Types of Financial Help
Covered California offers two types of help to pay for coverage: premium assistance and cost-sharing reductions.
Premium assistance is a tax credit that reduces the cost of your monthly premium. It’s also called the Advanced Premium Tax Credit, or APTC.
Cost-sharing reductions are subsidies that reduce your out-of-pocket costs, such as copays, coinsurance and deductibles.
Covered California uses the federal poverty level (FPL) to determine your eligibility for tax credits, cost-sharing reductions, and programs such as Medi-Cal.
To be eligible for premium assistance, you must:
- •Be a U.S. citizen, a U.S. national, or be lawfully present in the United States.
- •Have an annual household income between 100 percent and 400 percent of the federal poverty level.
- •Not have access to affordable, minimum-value health insurance through an employer.
- •Not be eligible for other public health coverage, including full-scope Medi-Cal, premium-free Medicare Part A or military coverage.
- •File taxes for the year that you will receive premium assistance.
- •File taxes jointly if you are married.
Cost-sharing reductions are subsidies that lower your out-of-pocket costs when you get health care, including your copays, coinsurance, deductibles and out-of-pocket maximum. Cost-sharing reductions are available to those who are eligible for premium assistance and have an annual household income up to 250 percent of the FPL. If you qualify, all Silver-level plans displayed to you will include cost-sharing reductions. You must choose a Silver Level plan to receive reduced cost-sharing.