Low-Income Individuals and Families Health Insurance Options

The Affordable Care Act (ACA) has made health insurance more accessible to families and individuals across the United States, including those in California. In 2018, 93 percent of Californians have coverage, indicating greater health outcomes for the state’s residents overall. However, this number still leaves seven percent of Californians — around three million individuals — uninsured.

California’s remaining uninsured lack coverage for many reasons. Some are ineligible for coverage due to their immigration status. Others come from low-income households where insurance may not be a top priority.

Some individuals may actually qualify for financial assistance but remain uninsured because they either have trouble with the enrollment process or don’t know they qualify for aid. And in some cases, California’s high cost of living, especially with regards to housing, may make insurance premiums difficult to afford even with financial assistance.

Despite these barriers, low-income individuals can still find affordable insurance. California offers several health insurance options for people with low incomes. Indeed, these options are often more affordable than remaining uninsured long-term.

Why Health Insurance Is Important for People With Low Incomes

Though paying for health insurance can be expensive, it generally saves people money in the long-term. By providing a safety net, health insurance helps everyone — especially low-income individuals — stay healthy without spending a fortune in the process. Here are a just a few reasons health insurance may benefit you and your family:

• Insurance makes preventative care more accessible: Preventative care services are the routine measures you take to maintain good health, such as getting a flu shot, visiting the dentist or getting a cancer screening. By reducing the cost of routine healthcare visits, insurance encourages preventative care, which can help you avoid more serious and expensive health conditions down the line.
• Insurance helps you handle emergencies: Medical emergencies do happen, and they can be costly. Without insurance, even one emergency hospital visit can trap a family in medical debt that’s difficult to escape. Ongoing medical bills, such as for cancer treatment, might be even more difficult to manage alone. Though coverage may seem expensive, it usually costs less than handling an emergency uninsured.
• The law requires people to have health insurance: Under the ACA, people are required to have health insurance by law. If you don’t have insurance, you may face fines. Since affordable options exist, it’s better to get the coverage you need and avoid fines rather than pay penalties while also running the risk of paying for a medical emergency on your own.

Health insurance comes with many benefits. It can save you money and help keep you and your loved ones healthy. Furthermore, low-income individuals need the benefits of health insurance even more than those with higher incomes, since it allows them to get the care they may otherwise be unable to afford.

In California, people with low incomes can benefit from a variety of affordable coverage options that make the advantages of health insurance available to almost everyone.

Affordable Insurance Options for Low-Income Californians

Low-income families and individuals in California have several options for finding affordable health insurance. The three biggest pathways to coverage are Medi-Cal, premium assistance and cost-sharing reductions.

Each program has slightly different features and eligibility requirements. But all three options make coverage more accessible to low-income Californians. The following sections will explain each program in more depth.

1. Coverage Through Medi-Cal

Medi-Cal is California’s Medicaid program, which provides inexpensive or free care services to more than 13 million Californians. Populations served by Medi-Cal include children and their families, senior citizens, people with disabilities, current and former foster care youth and some low-income adults, including those with diseases like breast cancer and HIV/AIDS, according to the California Department of Healthcare Services.

In accordance with the ACA, Medi-Cal covers the required 10 essential health benefits:

• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Mental health services
• Occupational therapy
• Outpatient services
• Physical therapy
• Prescription drugs
• Substance use disorder services

Medi-Cal also covers Medi-Cal also covers comprehensive dental care .

How to Qualify for Medi-Cal

Eligibility for Medi-Cal is determined by income level and household size as well as other factors. To qualify for coverage through Medi-Cal, a person must meet the following eligibility requirements:

1. You must be a California resident: You must live in California to qualify for Medi-Cal. Also note that children from low-income families may have access to Medi-Cal coverage regardless of citizenship status, as of 2016.
2. You must belong to one of these served populations: You must be a low-income adult, child, senior citizen, pregnant woman, a person with a disability or former foster care youth 26 years of age or younger.
3. You must meet income level requirements: Medi-Cal determines financial eligibility using Federal Poverty Level (FPL) guidelines as determined by the Department of Health and Human Services. To qualify for Medi-Cal, your household income must meet the percent FPL guidelines for your group and household size.

When determining your family’s eligibility, remember that some groups maintain eligibility at higher FPL percentages. For example, children can qualify for Medi-Cal up to 266 percent of the FPL. Under the Medi-Cal Access Program (MCAP), pregnant women qualify between 213 and 322 percent FPL

Furthermore, even your family doesn’t qualify for Medi-Cal, children might qualify for programs like the County Children’s Health Insurance Program (CCHIP) if your household income falls between 266 and 322 percent FPL. This means that some family members may qualify for low-income insurance even if other family members do not

If you or someone in your household qualifies for Medi-Cal, you can enroll right away, since there are no specific enrollment periods for Medicaid as there are for some other government health programs.

