Covered California For Individuals & Families

Covered California is where individuals and families can shop for and compare quality health plans among a variety of brand name insurance companies. You may even get help paying for your plan in the form for Advanced Premium Tax Credit (APTC), Cost Share Reduction (CSR) that lowers copays and, beginning 2020 in California, new state subsidies to help offset the total premiums for consumers who will not qualify for APTC.

Components of Plans in Covered California

Individual and Family Plans through Covered California are unique in that there are three components that have to be considered when applying for coverage.

• Tax benefits that you get through Covered California are based on your Federal Poverty Level (FPL) percentage:
• Advanced Premium Tax Credit (APTC). This is dollars that will be sent directly to the insurance company you choose to cover your medical expenses, after which the insurance company will bill you the net amount. The federal government helps those whose FPL percentage is between 138% and 400%
• Cost Share Reduction (CSR). The government helps fund the internal out of pocket expense for copays, coinsurance, and maximum out of pocket for those whose FPL percentage is between 138% and 266%. Only the Silver Tier gets this treatment.

• Tax forms.
• 1095A: The form you get from Covered California to give to your tax advisor to reconcile your APTC with your true taxable income.
• 8962: The form generated by your tax advisor to file with the IRS. It compares your APTC to the Premium Tax Credit you should have received based on your accurate taxable income. The completed form should be included in your copy of your tax return.

• Plan design concepts.
• Metal Tiers:
• Minimum Coverage: available to consumers under 30. These plans have a high deductible and out of pocket max. These plans do not qualify for APTC.
• Bronze: typically have the lowest premiums and have a 60% overall coverage.
• Silver: this is a special tier where depending on income, consumers may qualify for additional coverage known as Cost Sharing Reduction (CSR). Policies in this tier range from 70% to 94% coverage.
• Gold: plans in this tier do not have a deductible and have a 80% overall coverage.
• Platinum: with 90% overall coverage, these plans have the lowest out of pocket expenses.
  

What you’ll need to enroll

• Proof of current household income
• Government Issued ID such as a Driver’s License
• Proof of lawful presence, e.g. Permanent Resident Card, Employment Authorization Card, Visa or Passport. All documents must be current and valid.
• Birthdate for every person on the application
• Social Security number or Individual Tax Identification Number (ITIN) for every person on the application
• Home address and phone number

Please note that Medi-Cal recipients who want to purchase health insurance through Covered California will not qualify for APTC.

Consumers wishing to apply for Medi-Cal may do so through the Covered Ca website. Eligibility for Medi-Cal is determined by income. All applications with a Medi-Cal eligibility will be process by the Department of Public Social Services. All questions regarding application status need to be directed to DPSS.

2725 E Pacific Coast Hwy.
Suite #101

Signal Hill, CA 90755