Covered California has updated their income table for qualifying for either the premium assistance or Medi-Cal. The new income amounts reflect the modest increase to the federal poverty levels (FPL) which is the foundation for premium assistance. The new income amounts only apply to individuals and families who will apply for health insurance through Covered California for 2016. Households who renewed their coverage in 2015 or enrolled during open enrollment for 2016 are not affected by the higher income levels in most situations.
The minimum Modified Adjusted Gross Income (MAGI) for an individual to receive the premium assistance (Advance Premium Tax Credits) for a private health insurance plan is now $16,395, up from $16,244 in 2015. Covered California also added more information about income levels for pregnant women who may qualify for the special Medi-Cal Access Program.
Not included on the table are the higher income amounts for Med-Cal kid’s eligibility in the Bay Area counties of San Mateo, San Francisco, and Santa Clara. In these counties, household MAGI up to 322% of the FPL will have children 18 years of age and younger determined eligible for Medi-Cal. In all other counties of California the MAGI for Medi-Cal kids is 266% of the FPL.
Be aware that just because the household income is below 400% of the FPL, that doesn’t necessarily mean an individual or family will qualify for premium assistance. Premium assistance is based on affordability formula that uses the Second Lowest Cost Silver (SLCSP) plan in the region as a benchmark. If the SLCSP is determined affordable for the MAGI entered into the Covered California enrollment system, no premium assistance will be awarded.
- The household Modified Adjusted Gross Income (MAGI) is below 138% of the federal poverty level (FPL) you and the members of your family will be determined eligible for Medi-Cal and enrollment into a Medi-Cal plan transferred to you local county.
- Medi-Cal is based on monthly income, not necessarily annual income.
- If the household MAGI is below 266% of the FPL, children 18 years and younger will be determined eligible for Medi-Cal and will not receive premium assistance to enroll in a private health plan.
- If you reside in San Mateo, San Francisco, or Santa Clara counties and your income is below 322% of the FPL, your children 18 years old and younger will be determined eligible for Medi-Cal. (For more information on expanded Medi-Cal kids in these counties see: http://insuremekevin.com/medi-cal-set-snatch-bay-area-kids-parents-plans/)
- If you report to Covered California you are pregnant, the online enrollment will add an additional member your household to see if you qualify for Medi-Cal programs for pregnant women. (See: http://insuremekevin.com/should-you-report-your-pregnancy-to-covered-california-and-medi-cal/)
- Pregnant women with incomes below 322% of the FPL qualify for special Medi-Cal programs for mothers and infants.
- What type of income is counted for Covered California?