2. Premium Assistance Through Covered California

In addition to Medi-Cal, other low-income insurance options exist. One of these options is premium assistance through California’s regular insurance marketplace, Covered California. Premium assistance is a tax credit available to consumers to help reduce the cost of monthly healthcare premiums.

How to Qualify for Premium Assistance

To qualify for premium assistance, you must meet the following requirements for income and healthcare options:

1. You must meet income level requirements: To qualify for this healthcare tax credit, your household income must fall between 138 and 400 percent of the Federal Poverty Level.
2. You must meet citizenship requirements: You must be either a U.S. citizen, U.S. national or a lawfully present immigrant to receive premium assistance.
3. You must need insurance through the marketplace: You can only receive premium assistance if you do not have access to healthcare through an employer or other public health insurance programs like Medi-Cal.
4. You must plan on filing taxes: Premium assistance is a tax credit, so to benefit, you need to plan on filing taxes for the year in which you enroll. However, you do not need to have filed taxes before enrollment to qualify.

If you know you don’t qualify for Medi-Cal and plan on getting insurance through the marketplace instead, it’s a good idea to check and see if you qualify for premium assistance, since it can lower your overall insurance costs.

3. Cost-Sharing Reductions Through Covered California

In addition to premium assistance, cost-sharing reductions can make healthcare services even more affordable for low-income individuals. These subsidies reduce out-of-pocket costs for people enrolled in insurance through the marketplace.

Cost-sharing reductions help reduce co-pays, deductibles and out-of-pocket maximums, making services more accessible with insurance, so this option may benefit people who tend to struggle with out-of-pocket charges.

How to Qualify for Cost-Sharing Reductions

As with Medi-Cal and premium assistance, cost-sharing reductions come with unique eligibility guidelines. To receive price reductions, you must meet the following requirements:

1. You must qualify for premium assistance: Premium assistance and cost-sharing reductions overlap. You must qualify for premium assistance to receive cost-sharing reductions, though you may qualify for premium assistance by itself as well.
2. You must meet income requirements: You may qualify for cost-sharing reductions if your household income is 250 percent of the Federal Poverty Level or less.
3. You must enroll in a Silver-level plan: Plans through Covered California receive Bronze, Silver, Gold or Platinum rankings based on coverage level. To receive cost-sharing reductions, you must enroll in a Silver-level plan. Reduced cost plans appear in the marketplace as “Enhanced Silver-Level” plans.

In addition to premium assistance, cost-sharing reductions help low-income individuals and families afford the on-the-spot costs associated with receiving healthcare services.

Affordable Coverage Questions and Answers

Medi-Cal, premium assistance and cost-sharing reductions help make insurance available to many Californians with low incomes. However, every individual situation is unique — low-cost insurance options that work for some people may not work for others.

Health for California Insurance Center exists to help you find health insurance that meets your individual needs. With this in mind, here are answers to a few additional questions about affordable coverage options available in California.

1. Are There Affordable Insurance Options for Non-Citizens?

As a state with many immigrants, California works to promote the health of all its residents, not just U.S. citizens. Green card holders can apply for financial assistance and enroll in low-cost insurance plans through the Health for California marketplace as usual and may qualify for premium assistance or cost-sharing reductions.

Unfortunately, undocumented individuals won’t generally qualify for public insurance. However, they may find more affordable access to healthcare services through community health centers, county health programs and employer-based or student health plans.

Even if you don’t qualify for financial assistance, you may be able to receive care using programs in your community. Research options in your county and talk to a healthcare provider for more information.

2. What if My Application for Low-Income Insurance Is Denied?

Some applications for programs like Medi-Cal may be denied if the applicant doesn’t appear to meet the program’s requirements. If this happens, you can either search for other affordable options or challenge the decision.

If you feel your request for affordable insurance was wrongfully denied, you may be able to challenge the decision by filing an appeal through the California Department of Social Services.

After a hearing, appeals can be granted or granted in part as well as denied, so filing an appeal may be worth a try if you’ve been denied assistance through an affordability program. You can check data on recent hearing results in California for more information about successful appeals.

3. What if I Need Help Finding or Enrolling in Insurance?

California’s public insurance marketplace, Covered California, can make the application and enrollment process complicated, which may prevent some individuals from getting the coverage they need.

Finding affordable health coverage should be as simple as possible. Health for California provides an easy and fast online application process to find insurance options and determine your eligibility for financial assistance. Our agents can help you navigate the process and find low-cost insurance options that work for you.

If you’re interested in starting your insurance search, you can get a free quote through Health for California today.

Find Health Insurance You Can Afford

If you live in California and lack access to the healthcare you need, look into the state’s affordable insurance options for low-income individuals and their families. Financial assistance programs make health insurance available to almost all Californians. Accessible insurance helps keep all individuals healthy regardless of their resources.

If you’re looking for insurance options that fit your needs, check your eligibility for low-cost options by searching the Health for California website or speaking to an agent. Now that you’re aware of the options, you can find health insurance you can afford.