Kevin Knauss: Health, History, Travel, Insurance
Posts related to eligibility for health care programs based on household income such as Covered California, Medi-Cal, Medicare usually based on federal poverty levels.
For decades, Medi-Cal has verified the income for applicants and renewing beneficiaries using federal and state databases. The process known as the Income and Eligibility Verification System (IEVS). The California Department of Health Care Services has provided county Medi-Cal offices with a reminder of the IEVS process in an All County Welfare Directors Letter, 25-16. […]
The main takeaway is that the calculations for the ACA health insurance income estimates are separate from determining the tax on Social Security benefits. Specifically, all the Social Security income is included on the Covered California application as income, but only ½ is used for the combined income calculation of Social Security income taxes.
If one of the individuals in that two-person household is pregnant, the pregnant individual could gain Medi-Cal if the income is under $3,756 per month. This is based on the 213% column, full scope Medi-Cal for pregnant individuals. The other adult would still be eligible for Covered California and the subsidy since the monthly income is over 138% of the federal poverty level.
For a married couple, they can earn up to $2,433 per month and still qualify for MAGI Medi-Cal. This represents a 3.44 percent increase from 2024. MAGI Medi-Cal is the expanded Medi-Cal for low-income adults between the ages of 19 and 64 years of age.
Covered California households with incomes below 250 percent of the federal poverty will be eligible for a reloadable debit card to purchase food. The monthly amount will be $80 for each eligible household member. Through the application process, it will be determined if the individual or family is experiencing food insecurity.
The MAGI reported on lines 11, 6a, 6b, 2a, 2b, and 1h. Income from the schedules, such as schedule C Profit Loss from a business, is funneled onto line 1. You may need to find a specific schedule to determine the income or deduction to properly estimate your future income for Covered California. This is an income estimate. It is not necessary based on your last file federal tax return.
Because of the Social Security Fairness Act, Jan will receive a monthly benefit of $1,000. Unfortunately, Jan doesn’t receive the one-time lump payment for 2025 until December, too late to amend their Covered California income estimate. Jan and David must reconcile the higher annual income on their federal income tax return.
For eligible households with income over 250 percent FPL, only the Silver 73 plan will be offered, which is a better value than a Silver 70. At least for 2025, there will be no Silver 70 for qualifying households. The Silver 70 will still be offered to consumers who opt not to be considered for the Advance Premium Tax Credit subsidies based on household income.
Medi-Cal breaks up the income into unearned income, earned income, in kind income, and exempt income. Finally, there are certain expenses that will reduce the final countable income for eligibility in the Medicare Savings Program.
The Paragon Health Institute report on fraud in the ACA enrollments is flawed and biased. The report does highlight the desperate need for affordable health insurance in many states that have not expanded Medicaid.
