Financial assistance

You may qualify for financial help to pay for your medical coverage.
Help is available from Covered California if your income is less than a certain amount per year based on:
  • The number of people in your household
  • Your age
  • Your location

These FAQS will help answer your questions about receiving financial assistance from Covered California.

  • Learn more about financial assistance

    What type of financial assistance is available?
    There are two types of financial assistance: Cost-sharing reductions and premium assistance.

    • Cost-sharing reductions
      Cost-sharing reductions (CSRs) are subsidies offered through Covered California. If you are eligible, you pay less for your out-of-pocket expenses such as deductibles, copayments, and coinsurance when you use your plan. CSRs are only available if you purchase an Enhanced Silver plan (Silver 94, Silver 87, or Silver 73) through Covered California.
       
    • Premium assistance
      Premium assistance lowers the cost of your monthly premium, which is your monthly payment amount. It is available from the federal government or the state government. The premium assistance amount depends on the information submitted when you enroll. This may include your income, age, household size, and the cost of plans in your area. Premium assistance is only available for plans purchased through Covered California. The two forms of premium assistance that may be available to you are:

    1. The Advanced Premium Tax Credit (APTC), which is a federal tax credit. It can be applied in advance as a monthly credit on your billing statement or at the end of the year in a lump sum when you file your federal income taxes.

    2. The California Premium Subsidy (CAPS),  which is premium assistance from the state. In 2020, it is available to eligible individuals with incomes at or below 138% of the Federal Poverty Level (FPL) and between 200 – 600% of FPL and will appear as a monthly credit on your billing statement. 

    How do I qualify for financial assistance?
    To find out if you qualify for premium assistance specifically you must meet the following criteria:
    1) Earn 600% of the Federal Poverty Level or less, and
    2) Affordable coverage (the second-lowest cost silver plan) in your region costs more than your premium contribution level set by the government   

    View the table below to see income requirements for premium assistance. You can also use our subsidy eligibility calculator starting October 1 to find out if you might qualify for premium assistance and, if so, the estimated amount* you may qualify for. Contact your broker to learn about your options or call Customer Service at (888) 256-3650.

     

    Annual Income
      Annual Income
    Household size 600% of FPL 500% of FPL 400% of FPL 300% of FPL 200% of FPL Up to 138% of FPL
    Individual $74,940 $62,450 $49,960 $37,470 $24,980 $0 - $17,237
    Couple/2 people $101,460 $84,550 $67,640 $50,730 $33,820 $0 - $23,336
    Family of 4 $154,500 $128,750 $103,000 $77,250 $51,500 $0 - $35,535
    Premium contribution level Up to 18% of income Up to 16% of income Up to 10% of income Up to 9% of income Up to 6% of income $1/month
    1) Based on number of people reported on your tax return
    2) Based on Modified Adjusted Gross Income (MAGI)
    3) How much you’re expected to contribute toward premium cost. Should not exceed this limit.

    *The results from this tool are just an estimate based on the information you provided. If you decide to apply for a plan through Covered California, then Covered California will determine your eligibility and actual subsidy amount based on the information you enter in your application.
     

    To find out if you qualify for cost-sharing reduction plans, please report your income to Covered California. 


    How do I apply for financial assistance?
    If it looks like you may be eligible for either type of financial assistance,  please contact Covered California. Visit CoveredCA.com or call (800) 300-1506. 

     


    What are Enhanced Silver or cost-sharing reduction (CSR) plans?
    These are the Silver 73, Silver 87, and Silver 94 plans. These plans are only available through Covered California because they include financial assistance. You can only enroll in an Enhanced Silver plan if you qualify based on your income.  


    I already receive premium assistance. Will my APTC be the same as it was last year?
    Probably not. The APTC amount you will receive each year will most likely be different based on any changes in the health insurance rates in your area and your: 

    • Household size
    • Age
    • Income


    How can I make sure I get the correct premium assistance?​
    To make sure you get the correct premium assistance, update your household size, income, and other eligibility information with Covered California. Visit CoveredCA.com to make these updates, or call (800) 300-1506. 

