KQED News and The California Report
Updated: November 2015
On Jan. 1, 2014, the Affordable Care Act went into full effect. Now, almost two years later, California is embarking on the third open enrollment. While millions of Californians have taken advantage of the new benefits of the ACA, two million more people are eligible for benefits, but not signed up. If you're still uninsured — the deadline to enroll in a Covered California plan is Jan. 31, 2016.
We're here for you. This guide explains how the health law affects you, or your family here in California. In the guide we outline the health insurance options offered to you as a Californian and show you how to access them. If you're concerned about the cost, we also show you what help is available.
Simple. Understandable. Portable. Shareable.
You can download the printable version of this guide or pull it up on your smartphone or tablet.
You can also post any part of this guide on your blog or website — simply click the embed button on any page. And, of course, you can share the guide with your friends on Twitter and Facebook.
I Have Health Insurance
At a Glance
- If you already have health insurance from your employer, you don't have to do anything. The new health law does not require employers to change the insurance they provide.
- Medicare is largely unchanged by the Affordable Care Act, although the law improves coverage of prescription drugs.
- If you're already receiving Medi-Cal, you will continue to do so.
- If you buy insurance for yourself or your family, you have access to a new marketplace called Covered California. You may also qualify for tax credits to help you pay for health insurance. Anyone who does not have health insurance can buy it through Covered California.
Most people in California have health insurance, either from their employer or through a government program such as Medicare or Medi-Cal. If you are one of these people, the health law has very little effect on you. That's the headline.
But there are some caveats, so let's dive in.
Employer-based Health Insurance
If you receive health insurance at work, you are likely to continue to do so. But even though the health law is in full effect, employers may change plans, premiums, deductibles or other elements of the insurance they offer, just as they could before the health law was implemented.
The Affordable Care Act mandated several changes that benefit people with health insurance. These changes include:
- Children can stay on a parent's plan until age 26
- Your insurance company cannot drop you if you get sick
- You get free preventive care with no co-pay and no deductible, including many cancer screening tests (although some plans already in effect may be exempt from providing this benefit)
- Lifetime caps on coverage are banned
The main change for Medicare beneficiaries is that the Affordable Care Act closes the so-called doughnut hole. That's the coverage gap in Medicare Part D, which pays for prescription drugs. Under Part D, seniors pay a certain initial amount for prescription drugs, then pay all of their costs up to $4,700, when coverage starts up again. The ACA requires this coverage gap to grow more narrow over time. The gap will be completely closed by 2020.
Medi-Cal is the government health insurance program for the poor. (In other states, it's called Medicaid.) If you are currently receiving Medi-Cal, you don't need to do anything.
But what many people don't know is that Medi-Cal does not cover everyone who is poor. Under the Affordable Care Act, California expanded Medi-Cal to cover more poor people who do not have health insurance. This guide has more information about the Medi-Cal expansion.
I Buy My Own Health Insurance. What Does the Health Law Mean to Me?
Before the ACA went into effect, people who bought insurance for themselves or for their families had no leverage with insurance companies. If you bought your own insurance, you may have paid a much higher premium than a large company would pay for similar coverage. If you were sick, the insurance company could have charged you a higher premium or refused to cover you altogether.
Effective Jan. 1, 2014, many of those insurance practices are no longer permitted. The health law restricts what insurance companies are allowed to consider in setting premiums. Specifically, insurers may no longer use your health history to set rates. Instead, rates will be based on three factors only: age, where you live, and number of people in your family. You cannot be turned down or charged a higher premium because you are sick.
The Affordable Care Act also makes it easier for individuals to shop for insurance. As part of the law, California set up an online marketplace where you can buy health insurance. The marketplace is called Covered California. Each plan offered on Covered California must offer a standard set of benefits. The goal is that consumers can make an "apples-to-apples" comparison of competing plans.
As part of its responsibility, Covered California reviews plans that insurance companies want to offer on the marketplace. The agency certifies plans that meet the requirements of the health law. People can shop for these certified plans and compare prices. In addition, consumers may qualify for subsidies (in the form of tax credits) to help them pay for insurance.
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.
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.
I am an Immigrant
At a Glance
- Naturalized citizens are eligible for the same benefits as U.S.-born citizens.
- Most lawfully present immigrants are eligible for benefits under the Affordable Care Act and, like citizens, may be required to pay a penalty if they do not have health insurance.
