For those who qualify, the Covered California Marketplace may be their best option for purchasing health insurance. Individuals, families, and small businesses who qualify may receive tax credits toward their monthly insurance premiums while choosing a plan from carriers participating in the marketplace. For individuals and families, this currently includes carriers such as Blue Shield of California, Anthem Blue Cross, Health Net, Western Health Advantage, and Kaiser Permanente.
Eligibility for Advanced Premium Tax Credits (APTC) is based on gross income (for the employed) and net income (for the self employed). Any individual or family with income between 138% and 400% of the Federal poverty level (FPL) may be eligible for APTC.
Individuals or families with income below 138% of the FPL are considered Medi-cal eligible and will automatically be enrolled in Medi-cal once the application is submitted. Children under the age of 19 in families with income below 266% of the FPL will automatically be eligible for Medi-cal, however children under the age of 19 in families with income between 266% and 400% of the FPL will qualify for individual and family insurance plans (which may include APTC).
Annual Enrollment Period (AOEP)
Since everyone is required to have health insurance or suffer a tax penalty, it is important that you be aware of your ability to obtain coverage.
The next AOEP for Covered California begins November 15th and ends February 15th. It’s mandatory that you buy an insurance plan during the AOEP if you wish to have a policy in effect for the following benefit year. There is no AOEP for Medi-cal and this coverage may be purchased throughout the year. Unless you have a qualifying event (special enrollment period (SEP)) outside of the AOEP you cannot buy an individual or family insurance plan and may be subject to tax penalties.
Once your enrollment application is finalized we may request proof of income, proof of citizenship or lawful presence, proof of residency, or proof of minimum essential health benefits, if required. We will notify you in writing of all required items, monitor your account after the initial enrollment, and provide notifications about key legislation changes affecting your policy.
All J.C. Lewis Insurance agents are licensed by the state of California and are certified to sell policies through Covered California. Enrollment counselors at Covered California do not hold a California state insurance license and only offer general information about policies. If you want accountability, explanations, and a combined 57 years of experience in the insurance industry, let J.C. Lewis Insurance Services handle your enrollment. We’ll keep you safe.