There really is no mystery as to why the Covered California income chart doesn’t match the Medi-Cal federal poverty level income table. Covered California is working with two different programs. They must screen for MAGI Medi-Cal eligibility based on current monthly income and the latest federal poverty levels, and, they must also determine the Advance Premium Tax Credit subsidies following IRS guidelines that use the previous year’s federal poverty levels. And if you follow all of that, you are smarter than me!
California MAGI Medi-Cal
Posts related to how California MAGI Medi-Cal works, especially with Covered California, enrollment, termination, household income.
If your income increases, many people incorrectly assume they are no longer eligible for MAGI Medi-Cal. That is not the case. Medi-Cal is based on your monthly income, not necessarily your annual income. Just because you had an unexpected bump in your hours for one month, does not mean you are no longer eligible. Just report the change to Medi-Cal and let them make the determination. The same applies if you receive a one-time lump sum income amount. These types of events are not necessary counted against you.
There are a couple of different reasons why health insurance companies may be reluctant to extend a grace period beyond the current 30-day date range. The first reason is California’s expanded Medi-Cal option. If an individual or family has a sudden decrease of income – below 138 percent of the federal poverty level for adults – and they do not have employer sponsored health insurance, they can immediately apply for Medi-Cal and get coverage at no cost.
Why can’t people who earn too much money to qualify for either MAGI Medi-Cal or the subsidies through Covered California just be allowed to pay the monthly capitation rate for these plans? They are less expensive than private insurance and would offer some protection from the corona virus health care costs.
The federal government will consider only public benefits received directly by the person who is applying for the change in status, or if they’re listed as a beneficiary of the benefit. This means that your family members accessing public programs will not be considered as part of your public charge determination.
The Change Log Table shows that Sacramento County Medi-Cal returned the client’s household size to 2 and added the deceased spouse back into the household. The only notification the client received that Medi-Cal had meddled with her account was when she received a notice from Kaiser informing the client that her coverage had been terminated.
Is Covered California the only place to buy health insurance? No. You can buy a plan directly from one of the health insurance carriers available in your region. But there will be no subsidy to lower the monthly premiums. Enrollment into a health plan directly from the carrier is called off-exchange, as opposed to purchasing a plan on-exchange through Covered California.
What is interesting is that these 2020 FPL income levels are higher than what Covered California posted in their program eligibility income chart at the start of the 2020 open enrollment period. Covered California listed the single adult Medi-Cal annual income level, 138% of FPL, at $17,237 and for a two-adult household at $23,226. The DHCS 2020 FPL income chart lists a higher amount of $17,609 for a single adult and $23,792 for two adults.
The Medi-Cal HMO plans are very similar to private health insurance plans. The plans have member ID cards, a provider network, and a drug formulary. One of the biggest complaints I hear is that the Medi-Cal HMO plans have few primary care providers and specialists that are accepting new patients. I also hear the same complaint from my clients in private health plans.
If Medi-Cal makes any changes to your account through Covered California, and you have family members who are in a private health plan through Covered California, you need to finalize the new plan. In the above scenario, an additional subsidy was applied to lower the health insurance premium.