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California health insurance  -  Covered California Questions  -  Medi-Cal Kids for Children under 266%

Covered Ca agentWhy Are My Kids Offered Only Medi-Cal?

Expansion of Medi-Cal is a major part of the ACA health law and there is important information for California health care shoppers regarding this expansion, especially in regards to children. One part that is causing confusion is the new expanded eligibility for children so let's better understand how this has changed.

Why are my kids being offered Medi-Cal if over 138% of FPL?

By now, you have probably seen the health subsidy grid (right panel) in many shapes and forms. There is considerable financial help to help Californian's enroll in coverage if they make between 138% and 400% of the Federal Poverty Level (grid to the right). Below 138%, Medi-Cal (California's version of Medicaid) is offered to most eligible Californians but there is an expanded income range for children.

Here's the rule in a nutshell:

If the household eligible income is below 266% of the FPL, children in the household may be eligible for low cost Medi-Cal Kids. Your children will not receive subsidies towards standard Covered California plans if eligible for Medi-Cal.

This rule hasn't really made the press so many people are confused when they run their quotes in the Exchange and the kids are automatically enrolled in Medi-Cal. This can be well received or poorly received by the health care shoppers depending on their needs and situation. We'll discuss the pro's and con's of this move.

Pro's and Con's of the Medi-Cal offering

The people we have discussed respond with mixed feelings. Here are bullet points.

Pro's of Medi-Cal Kids

  1. Very low price. $13/child up to three children or $39/monthly max
  2. Depending on county, may be administered by health carrier (not county office)
  3. Low out of pocket for medical expenses varying by plan


Con's of Medi-Cal Kids

  1. Smaller networks of doctors/hospitals
  2. Different providers than other family members
  3. Administrative time and process of dealing with Medi-cal

Analysis of the Medi-Cal Kids

If cost is your primary concern (which is common these days), Medi-Cal is hard to argue against. It's very low cost both in terms of premium and out of pocket costs. The alternative would be to pay full price for the Covered California plans which can be very expensive.

Here's the issue.  The Medi-Cal networks are smaller to start with and they will be severely impacted by the roll-out of the law and the expansion of the Medi-Cal program in general. These doctors are already pretty impacted and they are likely to see their workload grow significantly. We'll start to hear more about this after enrollees start to use the new program.

Can you opt out of Medi-Cal and get the subsidy in the Exchange?

If you qualify for Medi-Cal (138% of FPL for adults or 266% for children), you cannot receive a subsidy towards an Exchange plan. That's just how the law designed. If over 138% but under 266%, you may still qualify for a subsidy for the adults in the family.

There is an alternative however...

You can still purchase an outright plan with no tax credit for your child if keeping their doctors is very important.  We can help you with this process while still getting the tax credit for the adults.  It's a little tricky with the system, but we'll be able to still enroll you in 10 minutes over the phone at 800-320-6269.

You can run your Covered California and Standard Plan Quote here to view rates and plans side by side from the major carriers...Free.

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If Your Income
Is In This Range

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2 People $22k - $64k
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4 People $33k - $97k

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