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Covered California - Health Care Costs and Getting Help Paying for Coverage

Covered California - Health Care Costs and Getting Help Paying for Coverage


Covered California uses the federal poverty level (FPL) to determine eligibility for financial help and programs such as Medi-Cal. These levels, set each year by the federal government, take into account the individual’s annual household income and household size.


Financial Help: Premium Assistance and Cost-Sharing Reductions


Covered California offers two main types of help to pay for coverage: premium assistance and cost-sharing subsidies.

• Premium assistance is a tax credit (formally called the Advanced Premium Tax Credit, or APTC) to reduce a person’s monthly premium cost.

• Cost-sharing reductions are subsidies to reduce an individual’s out-of-pocket costs (their copays, coinsurance, deductible, and out-of-pocket maximum).





Medi-Cal and Income Changes


If you have an income that qualifies for a Covered California health plan with premium assistance, and then later your income is lower and you become eligible for Medi-Cal, you will not have to repay the premium assistance you received, as long as you report the income change within 30 days. However, it is your responsibility to report this change to Covered California so that you can get help to switch programs.


If you have more questions about insurance, feel free to contact us!


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