50 comments on “More FAQ’s – on FPL Income Chart Frequently Asked Questions

  1. 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?

  2. 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.


  3. Hello,
    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?
    Thank you for your response

  4. Hi,

    I was wondering if you could possibly help me with some questions I have about medical and covered California income requirements…

    Mary F

  5. Hi Steve,

    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?

    13. Thank you for your help.

    • 2. The big issue here is whether your non-social security disability – retirement income counts as MAGI IncomeLine 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? Here’s instructions to appoint us as your Covered CA agent, 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

          • 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 Steve!

                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.

  6. 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.

  7. 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!



    • 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.

  8. 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.

          Click here for instructions to appoint us as your agent, so that we can get compensated to help you, no extra charge.

          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.

  9. 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

  10. Good morning Steve,

    So do I need to make F 1040 EZ as my income equal to $12000 per year, or do I need to count $18000 to IRS? Please let me know which income should I report for 1040 EZ.

    Thank you very much.

    Mark O

    • Sorry, I’m not licensed, educated or trained on filing taxes. I do have a webpage though with links to the 1040, instructions, more forms and information including FREE tax assistance from VITA. So, check that out.

  11. Hi, Steve. I qualified for Enhanced Silver 94 in 2015 using my 2014 income. Now I am doing my 2015 taxes and I need to know how much to put into my IRA to maintain this coverage (since I need some operations).

    I need to know the exact range of MAGI for 2015 and 2016 that will let me keep this coverage.

    Household= 2 people (one 66 year old on Medicare, so not eligible), me, 63 years old.

    Are you accepting new clients? Do you do taxes too? Thanks, Brian Alexander

    • Telling you an exact range is likely to get me in Federal Prison… Here’s a chart that shows the numbers. See the FAQ’s there is some question about the multiplication of the Federal Poverty Level X 138%… I also suggest you play with the numbers on our FREE quote engine.

      The “exact” range is VERY narrow. I dislike selling the Silver 94 as so many people wind up in Medi-Cal.

      Yes, we are accepting new clients. No we don’t do taxes. I’m only this involved, as I took a 2 S deferment from Vietnam to get a Bachelors Degree in Insurance. President Obama as Supreme Commander of US Forces, called me to duty.

      Click here for instructions to appoint us as your agent.

      • Thanks Steve. So I need between 138%-150% FPL (2014) to calculate my IRA contribution for 2015.

        I always put money into our IRAs, I just needed to know how much to put in there now to keep my 94 silver. Thanks, It’s pretty simple. Brian

  12. Stive

    Earlier of the 2016 we spoke of income for 2016 . Which income are we spiking of please advise .


    Diane P

    Sent from my iPhone

  13. Kirk . . .

    Who is responsible for CoveredCA’s newly released (“March 3, 2016”) MAGI numbers for household sizes 1-6?

    All of the “138%” amounts stated for these 6 households are higher than 138%, by up to as much as 1.28% for a household of 1 to just 0.04% for a household of 6. The numbers for 7, 8, and each additional person over 8 are correct.

    The effect of this error will be to force some persons into Medi-Cal, unjustly denying them access to CSR-enhanced commercial health insurance.

    Attached is a print of the Excel spreadsheet I have used and shared with other agents for three enrollment periods now, and its numbers are accurate to within $1.00.


    Life & Disability Insurance Analyst
    California Insurance License #0596197

    Pomona, CA 91766

    • Well, I guess we’re both right and both wrong. I found a document from HHS issued in the Federal Register on January 25 (no wonder no one heard about the changes) that was an update to the previously released 2016 FPL guidelines. https://www.federalregister.gov/articles/2016/01/25/2016-01450/annual-update-of-the-hhs-poverty-guidelines#t-1

      according to the January 25 update for the 100% FPL guidelines, your 138% column values are correct, but your chart did not update the 100% column with those values. As a result, all of your subsequent column values other than 138% are also incorrect. Attached is my revised worksheet with unlocked formulas so you can see for yourself how the numbers should be calculated. You might want to revise your document accordingly.

