California has made two new changes for 2020.
1. Increased Premium Tax Credit Subsidy
Premium Tax Credit Subsidies are now available up to 600% federal poverty level, increased from 400%. This increase will be state tax credit and will help more middle-income Californians get some premium assistance.
2. State Tax Penalty
Beginning in 2020, California will access a state tax penalty similar to the former federal tax penalty for any resident who does not maintain compliant health insurance coverage.
Covered CA is California's health insurance "marketplace". Health Insurers provide plans to the marketplace to be sold to individuals, families and small businesses. If you are eligible for a subsidy to help pay for the costs of your health plan and health care, you must purchase your coverage from Covered CA.
I can assist you with your Covered CA marketplace enrollment. There is not cost to you to use a certified agent to help enroll and provide continuous service on your health plan and Covered CA account. If you already have a Covered CA online account, you can delegate the agent of your choice at any time to take over service on you account and health plan.
QLE (Qualifying Life Event)/SEP (Special Enrollment Period) List for enrollment outside of Annual Open Enrollment Period (OEP). QLE/SEP Applies to both the Exchange and Private Market.
What are subsidies and how do they work?
Under the ACA ( Affordable Care Act ), there are two types of subsidy available depending on income level.
Tax Credit - this is a credit that can be advanced (paid to your insurance plan) to help reduce your monthly health insurance premium. If you qualify for tax credit, you can take it as advanced or decline the advance and get your credit when you file you tax return
Cost Share Reduction - known as CSR, the cost share reduction subsidy is available to those with low incomes (but above 138% FPL) and is paid to the health insurance company to reduce your share of costs on your deductible, co-pays and out of pocket annual maximum.
What is MAGI Medi-Cal?
MAGI ( Modified Adjusted Gross Income ) is the true income used to determine eligibility for subsidy and financial assistance (line 37 1040).
Due to the expansion of Medicaid in California ( Medi-Cal), individuals & families whose MAGI falls below 138% Federal Poverty Level ( see FLP 2018 chart above ) are eligible to enroll in low- or no-cost Medi-Cal coverage. The "asset test" has been eliminated and eligibility is based on MAGI.
Do I have to buy new health insurance/change my current health insurance plan?
Most individuals and families in California will be required to change their health insurance plan in 2014 to comply with the PPACA rules regarding qualified health plan coverage. The new health plans, known as Qualfied Health Plans (QHP) are currently in the design phase and should be available for public review in California in the early summer of 2013. These new plans must meet the requirements to include precious metal tier, actuarial value and contain the mandatory essential heatlh benefits. Those on grandfathered health plans (purchased prior to 3/23/2010) may continue on their current health plan and are not required to purchase a QHP so long as the insurance company continues the grandfathered plan. Those on non-grandfathered plans (purchased or changed to after 3/23/2010) will be required to replace that plan with a QHP.
What are grandfathered and non-grandfathered health insurance plans?
A health plan is considered grandfathered if it was purchase prior to the signing of the PPACA on March 23, 2010 and has not experience any significant plan benefit changes. Some grandfathered plans experienced benefit adjustments which made them non-grandfathered and some insurance company rules regarding adding/subtracting family members may also have made a grandfathered plan non-grandfathered. A grandfathered health plan is allowed to be kept in lieu of a QHP so long as the insurance company continues to keep the plan open for existing members
Non-grandfathered plans are health insurance plans purchased after PPACA was signed on 3/23/10 or plans that have made material changes to benefits or adding/subtracting family members. Non-grandfathered plans not protected against QHPs and those on non-grandfathered health plans must change to a QHP in 2014.
How will I buy new health insurance for myself and/or my family in California?
Individuals & families in California will purchase new health insurance coverage plans from several sources. Those in very low income range will enroll in Medi-Cal (CA Medicaid) and children may enroll in the California Healthy Families program. Those between 138% and 400% of the FPL ( Federal Poverty Level ) may purchase health insurance plans from the California Health Benefits Exchange known as " Covered California " and may receive a subsidy for both premium and plan benefits (co-pay, deductible, out of pocket) by purchasing through the California Health Benefits Exchange. Those who do not qualify for a subsidy may still purchase through Covered California but may also purchase outside of the exchange in the open market. Insurance carriers will have QHPs for inside of the exchange and QHPs sold exclusively outside of the exchange.
Are the new Qualified Health Plans Standardized?
Qualified Health Plans sold in the California health exchange (Covered California) will be standardized to meet certain rules including a metal tier, actuarial value and essential health benefits.
Health plans will fall into five tiers:
Silver & Silver Enhanced
Subsidy levels for those eligible for subsidy will be based on the Silver tier level. There will continue to be some differences between each insurance company's plans particularly in terms of network, drug formulary and so on.
Who may assist me in enrolling in a Healthcare Reform Qualified Health Plan?
For those purchasing health insurance inside of the Covered California exchange or via Medi-Cal/Healthy Families, you can purchase your health coverage from:
Licensed Certified Insurance Agents/Brokers
Navigators and Certified Counselors
Direct Benefit Assisters - includes trade unions, community services organizations, trade associations, some government departments such as Fish & Game, medical groups, hospitals, some tax advisors and attorneys
Directly through the Covered California Web Site
Navigators and Certified Assisters may be reduced or eliminated in 2018 by the Trump Administration
For those purchasing health insurance outside of the Covered California marketplace
Licensed Insurance Agents/Brokers
Directly from the Insurance Company