Health Care Coverage In California

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Magi Medi-Cal

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uses the federal modified adjusted gross income (MAGI) budgeting methodology. The MAGI Medi-Cal income limits are a percentage of the federal poverty level (FPL) and based on the coverage category. There is no asset test for MAGI Medi-Cal. (includes Childless adults - 138% FPL, Parents and other Caretaker relatives with a dependent child - up to 109% FPL, Children under 19 and up to 21 if FT student - up to 266 % FPL.

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Non-Magi Medi-Cal

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is the new term for the pre-ACA Medi-Cal programs that are as follows: Aged (65 or over), blind or disabled (ABD); Long Term Care (LTC); Medically Needy (MN) / Medically Indigent (MI); MN Sneede; SSI; CalWorks; Foster Care; Miscellaneous Special Programs (ie CMSP-safety net)

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Premium Tax Credits (PTC)

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Individuals may qualify for PTC to subsidize the purchasing of health coverage for those who are ineligible for Medi-Cal benefits
This program will be available for individuals with incomes between 100-400% of the FPL who are not eligible for zero SOC Medi-Cal or other Federal Health Insurance (Medi-Care, TRICARE, VA)
Plans will vary in cost depending on which METAL tier plan the customer selects (Bronze, SILVER, Gold Platinum)

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Cost Sharing Reductions (CSR) SILVER

The higher the metal value, the higher the % of HC $ the health plan pays...Platinum is the best also most $

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Cost Sharing Reductions (CSR) is a benefit that reduces out-of-pocket charges an enrollee must pay for medical care coverage by the plan (deductibles and copays); must be under 250% FPL to be eligible, only customers enrolled in the SIlver Plan are eligible

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Private Pay Insurance

Employer Coverage

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Un-subsidized Private Pay Insurance purchased through Covered California or directly from the Insurance Company
Provided by place of employment either free of cost or through payroll deducation