Covered CA & Medi Cal MAGI  Income Chart  
FPL Federal #PovertyLevel – Program, Eligibility & Subsidy Chart 

#FAQ ‘s, Explanations & More Details 

Footnotes

1   What is my Medi Cal or Covered CA  Household Size– Definition

Try this Flow Chart for a simpler explanation

How many dependents are on your Tax Return?  Section 151

Household Income includes all dependents on your return

2   What is MAGI Modified Adjusted Gross Income – Line 11 AGI + Social Security, Tax Exempt Interest & Foreign Income

Tax Return Reconciliation of Subsidy is on  8962 at the end of the year

4   MAGI based Medi-Cal    One can get FREE Medi-Cal base on  MAGI Income Line 37 of your 1040  – If your income falls  below 138% of the CA Poverty Line on the chart above.  There is no longer an asset  test, nor  estate recovery.

      Medi-Cal versus Covered California Income, Who Decides?  Kevin Knauss 

5   MAGI Medi-Cal for Pregnant Women

6   Medi-Cal Access Program   If you’re pregnant – up to 322% of FPL –  Formerly AIM

7   C-CHIP County Children’s Health Initiative Program in three northern CA counties

8   Kids under 19 go in Medi-Cal if MAGI Income is below 266% of Federal Poverty Level.  While you can purchase coverage direct from an Insurance Company at Open or Special Enrollment, there is no PTC subsidy or premium tax credit.

Learn More ==> Western Poverty Page 72

9   Enhanced Silver – Cost Sharing  94, 87 & 73  – in addition to subsidies, you get lower deductibles & Co Pays.  94 is better than platinum which is 90 and 87 is better than gold which is 80 – metal level.

Silver 70  has a $2,500 Deductible and Standard Metal Levels, Bronze $5k deductible, Gold and Platinum $0 Deductible

10   Federal Poverty Level FPL   My Coverage Plan.com   – Definition

FPL gets  adjusted annually, IMHO the best way to calculate is to Click here to calculate your premium assistance and get proposals

Federal Poverty Level (FPL): “An income level based on the official poverty line as defined by the federal Office of Management and Budget and revised annually or at any shorter interval that the Secretary of Health and Human Services deems feasible and desirable.” 22 CCR § 50041.5; see also 10 CCR § 6410 

Subsidies now go to 600% ^{CA Health Line} *

    Why Your Covered California Health Insurance Subsidy Dramatically Drops with an Income Increase  Kevin Knauss 

11   Use our free calculator to see how much subsidy and enhanced silver benefit you might qualify for.  Less than 138% of FPL generally qualifies one for Medi-Cal.

Silver 94 – Under 138% Only if you can’t get Medi-Cal

12  Silver 94 – Under 138% Only if you can’t get Medi-Cal

13 Click here to calculate your premium assistance and get proposals

We are paid by Covered CA and the Insurance Companies to help you, when you appoint us as your agent NO CHARGE!  

covered ca.com/documents-to-confirm-eligibility  

FAQ’s – on FPL Income Chart Frequently Asked Questions”