  • Reporting changes to Covered California

    What kinds of changes should I report to Covered California throughout the year? Why is this important?
    You should always report changes to Covered California within 30 days. This will help make sure you get the proper financial assistance and avoid getting too much or too little assistance. Receiving too much or too little assistance can affect your tax refund or balance due when you file your annual tax return.

    You should report these changes:

    • Change in income (employment, self-employment, income tax deductions, or other types of income). You must give Covered California permission to check your income annually or you may lose any financial help you may be receiving today. (Consent can be provided for one to five years.)
    • Adding or removing a household member (birth, adoption, or marriage).
    • Change of address.
    • Permanent move.
    • Corrections to your name, date of birth, or Social Security number.
    • Benefits received under another type of health insurance or program like Medicare or Medi-Cal.
    • Change in citizenship or immigration status.
    • Are incarcerated or released from incarceration.
    • Have a change in status as an American Indian or Alaskan Native or change your tribal status.
       

    You can report changes:

    • Online by logging into your account at CoveredCA.com
    • By phone at (800) 300-1506 or TTY (800) 889-4500
    • By telling your certified Covered California enrollment counselor, certified insurance agent, or county eligibility worker 

    If you have any questions, contact Covered California at (800) 300-1506 or by TTY (800) 889-4500. 

  • Tax credits and penalties

    What is the Advanced Premium Tax Credit (APTC)?
    The APTC is a federal tax credit designed to help lower your monthly costs for health insurance purchased through Covered California and is funded by the federal government.  

    How does my APTC affect my federal income taxes? ​
    Learn more about how to claim the premium tax credit on your federal tax return, or view the ACA tax provisions for individuals.

    How do I claim APTC on my federal tax return?​
    For any tax year, if you receive APTC payments in any amount or if you plan to claim the APTC, you must file a federal income tax return for that year.

    In the first quarter of the year, Covered California will mail IRS Form 1095-A. This form will help you reconcile the APTC  you received for the current benefit year to the actual amount of Federal Premium Tax Credit you were eligible for in that year based on the actual Modified Adjusted Gross Income you report to the IRS on your taxes.  

    For more information, visit the IRS website for tax filing tips and ACA tax provisions for individuals.

    Once I update my income, when will my APTC appear on my bills?​
    Once you have reported your income, Covered California will decide whether it should adjust your premium assistance. If there is a change to your premium assistance, the new amount will be reported to us. Your bill will be updated in one to two billing cycles after the information is received to reflect your most current premium assistance. In the meantime, please pay the amount billed. We will make any necessary adjustments if you are owed a credit.  

    What are the tax penalties for not having health coverage?
    Although the federal government zeroed out the federal tax penalty in 2019, California enacted legislation to restore the individual mandate and tax penalty for 2020. Those who choose to go without coverage in 2020 may be subject to a penalty as part of their annual state tax filing if they have access to affordable coverage within the cost limitations set by the state. There can be penalties of up to nearly $2,100 per family, which is based on 2.5 percent of household income or a minimum of $695 per adult, whichever is greater. The California Franchise Tax Board, which administers the state mandate, will assess the penalties for the 2020 coverage year when consumers file their taxes in 2021.

    Californians can file for an exemption due to financial or other hardship with Covered California. 

    If the federal individual mandate penalty is reinstated at any point, the state tax penalty will be adjusted.    
     
    To avoid the tax penalty, you must have health coverage for at least nine months of the year. If you're uninsured for just part of the year, one-twelfth of the yearly penalty applies to each month you're uninsured. 

    We're not tax professionals and cannot provide tax advice. If you need help, please get advice from a professional tax preparer or adviser.

    Need more help? Visit the IRS website for tax filing tips and ACA tax provisions for individuals.

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