- Some immigrants previously not eligible for Medi-Cal may now have access to health insurance, either under the Medi-Cal expansion or in the new Covered California marketplace. Subsidies are available to those who qualify.
- Undocumented immigrants are not eligible for benefits under the ACA and do not have to pay a fine if they do not have health insurance.
California has more immigrants than any other state. About 10 million foreign-born people live here, and just under half of them are naturalized citizens. Of the rest, many are living here lawfully; others are not. Whether they are eligible for the benefits of the ACA depends on their immigration status.
I Already Have Health Insurance. Do I Have to Do Anything Differently Because of the Affordable Care Act?
In short, if you already have insurance, nothing about your situation changes. There are some limited exceptions, but in general, if you have insurance through your job, or public insurance such as Medi-Cal or Medicare, you will continue to be insured through those programs.
I Am a Naturalized U.S. Citizen, and I Do Not Have Health Insurance. How Does the ACA Affect Me?
As a naturalized U.S. citizen you are eligible for the same benefits under the ACA as a U.S.-born citizen. Depending on your income, you may be eligible for Medi-Cal or for subsidies to help you afford insurance in the Covered California marketplace. You may need to pay a penalty if you do not have health insurance. Please consult the other sections of this guide for information about your rights and responsibilities under the health law.
I Have a Green Card. How Does the ACA Affect Me?
If you are a green card holder, then you are eligible for the same benefits as U.S. citizens under the health law. Green card holders are also called lawful permanent residents.
If you do not have health insurance, the ACA can help you get it. The health law provides two paths to assist you: through a new health insurance marketplace called Covered California, and through an expanded Medi-Cal program — the government's health insurance program for the poor. Your income will determine which one of these programs is for you. Please consult the I'm Not Insured section of this guide for a more complete explanation of benefits and how you can enroll.
Important note for lawfully present immigrants who are childless adults: Before the health law went into effect on Jan. 1, 2014 low-income childless adults were not eligible for Medi-Cal. But under the health law, they are now eligible. California is expanding Medi-Cal to include more people. If you have been denied in the past, you can submit an application to Medi-Cal via Covered California or at your county social security office.
I Am in the U.S. Legally, But I Do Not Have a Green Card. I Am Here under a Different Kind of Visa. What Does the Health Law Mean to Me?
U.S. law includes a wide variety of ways in which immigrants can be "lawfully present," even if they are not green card holders.
The Affordable Care Act provides benefits to immigrants lawfully present under many different kinds of immigration status. You can check this list from the federal government to see if you qualify.
If you do qualify, please visit Covered California section of this guide to learn more about the benefits available to you.
Depending on your income and the number of people in your family, you may be eligible for subsidies to help you pay for insurance. If you earn less than 400 percent of poverty ($47,080 for an individual or $97,000 for a family of four), you likely qualify for a subsidy.
Covered California has a cost calculator so you can estimate how much, if anything, you might have to pay for health insurance. The cost calculator will also indicate if you are eligible for Medi-Cal.
Even if you make too much money to qualify for a subsidy, you can still purchase health insurance on the Covered California marketplace. But those who do not qualify for subsidies may choose to consult an insurance broker or do other research, as there may be more options for you outside the Covered California marketplace.
I Am Lawfully Present and Want My Parents to Immigrate. Are They Eligible for Any Benefits?
If your parents are lawfully present, they are eligible to buy insurance on the Covered California marketplace. They may also be eligible for subsidies, depending on their income.
We Are a Mixed-Status Family. How Do We Handle Our Application?
A mixed-status family is a household of individuals present in the United States under different immigration or citizenship statuses. While undocumented immigrants are not eligible for benefits under the health law, lawfully present members of a mixed-status family likely are eligible for benefits. Please consult this document from the National Immigration Law Center.
I Am An Undocumented Immigrant. Can I Buy Insurance on the Marketplace?
In short, no. Under the health law, undocumented immigrants are not eligible for benefits. You are not eligible for subsidies on Covered California. Undocumented immigrants are also barred from purchasing health insurance on the Covered California marketplace, even if they use their own money. As an undocumented immigrant you do not have to pay a fine if you do not have health insurance.
Adults are not eligible for Medi-Cal, but under a new state law, starting in May, 2016, undocumented children will be eligible for Medi-Cal, if their family meets income requirements.
