Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

Dear Tom and Alan:

I’ve been on Covered California for a few years.

The biggest benefit for me has been that because of my income (or lack thereof!), my monthly premium has been cut in half because I receive a subsidy.

When my income changes, I check in with them to adjust the subsidy up or down.

My question is, have the numbers changed for 2018 to qualify for help with my payments?

I’m married, age 37, with two children.


Tom: Your premium subsidy does vary based on your household income.

Covered California looks at line 37 of your income tax return for adjusted gross income.

One of the potentially jarring features of Covered California is that you may be on the health plan of your choice, but your dependents are placed on Medi-Cal.

This can happen up to 266 percent of the federal poverty level, or, in Happy’s case, up to $65,437 total income.

A total of 213 percent of the federal poverty level, or $52,398, will definitely put the two children on Medi-Cal, no matter which plan enrolls Happy and spouse.

This is not necessarily bad because Kaiser can be your Medi-Cal provider. If your line 37 is less than 138 percent of the federal poverty level, then all family members go on Medi-Cal.

If it is less than 150 percent, then the wife and kids go on Medi-Cal, and you go on whichever plan you chose.

Al: Yikes! It’s a good thing we got the “Program Eligibility by Federal Poverty Level” for plan year 2018 from the Covered California website!

Here are some of the details:

For one person, income between $16,644 and $48,240 likely qualifies for a subsidy. Of course, the less you make the larger the subsidy.

For a couple, the range is $22,412 and $64,960.

For our reader, a household income in excess of $98,400 means he is no longer eligible for a subsidy.

Not everyone realizes that you can still enroll through Covered California even if you don’t get a subsidy. If income decreases during the year, maybe you can.

It is interesting that a household of eight can earn up to $165,280 and still get a subsidy. That’s 400 percent of the federal poverty level!

That same family could make up to $57,022 and all be placed on Medi-Cal. For each additional person beyond eight, the income can increase $5,768 and then nine or more could qualify.

Tom: If you know your income is going to be above the income levels and probably stay there, you could also apply directly to the insurance company for coverage.

Everyone is still limited to the open enrollment period, unless there is a “qualifying event,” but sometimes signing up can be easier by going direct.

All the plans are still the same: bronze, silver, gold and platinum, and the benefits are the same in or out of the Exchange (Covered California).

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Submit questions to schrette@gmail.com or alancash@gmail.com.