Get the Right Financial Help in the Form of an Advanced Premium Tax Credit

Covered California offers three types of financial help:

  1. Federal tax credits: These reduce the cost of your monthly premium. They’re also called the Advanced Premium Tax Credit (APTC).
  2. State subsidy: The state subsidy reduces the cost of your monthly premium.
  3. Cost-sharing reductions: subsidies that reduce your out-of-pocket costs, such as copays, coinsurance and deductibles.

Federal Tax Credits and the State Subsidy

To qualify for federal tax credits and the state subsidy, you must:

  • Be a U.S. citizen, a U.S. national, or be lawfully present in the United States.
  • 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.
  • For federal tax credits, have an annual household income between 100 and 400 percent of the federal poverty level.
  • For the state subsidy, have an annual household income between 0 and 138 percent or over 200 and up to 600 percent of the federal poverty level.

Cost-Sharing Reductions

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 federal poverty level. If you qualify, all Silver-level plans displayed to you will include cost-sharing reductions. You must choose a Silver plan to receive reduced cost-sharing.

Related Links

Options for Using Financial Help
Financial Help Is Based on Income
Estimating, Adjusting and Repaying Financial Help
See If You Qualify for Financial Help

For Covered California Members

Get the Right Financial Help in the Form of an Advanced Premium Tax Credit (APTC)

Financial help, also called (APTC), can lower the cost of health care for individuals and families who enroll in a Covered California health plan and meet certain income requirements.

The amount of financial help you receive is based on how much money you make, your tax household size, age and where you live. It’s important to keep Covered California updated about these changes so that your financial help can be adjusted if needed.

It is possible that you will qualify for more or less financial help than you received because at the end of the year, your income or your tax household size was different from what you reported to Covered California. If this happens, you may get money back when you file your taxes or you will have to repay the extra amount you received when you file taxes.

What do I do if I have a change in my income or application information at renewal or during the year?

During renewal, you can update your information at any time. Outside of renewal, you must report the change to Covered California within 30 days. At any time, if Covered California asks you to provide documents that verify your income, you must do so by the date listed on your notice.

To update your income or information safely and securely, you can log in to your Covered California online account. If you don’t already have an online account, we recommend that you create an account. You can also contact your Certified Insurance Agent or Certified Enroller or call Covered California at (800) 300-1506 (TTY: [888] 889-4500) and a service center representative will assist you to make the change in your account.

How can I avoid owing money when I file my taxes?

You can choose to take less of the premium assistance you receive each month. Your monthly premiums will still be lower. By taking less premium assistance during the year, there is less chance you will owe back money at tax time.