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Obamacare Explained: A Guide for Californians

Produced by KQED News and The California Report

I Do Not Have Health Insurance

At a Glance

  • Millions of Californians gained insurance coverage under the Affordable Care Act, more than 2 million more remain uninsured statewide.
  • Under the health law, most people must have insurance or pay a fine.
  • People who are uninsured may get insurance in one of two ways: an expanded Medi-Cal program or Covered California, the state's online health insurance marketplace.
  • People who buy insurance on Covered California may be eligible for federal tax credits to help them afford health insurance.

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In California, the rollout of the Affordable Care Act was widely acknowledged as being quite successful in giving access to health insurance to many people. Before the health law went into effect on Jan. 1, 2014, 7 million Californians did not have health insurance. Today, more than two-thirds of them have coverage. Still, more than two million people are eligible for financial help in accessing health coverage, but have not signed up.

What the Health Law Changed for Individuals

Under the Affordable Care Act most people must have health insurance or pay a fine. The fine was fairly small in the 2014 and got bigger in 2015. For tax year 2015, if you are not insured, the penalty is 2 percent of your income or $325 per person, whichever is greater. (Penalties for children are half the amount for adults.) If you are not insured in 2016, the penalty will be greater: either 2.5 percent of your income or $695 per person, again whichever is greater.

Some people are exempt from both the requirement and the penalty. These include people living in the U.S. without proper documents, members of federally recognized Indian tribes and people who are in prison. Other people may be exempt as well.

The Affordable Care Act provides two paths to help uninsured people access health insurance. You can buy a plan on the state's health insurance marketplace called Covered California.

Alternatively, you may be covered by an expansion of Medi-Cal, the government's health insurance program for people who are low income. Your income will determine which one of these paths is for you.

The New Marketplace — Covered California

On the Covered California marketplace, people can compare health insurance options for themselves and their families. Insurers may no longer deny you coverage because of a current or past health condition. In addition, many people qualify for government subsidies — in the form of tax credits — to help them purchase health insurance.

Expanded Medi-Cal program

Medi-Cal is the government health insurance program for people who are low-income or disabled. Under the health law, California expanded the income limits for the Medi-Cal program, and many more low-income people now qualify.

Which Program Am I In?

Your income determines whether you will buy insurance through the marketplace or are covered by Medi-Cal.

The health law uses a new calculation of income, called Modified Adjusted Gross Income (MAGI). In general, it's the total of your adjusted gross income — plus any tax-exempt income you might have. But it's not last year's income. When applying for insurance, you will be asked to estimate what you expect your 2016 income will be. If you expect to earn roughly the same next year, you can estimate your MAGI by adding lines 8b and 37 from your 1040 tax return. But if you think your income will change, you will need to estimate.

If you want more specifics of what income is counted — and what income isn't — check this helpful summary (pdf) from the UC Berkeley Labor Center.

Once you have calculated your income, look at the chart below. If your 2015 income is at or below the number that corresponds to your household size, you are probably eligible for Medi-Cal. This guide has more information about the Medi-Cal expansion.

If your income is higher than the number you see below, you may buy insurance on the Covered California marketplace. This guide has more information about Covered California.

The income amounts shown are approximately 138 percent of the federal poverty level. That's the new upper limit for Medi-Cal eligibility.

In either case, you can apply at Covered California. Through the application process, you will find out if you are likely to be eligible for Medi-Cal or if you qualify for a subsidy to buy private health insurance on the Covered California site. Even if you make too much money to qualify for a subsidy, you can still enroll in insurance through Covered California.

Here are the income limits for Medi-Cal. If you are below the income limit listed for your household size, you likely qualify for Medi-Cal.

Household Size Income
1 $16,243
2 $21,983
3 $27,724
4 $33,465
5 $39,206
6 $44,947
7 $50,687
8 $56,428

If you are an immigrant who has a green card and you have been living in the U.S. five years or longer you are eligible for the same benefits of the Affordable Care Act as U.S. citizens. You may need to pay a penalty if you do not have health insurance. If you are in the U.S. legally, but do not have a green card, you are also eligible for many of the benefits of the Affordable Care Act. You can read more in the I Am an Immigrant section of this guide.

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