In extraordinary circumstances undocumented immigrants may be eligible for a program called "Emergency Medi-Cal." For example, a woman who is pregnant is eligible for Emergency Medi-Cal for prenatal care and the delivery of her baby.
I Am Covered by Medi-Cal
At a Glance
- Before the health law went into effect, many low-income people were not eligible for Medi-Cal. For example, adults who did not have children could not get Medi-Cal coverage.
- Under the health law, California is expanding Medi-Cal so that more people will be covered.
- You qualify if your income is less than about $16,243 for an individual or $33,465 for a family of four.
Medi-Cal is the government health insurance program for people who are low-income or disabled. In the past Medi-Cal did not cover all poor people. For example, unless they were disabled, adults who did not have children were probably not eligible for Medi-Cal.
What the Health Law Does
The Affordable Care Act provides significant funding for a dramatic expansion of Medi-Cal. The program is called Medicaid in other states.
Effective Jan. 1, 2014, anyone earning up to 138 percent of the federal poverty level became eligible for Medi-Cal.
In real dollars, that means individuals making up to about $16,243 a year or a family of four making up to about $33,465 a year are now eligible for the insurance.
In the Past, I've Found the Sign-Up Process Confusing. What Do I Do?
The Affordable Care Act mandates changes in the application process to simplify it and make it more streamlined. People can apply in person or by mail. Medi-Cal applicants may also apply at CoveredCA.com, the website of the state's new insurance marketplace.
The health law also created a new definition of income for Medi-Cal. It's called Modified Adjusted Gross Income, or MAGI. Your assets will no longer be used in determining whether you are eligible.
I'm on Medi-Cal Now. Do I Have to Do Anything to Keep My Coverage?
No. You will continue receiving benefits. You don't need to do anything new. But, just like you do now, you will need to continue to reapply periodically to maintain your benefits.
How Does Covered California Work?
At a Glance
- The state has set up a new online marketplace, called Covered California, where people can buy insurance.
- All health plans offered in Covered California feature the same standard set of benefits.
- Effective Jan. 1, 2014, insurance companies may consider only three factors to determine the cost of your premium: age, geography and family size. Your health history may no longer be considered in setting premiums.
- To help you pay for insurance, the federal government is offering tax credits for people who qualify, based on their income.
For millions of Californians, the online marketplace — Covered California — is the heart of the health law. If you are uninsured, or buy insurance for yourself or your family, Covered California is where you can shop. So far, two million people have purchased insurance on Covered California, and many others are eligible for subsidized coverage, but not signed up. If you do not have health insurance, you may need to pay a penalty. In tax year 2015, that penalty is 2 percent of your income or $325 per person, whichever is greater. If you do not have insurance in 2016, the penalty rises to 2.5 percent of income or $695 per person. (Penalties for children are half the amount of adults.)
Buying Health Insurance Today
Before the Affordable Care Act, if you bought insurance for yourself or your family, it may have been hard to find a policy with comprehensive benefits. Health insurance companies were generally not required to cover specific areas of care. If you had an illness, the health plan might have charged you a very high premium to get the care you wanted, perhaps more than you could afford. Or you might have found an affordable plan, but the company would not have covered the care you needed. For example, the company might have excluded specific illnesses based on your health history.
What Changed With the Health Law?
Under the Affordable Care Act, the state set up an online marketplace, called Covered California, where insurance companies, like Kaiser or Anthem Blue Cross, offer plans.
A big part of Covered California's responsibility is to negotiate with insurance companies to get the best quality plans — at the best price — for you to choose from. In 2016, 12 companies are offering plans on the Covered California marketplace, including statewide companies Anthem Blue Cross, Blue Shield, Kaiser and Health Net, as well as eight plans that will offer coverage in certain regions: Chinese Community Health Plan, L.A. Care, Molina Healthcare, Oscar, Sharp Health Care, United Healthcare, Valley Health Care and Western Health Advantage.
Before We Dive Into How Much This Will Run You, Let's Explain a Few Terms.
You've probably heard of premiums, deductibles and co-pays. In considering what health insurance policy to sign up for, you need to think about your health status, what health risks might come your way and your own financial ability to cover those risks. For example, do you have diabetes? You can probably calculate the cost of the prescription drugs you need. Are you an avid athlete who might sustain an injury? You might want to think about how much a broken leg might run you.