• In CA. What is the max income for children medical , family of 6?
  • 266% of Federal Poverty Level. $86k – Higher in some counties under C-Chip. Use  our complementary calculator.
• If my line 37 on my return is $40,103.. 3 people in house, i am only insured, 92656 is zip… I want blue shield Platinum, 90/10…can I get tax credits and if so how much?
  • Get a complementary quote and subsidy calculation by clicking here. We do not know the dates of birth. We guessed at that information and you will get a ball park quote shortly. Based on total guess work, you may get $400 in tax credits and qualify for Silver 87. We suggest you take the Silver Enhancement rather than pay for Platinum. What is your reason for Special Enrollment, rather than waiting for Open Enrollment?
• I have a Anthem PPO 70 Silver plan. I have one dependent, therefore a household size of 3. I currently am receiving a subsidy of approximately 900-1000 per month based on a $60,000 income. If I were to make more money, where does the subsidy stop. I’m not sure how you figure a household size of three.
  • Please enter your information into our complementary quote and subsidy calculator and just play with the household income, when you get your calculations. Our income chart isn’t fully accurate and it doesn’t show the lowest cost silver plan.
• I’m 66 years old My question is; if my income goes to about 16,000 do I qualify for Medi cal with no out of pocket expense including premium?
  • Since you are over 65, I don’t believe you are eligible for MAGI based Medi-Cal since you now have Medicare, don’t you?
  • Here’s our webpage on what Medi-Cal offers in benefits.
  • Here’s our webpage on Medi-Cal eligibility for aged & disabled. Then see the CA Health Care Advocates Site for Medi-Cal qualification if you have Medicare.
  • We don’t get paid to assist you to get into Medi-Cal. We can help you with a Medicare Advantage Plan Medi-Medi though.
• I was wondering if you could possibly help me with some questions I have about medical and covered California income requirements…
  • Please state your questions and we will reply. Telephone support is only available for those you have appointed us as their Covered CA agent – Instructions.
  • Please get a free quote, FPL determination – Medi-Cal or subsidy calculation here. Then we can be more helpful on whether you qualify for enhanced silver 94.
  • Here’s the definition of what counts as MAGI income.
• 1. I have two children with my boyfriend and I am not employed at the moment.   2. We were told that myself and the kids were covered under medi-cal but my boyfriend is not because his income is too high. 3. I was wondering if this could be because I claimed the children on this past years taxes?  4. I have looked at the income charts and were well below as a family of 4 and qualify for food stamps so why not medi-cal?
  • 2. Right, since you are not married, you would have two different 1040 forms and two different MAGI calculations.
  • Your boyfriend can get FREE quotes and enroll in a Covered CA plan with us as his agent, assuming we can find a special enrollment trigger. Change in Income?
  • 3. Use the FREE subsidy and FPL calculator with your boyfriend and the kids and see what happens.
  • Do the kids qualify as dependents for your boyfriend under Section 152?
  • 4. You are not a family of four. You’re filing two different returns right?
  • Please contact Medi-Cal direct for further qualifications to get in there. I don’t get paid to enroll or assist with Medi-Cal.
  • What about child support – Dependent Exemptions??
• 1. I am on disability retirement and my wife is still working, self-employed psychotherapist.  2. I get disability payments from Liberty Mutual (LM) which are not considered taxable income. 3. Our cobra ends at the end of April. 4. So I’m trying to continue with Kaiser but get the federal tax credit on the monthly premiums. 5. Both Kaiser and Covered California told me that without including the LM payments we would qualify for Medi-Cal, but I know we would be disapproved because we have investment savings that would disqualify us. 6. So, back to Covered California, they tell me go ahead and include the LM income so then I would qualify for the federal tax credits….was told that our total was just under the limit for 2 people of $63,720 so we qualify. 7. I go through the application online with them on the phone and we get to the point of choosing a plan, and nothing shows up for the federal credit amount…..it just shows the full monthly price for the plan I chose. 8. They went through the whole application again to make sure I didn’t make any errors, and they say its a glitch, that it should be showing a credit. 9. They send a report to their Resolution Team. Tonight I get an online notification saying that our total income is over the limit!!  10. Did the income limit get lowered, they don’t say.  11. Do you agree that the $63,720 is the correct income limit to be under to be able to get federal tax credit?  12. I know that Medi-cal disqualifies you for having too much assets, but does Covered California do that as well?
  • 2. The big issue here is whether your non-social security disability – retirement income counts as MAGI Income – Line 37 of your 1040 + 3 other things – Foreign Income, Tax Exempt interest and Social Security Benefits. Click on the link for the EXACT definition.
  • Do the Liberty Mutual Disability Payments show up on line 16 of your 1040? Anywhere on your 1040?
  • For more information on whether Disability Payments are taxable check these links:
  • Disability vs SDI State Disability
