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Financial Assistance FAQs

Understanding tax credits, subsidies, and financial help for your Covered California health insurance.

Why did I receive a 1095-A form?

You received Form 1095-A because you or someone in your household was enrolled in a health plan through Covered California during the tax year.

What's on Form 1095-A?

  • Monthly premium amounts for your health plan
  • Amount of advance premium tax credit (APTC) paid on your behalf
  • Information about all covered household members
  • Second lowest cost Silver plan premium (SLCSP) for your area

When will I receive my 1095-A?

Covered California mails Form 1095-A by January 31st each year for the previous tax year. You can also download it from your Covered California account online.

What if I didn't receive my 1095-A?

  • Check your Covered California online account first
  • Verify your mailing address is current
  • Call Covered California at 1-800-300-1506
  • Request a duplicate form if needed

What do I do if I owe money back for my tax credit?

If you owe money back, it means you received more advance premium tax credit than you were eligible for based on your actual income. This is called "reconciliation."

Why This Happens

  • Your income was higher than estimated
  • Your household size changed
  • You didn't report changes timely
  • Your filing status changed

Repayment Caps

Maximum repayment amounts for 2024:

  • Under 200% FPL: $350 (single) / $700 (family)
  • 200-299% FPL: $900 (single) / $1,800 (family)
  • 300-399% FPL: $1,500 (single) / $3,000 (family)
  • 400%+ FPL: No cap (full repayment)

What is the Premium Tax Credit and how does it work?

The Premium Tax Credit (PTC) is a refundable tax credit that helps eligible individuals and families afford health insurance purchased through Covered California.

How It's Calculated

The credit amount is based on:

  1. Your household income as a percentage of the Federal Poverty Level (FPL)
  2. The cost of the second-lowest Silver plan in your area (benchmark plan)
  3. Your expected contribution based on your income level
  4. Your household size and ages of family members

Two Ways to Receive the Credit

1

Advance Payments (APTC)

Paid directly to your insurance company each month to lower your premium. This is the most common method.

2

Tax Return Credit

Claim the full credit when filing your taxes. You pay full price during the year and get refunded later.

Income Eligibility for 2024

Household Size 138% FPL (Medi-Cal) 150% FPL 400% FPL
1 $20,783 $22,590 $60,240
2 $28,208 $30,660 $81,760
3 $35,633 $38,730 $103,280
4 $43,058 $46,800 $124,800

When should I report income changes to Covered California?

You should report income changes to Covered California within 30 days of the change occurring. This is crucial for maintaining the correct amount of financial assistance.

Changes You Must Report

  • Income increases or decreases of 10% or more
  • Job changes (new job, job loss, hours change)
  • Household size changes
  • Address changes
  • Marriage or divorce
  • Birth or adoption
  • Death of a household member
  • Tax filing status changes

How Income Changes Affect Your Subsidy

Income Goes Up:

  • Your monthly subsidy decreases
  • You pay more for your premium
  • Prevents owing money at tax time

Income Goes Down:

  • Your monthly subsidy increases
  • You pay less for your premium
  • You might qualify for better cost-sharing reductions

What are Cost-Sharing Reductions (CSRs)?

Cost-Sharing Reductions (CSRs) are extra savings that lower the amount you pay out-of-pocket for deductibles, copayments, and coinsurance. These are only available with Silver plans.

CSR Eligibility Levels

Enhanced Silver 94

Income: 138-150% FPL

Actuarial Value: 94%

Benefit: Plan pays 94% of covered healthcare costs

Enhanced Silver 87

Income: 150-200% FPL

Actuarial Value: 87%

Benefit: Plan pays 87% of covered healthcare costs

Enhanced Silver 73

Income: 200-250% FPL

Actuarial Value: 73%

Benefit: Plan pays 73% of covered healthcare costs

Example Savings with CSRs

Plan Type Annual Deductible Doctor Visit Generic Drugs Out-of-Pocket Max
Regular Silver (70%) $4,500 $40 $15 $8,700
Silver 94 (CSR) $0 $5 $3 $1,150

Who is eligible for financial assistance?

To be eligible for financial assistance through Covered California, you must meet several requirements:

Basic Requirements

  • Be a California resident
  • Be a U.S. citizen, national, or lawfully present
  • Not be incarcerated
  • File taxes (with some exceptions)
  • Not have access to affordable employer coverage
  • Not be eligible for Medicare or Medi-Cal

Income Requirements

Your household income must be:

  • Above 138% FPL to avoid Medi-Cal
  • Below 600% FPL for California subsidies
  • No upper limit for federal subsidies (as of 2021)

FPL = Federal Poverty Level

Special Situations

Families with mixed immigration status can still apply. Only eligible family members will be enrolled, but the entire household income is considered for subsidy calculations.

You may still qualify if your employer coverage is considered "unaffordable" (costs more than 9.12% of income in 2024) or doesn't meet minimum value standards.

Students can apply independently if they file their own taxes. If claimed as a dependent, they're included in their parents' application.

Still Have Questions?

Need help understanding your financial assistance options? Our certified enrollment counselors can help you maximize your savings.

Call us at (818) 350-2675 for free assistance.

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