Here's some jargon to help you in your decision:
• Premium: this is the amount you pay, generally monthly, to a health insurance company for your plan.
• Deductible: this is the amount you pay — out of your own pocket — before your insurance begins to pay, although some services on Covered California plans are covered outside of the deductible. For example, on all Covered California plans, you can see your primary care doctor with just a copay. Some preventive services are free.
Two cautionary notes: First, you want to be careful to pick "in network" providers, as they are usually less expensive than doctors and other providers not in your network. Second, plans with lower monthly premiums generally have higher deductibles. When you're considering different plans, think of how much health care you are likely to use, then add your total annual premium and your deductible to consider what your annual costs might be.
• Copayment: this is set amount you pay — out of your own pocket — when you access care, such as when you see a doctor or buy a prescription drug.
• Coinsurance: this is a set percentage you pay — out of your own pocket — when you access care. Some plans may charge a copay, some may charge coinsurance.
• Out-of-pocket maximum: This is the maximum amount you will pay, out of your own pocket, in a year. For many Covered California plans, this is $6,250 for an individual or $12,500 for a family. Once you reach the out-of-pocket max, all your medical expenses are generally covered by your health insurer, at no additional cost to you. Again, this is for in-network care. If you go out of network, your costs could be higher.
How Much Will I Pay?
Under the health law, insurers may consider only three factors when setting premiums: your age, where you live and your family's size. Insurance companies cannot turn you down or charge you a higher premium because you are sick or had a previous illness or accident.
To set up Covered California, state law established 19 geographic regions. That's the "where you live" factor insurers may use in setting premiums.
You can easily compare specific plans and premiums available to you — according to where you live, your age and the number of people in your family — by using Covered California's online calculator.
I've Heard the Government Is Offering Subsidies to Buy Insurance. Tell Me More.
You may qualify for a subsidy — in the form of a tax credit — to help you pay for health insurance. Tax credits are available on a sliding scale, according to your income. About 90 percent of people who purchase a Covered California plan qualify for a subsidy.
If you earn between 138 and 400 percent of poverty ($16,243 - $47,080 for an individual; $33,465 - $97,000 for a family of four), you may qualify for a federal tax credit. The credit will be applied to the cost of your premium. You choose when you want to receive the credit. You might want to receive it monthly, so that you will pay less each month, or you may elect to receive it all at once when you file your taxes in the following year.
In order to receive the subsidy, you must buy a plan through Covered California. You cannot apply the subsidy to a plan you find outside of Covered California.
Covered California offers a calculator to help you estimate the cost of your insurance after the tax credit has been applied -- and to help you compare the prices of the different plans available to you. The tax credit is based on your ability to pay for the second-lowest-cost silver plan. But you can apply the credit to any plan you wish to buy (except for a catastrophic plan). More on the "tiers" of plans further below.
The health law is using 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 to calculate your subsidy you don't use last year's income. When applying for insurance, you will be asked to state what you expect your 2016 income will be. If you think you will 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 from the UC Berkeley Labor Center (pdf).
What If My Income Changes During the Year?
If your income changes, your subsidy amount may go up or down. You should contact Covered California right away to adjust the amount of subsidy you receive. If you estimate your income too low — and get a higher subsidy as a result — you could have to pay back some of the subsidy at tax time. Alternatively, if you estimate too high, you could get a refund.
What Kind of Coverage Can I Get?
Any plan offered in Covered California must include a standard set of benefits across 10 categories. These are:
- Ambulatory patient services (that means routine doctor's office visits, lab tests, etc.)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including pediatric dental care
What Is the Difference Between a Silver-Tier Plan and Other Plans?
Individual health plans in Covered California are offered in tiers of coverage: platinum, gold, silver and bronze. The difference between the tiers is not what benefits are covered. Under the health law, each plan must offer the same standard benefits.
The difference between the tiers is cost. If you pay more each month for the premium, you will pay less when you need health care. The less you pay each month for the premium, the more you will pay when you need health care, the more you pay for the premium, the less you pay when you need care.
The platinum tier has the highest monthly premium, but there is no deductible and you have a $20 copay when you see your primary care doctor.
At the other end of the spectrum, in the bronze tier, you will pay much less each month for the premium. But bronze plans have a $6,500 deductible and a $70 copay when you see your primary care doctor. Silver tier plans have a $2,500 deductible. All plans have a limit on your maximum out-of-pocket costs for the year. For most plans, what you pay for health care, after your premium, is capped at $6,250 for individuals and $12,500 for families. This is a big change under the health law. In the past, in some cases, out-of-pocket costs could have been tens of thousands of dollars.