  • Taxable vs Non Taxable Income
  • IRS Publication 525 Taxable vs Non Taxable Income See page 17 the section on Disability Pensions.
  • My interpretation, which I’m not allowed to give you, as I’m not a CPA or Tax Attorney is that your LM payments are showing up on line 7 of your 1040. Is that correct? Please check with competent tax counsel and respond below or email me privately as to what your line 37 Adjusted Gross Income will be for 2016.
  • 3. Cobra ending will give you a special enrollment period.
  • 5. I do not care what anyone says over the phone. Medi-Cal no longer has an asset test for Health Insurance Coverage under Health Care Reform. It’s all MAGI Income. Here’s a chart showing the income levels, Medi-Cal, Enhanced Silver and max amount for subsidies.
  • 6. While you might be under the limit of $63,720 – 400% of Federal Poverty Level – there is a complex formula CFR 1.36 B that tells you exactly what the credit will be. It’s not a yes or no credit – it’s how much. Click here to use our FREE Quote Engine to calculate your credit.
  • 11. Yes I agree, that’s what’s on the income chart. But it’s not a yes or no question. Use our Quote Engine to calculate.
  • 12. Covered CA is basically just a sales agent for Medi-Cal. It’s the same rules. Assets are no longer relevant for Medi-Cal.
  • If you don’t qualify for subsidies and even if you do, the premium would be deductible from your wife’s self employment on line 29 of your 1040.
  • How about going direct to an Insurance Company using the quotes from our quote engine above so that we can get paid for helping you and being honest about referring you to tax counsel and official IRS publications as to whether your LM income counts as MAGI income. IMHO it does, thus Medi-Cal is off the Table anyway. Did your phone calls get you any actual reference materials or citations. If you have a complex claim, who will be there to actually help you? Here’s 15 reasons how we can be of help. How long were you on the phone with Covered CA & Kaiser? if by chance our quote engine and your CORRECT MAGI income estimate gets you subsidies. There is NO EXTRA charge for our help. Covered CA and Kaiser will pay us, so that they don’t have to hire as many telephone people.
  • Please note also that if your income goes over 400% of Federal Poverty Level for 2016 you have to pay back all the subsidies! Learn more ===> Premium Tax Credit Form # 8962
  • Publication 974 Premium Tax Credit
  • Here’s where a guy had to pay back $13k as Covered CA said Social Security Income didn’t count.
  • Ways to keep your income under 400% of poverty level. But do not even think of asking me to get involved in any shenanigans with you!
• Hi Steve,
  Been meaning to respond and give you updates. First off, thank you so much for your response back then with great information! You were right on many points.
  We ended up qualifying for Medi-cal because they don’t look at assets just “taxable” income. Since the LM disability income isn’t taxable we only had some dividend income and my wife’s small income (on our 1040) so we were under the limit to qualify us. We started 6/1 the day after cobra ended. It took a month, til 7/1, to get back on Kaiser again…Medi-cal through Kaiser. Had a health emergency on 6/9 and had to go to our neighborhood health clinic, but that lasted only a week fortunately.
  I’m awaiting an appeal on SS disability (initial SSDI claim was denied in March). That, I believe, will be considered taxable income, right? If so that could then kick us off Medi-cal, but will have to cross that bridge if/when that happens. LM required me to apply for SSDI and then appeal too because if it is approved they won’t have to pay me as much (about 90% of what they’re paying me now).  Thank you again Sara
  • Here’s the rules & details on MAGI calculation of Social Security Benefits
• Hi Steve,
  My main question, that I can’t seem to find an answer to anywhere, is whether SS Disability income is considered taxable in the same way as SS retirement income is calculated. Everything I see is talking about SS retirement income, not disability income. Is there any difference when it comes to taxes?
  Thanks,
  Sara
  • Social security benefits include monthly retirement, survivor, and disability benefits. They do not include Supplemental Security Income (SSI) payments, which are not taxable Page 1, Introduction Publication 915
• I kind of hope they don’t approve the SSDI appeal. Not only will there likely be some of it taxed, but the non-taxable LM [Liberty Mutual] disability funds will be reduced, and we will be kicked off Medi-cal so will have to start paying something toward a covered california policy.  A benefit, I guess, to getting SSDI, however, is that Medicare starts 2 years later and won’t have to wait til I’m 65 (so it’ll be about a year early for me).
  • Check out our complementary quote engine, above right, to see what your subsidies and enhanced silver levels are, depending on your MAGI income. You should be able to get a much wider provider list, which is also in our quote engine.
• 1. I have Covered Ca plan since 2014, I am self-employed.  2. In 2015, my gross revenue was just short of $25,000. 3. I had to lend my business lots of money. 4. I have a 94 [Enhanced] Silver Plan and used to have a Silver 87 through Anthem. 5. I have to send in a Profit & Loss Statement [Schedule C] for 2015 and am worried I may not be able to keep my insurance. 6. What are your thoughts?
  • 2 The question is, what number will you be putting on line 12 of your 1040 Business Income or Loss.
