California at 1-800-300-1506 or visit www.CoveredCA.com for information.

 Medicare Open Enrollment

  • Medicare’s open enrollment period is October 15 through December 7 for all people with Medicare.  Medicare clients can change their Medicare health plan and prescription drug coverage, which will take effect January 1, 2014.  People with Medicare can call 1-800-MEDICARE or visit www.medicare.gov for plan information.  If the person is satisfied with their current plan, they do not need to do anything.

Getting Help With Covered California

1. How can I choose a health insurance plan?

If you qualify for private health insurance plans through Covered California, you can visit www.CoveredCA.com to easily shop and compare health insurance plans. Covered California health plan brochures are also available for you.

2. What region am I in?

There are 19 pricing regions in California. For health plans that consumers can get through Covered California, either with or without premium assistance, the plans available and their prices vary by region. The easiest way to find the pricing region you live in is to use our Shop and Compare Tool online at www.CoveredCA.com/fieldcalc4calculator. After entering your home ZIP code, the Shop and Compare Tool will show you your pricing region. You may also call our Service Center for assistance by calling (800) 300-1506.

3. How much will my health coverage premium cost?

The cost depends on what health insurance programs and financial assistance you qualify for, as well as which plan you choose. You can use the cost calculator at www.CoveredCA.com to find the cost and see if you qualify for help paying insurance.

4. I don’t have all the information I need to answer the questions on the application. What should I do?

If you don’t have all the information, sign and submit your application anyway. We will call you to tell you what to do within 10 to 15 calendar days after we get your application. If you don’t hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).

If you don’t have all the information, sign and submit your application anyway. We will call you to tell you what to do within 10 to 15 calendar days after we get your application. If you don’t hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).

5. Can I get help with my application or with choosing a plan?

Yes! Help is free. Certified Enrollment Counselors or Certified Insurance Agents are  available in communities across the state to give you information about new health insurance choices and help you apply. You can also  get help by visiting  your  county social  services office. You can  get help in many different languages.

Get help  with your application or with choosing a plan:

    • Online: Visit www.CoveredCA.com.
    • By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
    • By fax: Fax the appeal to 1-888-329-3700.
    • By mail: Mail the appeal to:
      Covered California – Appeals
      P.O. Box 989725
      West Sacramento, CA 95798-9725
    • In person: We have trained Certified Enrollment Counselors and Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free!

 

For a list of Certified Enrollment Counselors and Certified Insurance Agents near where you live or work, or a list of county social services offices near you, visit www.CoveredCA.com or call 1-800-300-1506 (TTY: 1-888-889-4500).

6. What if I don’t agree with the decision Covered California makes?

You can file an appeal. To appeal a decision you don’t agree with, contact Covered California in one of these ways:

    • Online: Visit www.CoveredCA.com.
    • By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
    • By fax: Fax the appeal to 1-888-329-3700.
    • By mail: Mail the appeal to:
      Covered California – Appeals
      P.O. Box 989725
      West Sacramento, CA 95798-9725
    • In person: We have trained Certified Enrollment Counselors and Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free!

 

For a list of Certified Enrollment Counselors and Certified Insurance Agents near where you live or work, or a list of county social services offices near you, visit www.CoveredCA.com or call 1-800-300-1506 (TTY: 1-888-889-4500).

7. How can I file an appeal regarding my Medi-Cal eligibility?

Consumers seeking to file an appeal regarding Medi-Cal eligibility and/or determination should contact their county human services agency.  The new telephone number for all Medi-Cal state hearing requests, including Affordable Care Act appeals, at the State Hearings Division is toll-free 1-855-795-0634 (Voice), 1-800-952-8349 (TDD), and 1916-651-2789 (fax).  In addition, appeal requests may be emailed toshdacabureau@dss.ca.gov or mailed to the following address:

    • California Department of Social Services
      State Hearings Division
      P.O. Box 944243, Mail Station 9-17-37
      Sacramento, California 94244-2430.

8. This application asks for a lot of personal information. Will Covered California share my personal and financial information?

No. The information you provide is private and secure, as required by federal and state law. We use your information only to see if you qualify for health insurance.

9. How can you use Covered California in conjunction with Medicare parts A, B and D?

Individuals who are eligible for Medicare will not be eligible to receive premium assistance through Covered California. Additionally, Medicare supplement insurance (Medigap) plans will not be offered through Covered California.

Financial Assistance

1. Can I get health insurance even if my income is too high?

Yes. Any Californian who qualifies can purchase private health insurance through Covered California regardless of income. We use your income to help us find the health insurance that is most affordable for your family.

2. I don’t make a lot of money. What programs are available to help me get health insurance?

Starting on January 1, 2014, people who need health insurance may be able to get help in one of these ways:

    • Premium assistance: Premium assistance is available to help make health insurance affordable. People who qualify for premium assistance may take them in advance (before they file taxes) to make their monthly premiums lower. Or they can take them at the end of the year and pay less in taxes. The amount of assistance for monthly premiums depends upon your household size and family income.
    • Medi-Cal: Medi-Cal is California’s Medicaid program, paid for with federal and state taxes. It’s health insurance for low-income California residents who meet certain requirements. If your income is within the Medi-Cal limits for your family size, you will receive Medi-Cal coverage at no cost to you.

3. If my income changes, will my premium assistance change immediately?

No, your premium assistance will not change immediately. We will process any new information we have. And, we will tell you if the amount of your premium assistance changes.

4. If my income changes, how will the change affect me when I file my taxes?

It is important to report income changes to Covered California that impact the amount of premium assistance (or tax credits) that you receive. If your income decreases, you may qualify to receive a higher amount of premium assistance and reduce your out-of-pocket expenses even more. However, if your income increases, you may receive too much premium assistance and may be required to repay some of it back when you file your taxes for the benefit year.

5. What if I didn’t file taxes last year?

If you didn’t file taxes last year, you can still apply for health insurance and get premium assistance. We will use your income to help us find the health insurance that is most affordable for you and your family. If you qualify for premium assistance, you must file taxes for the benefit year.

6. What if my income changes after I apply for health coverage?

If your income changes, it may change what kind of health insurance you qualify for. If you have private health insurance through Covered California, call to report any change in your income that may affect your eligibility within 30 days. If you have Medi-Cal and your income changes, contact your county social services office within 10 days.

7. If an adult is claimed as a tax dependent by their parents, will their parents income count towards the dependent adult’s income for eligibility?

Yes. The adult who expects to be claimed as a tax dependent by his/her parents will have his parents income counted when determining income eligibility under the MAGI methodology.  Federal regulatory reference is 42 CFR 435.603(f)(2).