You can decide which tier — and which plan — is for you by considering your own finances and health care needs. The best way to know your options is to plug your household income and other data into Covered California's calculator. It will show you specific plans that are available to you, what the cost will be to you, and what subsidy you are likely to qualify for.
I Would Like to Talk to Someone in Person. Where Can I Go For Help?
Covered California has certified thousands of people across the state to provide in-person assistance to help consumers enroll. There is help available in both English and Spanish — and some certified counselors speak other languages as well. This page of the Covered California website provides links to certified counselors and insurance brokers trained in Covered California insurance plans as well as county offices where you can go for help. You can also call Covered California: 1-800-300-1506.
I Can't Even Afford the Copayment or Deductible. What Do I Do Now?
In addition to the tax credit, the federal government also offers special subsidies based on income and family size. If your income is less than about 2.5 times the poverty level — $29,425 for an individual or about $60,625 for a family of four — you may be eligible. These subsidies can help reduce what you have to pay when you see the doctor or get other health care.
I'm 28 and Healthy. I Only Worry About What I'd Do If I Were Hit by a Bus. Which Plan Should I Pick?
You can certainly look at the bronze plan and see if the coverage makes sense for you. Covered California also offers a catastrophic plan. It does not cover doctor's visits or even emergency room visits, but is meant to protect you against catastrophic medical bills. This level of coverage is available to people up to age 30. It's also available to other people who can demonstrate that they are experiencing financial hardship and to certain people whose policies were canceled because they did not meet the requirements of the health law.
Even With All This Help, I Cannot Afford to Buy Insurance or Pay The Penalty. What Do I Do?
If you are looking at the least expensive plans, and your cost for the premium is greater than 8 percent of your household income, you are exempt from the requirement to have health insurance. You do not need to pay a penalty.
I Don't Like the Insurance My Employer Gives Me. Can I Buy Insurance on Covered California?
You can, but because you are turning down insurance you already have through your job, you are probably not eligible for the tax credits. But, again, there are exceptions. The insurance offered by your employer must be "affordable" as determined by two criteria. First, the total annual premium you pay for coverage for yourself must be less than 9.5 percent of your income. And, second, the plan must cover at least 60 percent of health care costs. Your employer can tell you how much your plan covers. If you do not meet these two criteria, your plan is not "affordable." You may visit Covered California, buy insurance there and apply for a tax credit.
I'm Covered by My Employer, But My Family Is Not. Are They Eligible for Subsidies?
If your employer does not offer insurance to your spouse and dependents, then, yes, they can buy insurance at CoveredCA.com, and they may be eligible for subsidies.
If your employer does offer family coverage, your family may not be eligible for subsidies — if the insurance for you, the employee, is "affordable" as described above. The "affordable" coverage from your employer negates other family members' eligibility for subsidies — unless your contribution is greater than 9.5 percent of your income and covers 60 percent of costs, as described above. It does not matter how expensive the spouse and dependent coverage is. If the premium for you, the employee, is "affordable," they are not eligible for subsidies with Covered California.
How to Calculate Your Premium
At a Glance
- The federal government is offering tax credits to help you afford health insurance.
- Eligibility is based on your family size and income.
- The tax credit can take effect as soon as you buy health insurance. You do not need to wait until you file your taxes to get the credit.
The federal government offers subsidies to help you afford health insurance.
The subsidies are available as tax credits. But you don't have to wait until tax time to collect this credit. If you wish, you can claim the tax credit on a monthly basis to offset the monthly cost of your premium.
Am I Eligible For a Subsidy?
Your eligibility for the credit is based on your income. If you earn between 138 percent and 400 percent of the poverty level, you may qualify. For 2016, that's about $16,243 to $47,080 for an individual and $33,465 to $97,000 for a family of four. The subsidies are available on a sliding scale. In other words, the lower your income, the higher your subsidy amount.
How Can I Find Out How Much of a Subsidy I Might Get?
Covered California, the state's health insurance marketplace, has an online calculator you can use to estimate the amount of both your premium and your subsidy, if you qualify for one.
Please visit Covered California to calculate your premium, with or without the subsidy. You can also compare different plans available to you.