  • 3. I don’t know where lending money to a business shows on Schedule C. See our Schedule C page for Official IRS Instructions or contact competent tax counsel. Here’s VITA which is run by volunteers and its free.
  • 5. What will you have for line 37 MAGI Income?
  • 6. If your income is too low, then you get FREE Medi-Cal. If you want private coverage, you can opt out of subsidies and pay the full price. Here’s our FREE Quote Engine. The quote engine will calculate subsidy and Medi-Cal qualification based on MAGI Income.
• Hi Steve—  1. I’ve CCed [redacted] (my wife), and [redacted] (my Mom, who has strong opinions re my healthcare) 2. For the last 2 years I’ve been on an [redacted] PPO through the [redacted] union.  3. On March 31 my coverage ended. 4. I’m trying to figure out how to best proceed. I would like a PPO (my Mom feels strongly that it’s a plan where I could be treated at a hospital of my choice out of state if I’d like).   5. Also, this year (for the first time) I’m filing my taxes jointly with my wife.  6. She has been on Medi-Cal due to her tax bracket, but we’re presuming that since we’re filing jointly now, she may be ineligible for Medi-Cal some point soon.  7. How does that work? How/when would we be notified?  8. Finally, I’m curious how your services work re payment. Will using your services cost me more money than going through the Covered CA marketplace?  Thanks so much!  Best,  Jerry
  • 3. That gives you 60 days to get new coverage – Learn More
  • 4. Click here to get quotes from ALL companies, with and without subsidies, in and out of Covered CA.
  • 7. The quote engine will give you a calculation of what plans your qualify for based on MAGI Income. Line 37 of your expected 2016 tax return. But that is simplistic – click on the click for exact definition of MAGI income. See also the income chart.
  • You are supposed to notify Medi-Cal within 30 days of income or family status changes. You will hear from them if your wife no longer qualifies. I don’t get paid to do Medi-Cal. Here’s everything I have on Medi-Cal. When your wife gets notified that she’s losing Medi-Cal that gives her a special enrollment period. Also, there is a special enrollment period when one gets married.
  • 8. I get paid from whatever insurance company you choose. The 10 minutes I spent answering your questions today – save them time and money. I would also hope that with my education, background and experience, you are getting better and more helpful answers here.
  • Is the income limit for premium assistance based on the persons AGI (adjusted gross income) as I was told by the agent at Covered California ?
  • That is very close and I would still give that phone representative the cigar, however it’s not fully accurate.
  • First, the term is MAGI, Modified Adjusted Gross Income, which is AGI plus a few extra things for some people. Learn more on our MAGI page. Be sure to read carefully and never trust anything over the phone and without documentation. Here’s where Covered CA’s advise caused at $13k refund of all the subsides as they didn’t tell the client that he needed to add back in Social Security Income.
  • Second, what you did last year is only a guide. The issue is what do you expect your CURRENT year MAGI income to be? Thus, if you earned say 20K last year as a single, sure you get premium assistance and enhanced silver benefits but if you earn over $47k you have to pay back all* the subsidies at tax time. That is why there is a rule to report income changes within 30 days.
• my income did not change from the number I used when I signed up; and it isn’t going to change this year either. They approved me for premium at that income but when I do my taxes- Im told I owe it all back…!
  • Please when stating income, give more details.
  • What was your MAGI Income, line 37 of your 1040 + a few extras for 2014 and 2015?
  • What is your line 22 total income?
  • How are you defining income?
  • What was the reason your tax person said that you owe all the Advance Premium Tax Credit back?
  • Do you get Alimony, line 11?
  • Schedule C Business Income Line 12?
  • Were you offered affordable coverage 9.5% at work?
  • Are you claimed as a dependent on your parents tax return?
  • Student Loans?
  • Eligible for coverage on parents coverage? Spouses Coverage?
  • Lawfully Present in the USA?
  • Please co-operate, since we are not your agent and not getting paid to help you, by getting a FREE quote and subsidy calculation on our website, so that we have an idea of what your MAGI income is and what the subsidy should be.
  • Covered CA states all over their website that they don’t give tax advise. One must read the OFFICIAL IRS Rules Publication 974 – 71 pages to get authoritative answers. Here’s where the wrong answer from Covered CA caused someone to pay back $13k as Social Security counts as MAGI Income.
  • It’s a real shame that our government is so much like the emperor wears no clothes. I went to a seminar where our local congress person had a speaker give us WRONG information about how things were Pre Obama Care. When I raised my hand to correct her, the Congress Woman’s Aid and the other speaker told me that I must NEVER correct or interrupt a well respected Congresswoman’s Dog & Pony show!
  • You are welcome to email me the relevant documents privately.
• Hi, i am currently on Medi-cal. i am about to turn 65 and will be required to register for medicare. How do the two work together? What will my choices for coverage be? What about the supplements? Thanks so much
  • See our webpage on Introduction to Medicare
    • Aged and Disabled Federal Poverty Level Program