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.
The income section of the Covered California application is very date sensitive. If your application does not show any income in the month you are applying, you will be determined eligible for Medi-Cal. This is because Covered California screens for Medi-Cal eligibility based on your monthly income, regardless of how much income you earned prior to applying for Covered California.
The minimum annual income in order to become eligible for the Covered California health insurance subsidies for a single adult is $18,756 for 2022. That is $980 higher than the minimum annual income for 2021, approximately a 6 percent increase. The minimum amount for 2 adults is $25,269 annual income. Estimated income amounts below 138 percent of the federal poverty level on the Covered California application will make the household eligible for Medi-Cal.
If you indicate that your income in 2022 will begin on January 1, 2022, and you are applying in December, Covered California will determine you have NO income for December and are therefore eligible for Medi-Cal.
The “California Premium Credit Program” is not an eligibility-based program. Starting plan year 2022, the $1 state premium credit will apply to both subsidized and unsubsidized Covered California QHP enrollees, including the catastrophic QHP enrollees but will exclude individuals in a dental-only plan.
The unemployment subsidy benefit further increased the subsidy. Because everyone was now eligible for the Enhanced Silver 94 plan, we switched this member from the Gold to the Silver plan. The new subsidy of $1,016.53 dropped the health plan rate to $1 per month. The better member cost-sharing for copayments and coinsurance will save the family even more money.
Covered California has worked with the health plans to transfer any accumulation of member health care expenses from the off-exchange plan to a new on-exchange plan through Covered California. For example, if you have spent $1,000 toward meeting your deductible under your current plan, that $1,000 accumulation would be transferred to the new plan. Many health plans have announced they will participate in the transfer.
The income ranges in the revised table did not change because they were based on the already released 2021 federal poverty levels for income. What has changed is that the California Premium Assistance Subsidy is no longer listed. This is because the new federal Premium Tax Credit subsidies are larger than anything California was offering. Also note that the Federal Premium Tax Credit extends beyond 600 percent of the federal poverty level.
The 56-year-old San Mateo County resident purchased health insurance through Covered California in 2020 and 2021. The estimated income was $45,000. In 2020, after the Covered California subsidy, the individual paid $109.98 per month for the Kaiser Silver 70 plan. In 2021, the Kaiser Silver plan jumped to $285.71, a 160 percent increase over the prior year.
In scenario III, the income situation is reversed. The couple estimated a MAGI of $25,000, but ended up with a final MAGI of $55,000. However, they don’t have to repay all of the $4,375 excess federal Premium Tax Credit they received from the federal government because there is a repayment limitation. In their case, they only have to repay $2,700. The higher income puts the couple into the California subsidy income zone and they get to claim a $376 tax credit on their California income tax return.
Unfortunately, many of us don’t fully factor in the costs of doing business when we think of our monthly income stream. Consequently, many small self-employed individuals may have applied and received unemployment benefits greater than the actual net taxable income received during normal business operations.