      On 09-Mar-16 09:45, Duran, Gil (CoveredCA) wrote:
      Hi Max,

      The FPLs introduced into the application on 3/7 are set by the federal government, and the chart we released to agents was reviewed by our Legal and Policy divisions. I am confident they are accurate figures. The issue may be that the way Medi-Cal eligibility and APTC eligibility are determined uses two different years for determinations. Below is a summary of the issue which can also be found in our release notes here. I found this chart is also helpful to explain what happens when Medi-Cal changes to start using 2016 FPLs.

      Let me know if you have any questions,

       Covered California and Medi-Cal use the FPL to determine financial eligibility for Insurance Affordability Programs (Medi-Cal, Advanced Premium Tax Credit, Cost-Sharing Reductions, etc.)
       FPL is a function of household size and income
       The FPL guidelines adjust every year for inflation
       The FPL guidelines are issued at the beginning of each year by the U.S. Department of Health and Human Services (DHHS)
       DHHS issued the 2016 FPL guidelines per Bianca’s email below; DHCS has chosen to implement in the release this weekend
       Modified Adjusted Gross Income (MAGI) Medi-Cal eligibility determinations in the online application will use 2016 FPLs as of March 7, 2016
       Per regulation, Covered California (APTC/CSR) will continue to use 2015 FPLs through the 2016 coverage year.
       How will this affect consumers?
       New consumers will first be evaluated for Medi-Cal eligibility, using 2016 FPLs. If not eligible for Medi-Cal, they will be evaluated for Covered California (APTC/CSR) using 2015 FPLs.
       Covered California consumers who report changes may be reevaluated for eligibility and find that they now qualify for Medi-Cal.

  14. Hello Steve.

    Thanks for your time. Bob P here.

    I would like to know the income levels to stay above medi-cal becoming involved in my insurance for 2014 and 2015. Thank you so very much.

    Bob P

  15. I’m trying to help my son in CA renew a medi-cal eligibility based solely on income. He’s self employed (sch C), and I believe based on his past business expenses that his AGI (line 37 on the 1040) for the 2015 return will fall below $16200. However, from what I’ve read so far

    1. certain sch C deductions are not allowed.

    His 2015 return is not yet completed. Is this true? Any thoughts or recommendations for his renewal application?

  16. I left my previous job in Dec 2015. I am currently out of job. I think I will maintain my out-of-job status till the end of May. So I have no income this point. But my estimated income if I start working in June will be around $45000. Should I qualify for Medi-CAL now? But my estimated income will be higher than the amount of Medi-CAL requires, the CoveredCA gives me an enhanced Silver 87 benefit.

    So what income should I input? and what program should I enroll?

    • Everything comes out in the wash when you file your 2016 taxes. So since your “vacation” is voluntary, I suggest you use the $45k and enroll now. The deadline is Sunday night. If you use a certified agent, the deadline is next Saturday the 6th.

      If you qualify for Silver 87, that’s great. Not only subsidies, but 17% extra benefit that Silver 70. http://enhanced-silver.com/

      You can get quotes, subsidy calculation on this website by clicking here.

      How about using the time to search for a job that includes benefits and see if you can earn say $80K working and contributing more to the economy?

      • I wish I can start searching for the job earlier. But I need to take care of my kids and finish my study. I was taking leave of absence from school to take the job to pay for my kid expense. Now, I have a little bit of saving for us to survive through June this year. Since I voluntarily left my previous job, I am not eligible for my school’s insurance program. Then I have to look for alternatives.

        I am so confused about estimated income. I talked to the agent at CoveredCA. They said since I am not earning income at this moment, I should enroll in Medi-Cal even though my income for the whole 2016 may be higher as I may get penalized for not enrolling Medi-cal if I am eligible to. But then if my whole 2016 income is higher than what is allowed in Medi-Cal, what will happen? I am very confused.

        • Right, kids and studies are important. It’s our future. I’m not sure if you would qualify for Medi-Cal now, that you are unemployed, BUT your estimated 2016 income is too high. I’m running out to go to a concert and then visit my Aunt and Uncle. I will post more on estimated income and Medi-Cal shortly.

          In the end, it’s all based on MAGI Income, line 37 of your 1040.

          Sometimes it’s difficult to get out of Medi-Cal.

          Don’t forget, neither Covered CA or I, am allowed to give tax or legal advise. Since we have a deadline tomorrow or Saturday… You might apply for Covered CA now and then apply for Medi-Cal and see if they accept you. Direct Medi-Cal enrollment is here…

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