How to Get the Obamacare Subsidy

Many Eligible Californians Are Not Taking Advantage of Health Insurance Subsidies

A recent New York Times* article reported a surprising fact about the makeup of Californians who have purchased their health insurance through Covered California: so far, individuals and families who qualify for subsidies are the least likely to use the exchange to buy their insurance. This is despite the fact that the federal government will pay part of their insurance premium if they purchase through the exchange.

It’s not clear why Californians who qualify for the subsidy are not taking advantage of it. Here are a few ways to help get the word out and increase participation by this group.

Know Who Qualifies for the Premium Subsidy

Who qualifies for subsidized premiums? Citizens and permanent residents (at least 5 years) who are not covered by an employer’s plan and are

  • Individuals that make $15,856 – $45,960
  • Families of four that make $32,499 – $94,200

The amount of premium assistance depends on an individual’s income and age and where the person lives. (Click to learn options for individuals and families who do not meet these income or residency requirements for a health insurance subsidy.)

The Affordable Care Act sets a monthly maximum that people will pay for health care, based on where their income falls in the federal poverty level scale. In general, the less income someone makes, the less he or she will have to pay for health insurance and the more the federal government will help.

This downloadable pamphlet explains the details,

in English.

in Spanish.

Know Who Qualifies for Cost-Sharing Subsidies

While premium assistance can help reduce premium payments, cost-sharing subsidies protect lower-income people from high out-of-pocket costs when they receive services. In 2013, those with incomes that are

  • $15,856 – $28,725 for a single person
  • $32,499 – $58,875 for a family of four

might be eligible for those subsidies.

To find out more, download,

in English.

in Spanish.

Know the Main Benefits of Obamacare

Many people still have little understanding of how Obamacare will help them personally, so they lack the incentive to sign up now. This short entertaining video breaks down and explains the changes in an easily digestible manner.

Watch the “YouToons Get Ready for Obamacare” to learn simple ways to explain how Obamacare will help individuals and families:

(Click to watch the video in Spanish, “Los YouToons Se Preparan Para Obamacare.”)

Some of the benefits that matter most to individuals and families include:

  • Free preventive care. No co-payments for preventive care, regular wellness visits, and cancer screenings.
  • Young adults can stay on their parents’ health insurance until age 26.
  • Insurance companies cannot cancel people’s health insurance if they get sick.
  • Insurance companies cannot deny coverage because of pre-existing conditions.
  • Insurance companies cannot put annual and lifetime limits on the care you get, so they can’t contact you while you’re in the hospital receiving treatment and tell you that you’ve run out of benefits.
  • Former foster care youths who had Medi-Cal at age 18 are eligible for Medi-Cal up to age 26.
  • Insurance companies must spend at least 80% of your money on health care or give you money back.

People will be able to shop and get help online (Covered California) or by phone (1-800-300-1506). In the Covered California marketplace, subscribers can compare plans side by side, line by line, benefit by benefit. They will know the costs, the amount of any subsidy they are eligible for, and the premium they will pay after the subsidy is deducted.

To see the plans and rates for 2014, download the Covered California health plans booklet.

How the Premium Subsidy Works

Premium assistance is a federal tax credit that is deducted directly from the premium at the time an individual or family enrolls in health insurance. Enrollees do not need to wait until they file a tax return at the end of the year.

Here are a few important things to know:

  • Premium assistance reduces the cost of an individual’s or family’s health insurance plan premium.
  • Premium assistance is only available through Covered California. Californians must purchase their health insurance plan from Covered California if they want to get premium assistance.
  • Premium assistance is paid directly to the health plans by the federal government.

To see the rates for all the plans offered by Covered California in 2014, download their health plans booklet.

Help South Los Angeles Residents Get Covered

Sharing knowledge of who is eligible for subsidies, the types and benefits of the subsidies, and the value of getting coverage through the Covered California exchange are some of the ways we can help ensure that eligible South Los Angeles residents don’t get left out of Obamacare’s protections.

For more information about how to help South Los Angeles residents get coverage, contact the Southside Coalition of Community Health Centers at (213) 741-0821, ext. 263, or Covered California at (800) 300-1506. To learn about options for residents who do not qualify for a subsidy, see “Obamacare Options”.

Source: *Katie Thomas and Andrew Pollack, “California Encouraged by Health Plan Enrollment,” New York Times (Nov. 21, 2013), http://www.nytimes.com/2013/11/22/business/california-encouraged-by-health-plan-enrollment.html.

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