This is single-handedly the most important question that a Californian can ask Jan 1st, 2014 and after. It could mean the difference of $1000's dollars in health insurance premium per year. There are a few key requirements but we'll look at the three big ones that will dictate whether most people will qualify for a subsidy or not. It's estimated that approximately 50% of Californian's are eligible so many people can expect to gain this benefit. Let's get started...how do you know if you qualify?
This step gets a little tricky but we'll try to simplify it as much as possible. Feel free to call us at 800-320-6269 regarding your situation.
If you are offered group health insurance from your employer or through a spouse/domestic partner/parent and the coverage is affordable (definition below) to the employee only (not considering dependent costs) and the coverage is of a minimum value (bronze level of health benefits), you may not be eligible for a subsidy. You just have to be offered the coverage. Choosing to decline coverage does not affect your eligibility. All companies are required to send out notification as to whether they are offering affordable coverage of a minimum value but expect some confusion on this front...it's very complicated. Let's break down the two main points.
Is the group coverage affordable?
Here's the rule...does your employee-only share of the second lowest priced, MV plan offered by the company (not necessarily the one you're on) exceed 9.5% of your gross income. Again, remember that they do not look at dependent cost...only employee costs. Furthermore, if the employee only premium is shown to be affordable (under 9.5%), the dependents will likely not be able to qualify for a subsidy. It's a big issue in the structure of the bill but HHS has verified this interpretation.
Is the plan of Minimum Value?
This gets even trickier. All the new Metallic group plans will be Minimum Value by
law (at least Bronze level). Many companies will
opt for an early renewal (called grandmothering) so they can
keep old plans and rates.
Not all the carriers have certified if their
2013 plans are MV and the worksheet used to run
the calculation is just short of rocket science.
So what should you do?
Look to your company or their broker to provide you with the Notification for existing employees and shortly after hiring for new employees. If you do not have group coverage or if your offered coverage coverage does not provide an affordable (your employee only premium is less than 9.5% of gross income) MV option, continue on to see if you meet the next big requirement.
There is an income basis to qualify for a
California health subsidy. You need to make
between 138% and 400% of the Federal Poverty
Level. The amounts are based on your best
estimate of this year's personal Modified
Adjusted Gross Income (total household).
If you make under 138% of the FPL, Medi-Cal will be available to you at no charge. If you are eligible for Medi-Cal, you will not be able to get a subsidy towards one of the Metallic plans.
The upside is $1000's of dollars to offset health insurance premium. Are there downsides? There are two issues both tied to the same situation. Some people have Grandfathered plans, plans which were started and not changed materially since 3/22/2010. These plans are not affected by the new requirements. They may have lower rates (than un-subsidized plans) but more importantly, they may have much larger doctor networks. The new Exchange networks are about 2/3rds the size of the old PPO networks (which Grandfathered plans use). If doctor/hospital choice is critical to you, make sure to first check the new networks if you have a Grandfathered plan. Non-grandfathered plans automatically had to move to the new plans either way.
These are main requirements aside from general citizenship, resident requirements. Please feel free to email below or call us with your particular situation since so much money is at stake with the subsidies.
We'll try to find the maximum subsidy available at no cost to you.
Again, there is absolutely no cost to you for our services. Call 800-320-6269 Today!
YOU MAY STILL BE
ABLE TO ENROLL
In just 15 minutes:
With Existing Account
We can help you:
If Your Income
Is In This Range
Current Years Estimate; All those that file together on one 1040:
|Single Person:||$16k - $47k|
|2 People||$22k - $64k|
|3 People||$27k - $80k|
|4 People||$33k - $97k|
"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"
"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."
"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."
"I thank you very much for the time that you have invested in handling everything
"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."
"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"
"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"
"You are my new best friend. A HUGE thank you again.
20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable
We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.
We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.
Call us...you will be Pleasantly Surprised. 800-320-6269
We'll quickly see if you have the best priced plan available and if you qualify for a tax credit800-320-6269
This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.