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Covered California 2016 Guidelines

With the implementation of the Affordable Care Act many Californians will receive subsidies based on their modified adjusted gross income (line item 38 on your 1040 tax form or line 22 of your 1040A form) and the Federal Poverty Level.

For the year 2016, Covered California will base the subsidy on the  Federal Poverty Level 2015 guidelines.

Below the 2014 Federal Poverty Level ( FPL ) Guidelines for the U.S. (subsidy):

Household Size

100 %

138 % Medical eligible 150% Special Subsidy on Silver Plan 96% 200% Special Subsidy on Silver Plan 87 % 250% Special Subsidy on Silver Plan 73% 266% mix family, minors are eligible for Medical 300% Premium Assistance 400% No Subsidies
1 $11,770 $16,242 $17,655 $23,450 $29,425 $31,308 $35,310 $47.080
2 $15,930 $21,983 $23,985 $31,860 $39,825 $42,375 $47,790 $63.730
3 $20,090 $27,724 $30,135 $40,180 $50,225 $53,440 $60,270 $80,360
4 $24,250 $33,465 $36,375 $48,500 $60,625 $64,505 $72,750 $97.000
5 $28,410 $39,205 $42,615 $56,820 $71,015 $75,570 $85,230 $113,640
add per person $4,160 $5,740 $6,330 $8,320 $10,400 $11,065 $12,480 $16,640

Many Californians are overwhelmed by just looking at a chart like this. Did you know that we will di it for no extra charge as your agent? We can figure out how to get the subsidy you deserve and avoid unwanted services as your agent. Email us at info@solidhealthinsurance.com and we will make sure that we find you an affordable health plan in California.

 

COVERED CALIFORNIA ENHANCED SUBSIDY ELIGIBLE

The Enhanced Benefit on the Silver Plan are based on income and dependent status.

  •  if your FPL is between 139% – 149 %  ( for a single  $16,243 -$17,654 )  you only pay 4 % of the monthly costs up to $58.  94% of costs are subsidized  (your have$ 75 deductibles , $ 5.00 for doctor visits. specialist $8.00 – out of pocket maximum is $ 2250) ( see chart below )
  • If your FPL is between 151% -200 % ( for a single $17,655- $ 23,449) you only pay 6.3% of the cost, monthly up to $ 123 . 87% of the cost is subsidized ( you have a $1550 deductible , $ 15 doctor visit , $ 25 specialist – OOP is $ 2250 ) ( See chart below )
  • IF your FPL is between 201% -250 % ( for a single $ 23,450- 29,725 ) you pay 8.05% of the cost monthly up to $196, 73% of the cost is subsidized. You pay $40 for primary care visits, $55 for specialist , your out of pocket is $ 5450) (see chart)

If your income is greater than 250% and less than 400% the subsidies are lower.

MEDICAL ELIGIBILTY

  • For Californians whose modified adjusted gross income ( line item # 38 of 1040 – or line item 22 on 1040 A) is in the bracket of 100-138 % qualify for Medical and not Covered CA.
  • In “mixed” families who have a MAGI of  266% FPL or less, the minors will be eligible for Medical and not Covered CA. The parents will be eligible for Covered CA. We can explain to you how to avoid this.
  • Pregnant women who have a MAGI of 213% FPL or less qualify for Medical and not Covered CA

The Open Enrollment Period is from November 15st 2015 – January 31st, 2016 . In this period all Health Plans will be GUARANTEED ISSUE. No medical underwriting is required, no pre-existing conditions, and no limits on coverage. All Health Plans will be standardized with” metal” plans that cover 10 Essential Health Benefits (whether inside or outside of the exchange). Covered CA has negotiated a rate increase of 4.0% statewide and for the Los Angeles region ( Region 16 ) of 2.5 %.

Rates and provider networks will vary by insurance carriers. California has 19 rating areas. In our region Blue Shield  and Anthem will be PPO carrier (Anthem has a weighted average rate decrease of 3%, Blue Shield a 6.5% rate increase). Kaiser show a moderate rate increase of 4.5 %. Molina Health care a rate decrease of 9.8% . Rates will be calculated by region and by age of each family member. Children over the age of 21 are rated as adults.

Many Californians are overwhelmed by the task of figuring out the new affordable care acts and how to maximize the benefits for your family. As your agent, we can help. Email us at info@solidhealthinsurance.com or receive a free premium quote. We will make sure that we find you and your family an affordable health plan in California for 2016.

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