Covered California Income Eligibility Estimator
Estimate your potential eligibility for financial assistance through Covered California based on your household income and size.
Your Estimated Eligibility:
"; eligibilityMessage += "Your estimated income is $" + annualIncome.toLocaleString() + " for a household of " + householdSize + " people."; eligibilityMessage += "This is approximately " + fplPercentage.toFixed(1) + "% of the Federal Poverty Level (FPL) for your household size (based on 2023 FPL data)."; if (fplPercentage < 138) { eligibilityMessage += "Based on your income, you likely qualify for Medi-Cal (California's Medicaid program), which provides free or low-cost health coverage. You should apply through Covered California, and they will determine your Medi-Cal eligibility."; } else if (fplPercentage >= 138 && fplPercentage <= 250) { eligibilityMessage += "You likely qualify for Premium Tax Credits (APTC) to lower your monthly health insurance premiums and Cost-Sharing Reductions (CSR) to reduce your out-of-pocket costs (deductibles, copays, coinsurance). You should explore plans through Covered California."; } else if (fplPercentage > 250 && fplPercentage <= 400) { eligibilityMessage += "You likely qualify for Premium Tax Credits (APTC) to lower your monthly health insurance premiums. You should explore plans through Covered California."; } else if (fplPercentage > 400) { // Note: Due to ARPA/IRA, the 400% FPL cliff for APTC is temporarily removed, // meaning people above 400% FPL may still qualify if benchmark plan costs exceed 8.5% of income. eligibilityMessage += "Based on your income, you may not qualify for significant financial assistance (Premium Tax Credits or Cost-Sharing Reductions) under traditional guidelines. However, due to recent federal legislation, you might still be eligible for Premium Tax Credits if the cost of a benchmark plan exceeds a certain percentage of your income. It's highly recommended to apply through Covered California to get an exact determination."; } eligibilityMessage += "This is an estimate based on 2023 Federal Poverty Level data and general eligibility guidelines. Your actual eligibility will be determined by Covered California upon application."; resultDiv.innerHTML = eligibilityMessage; } .covered-california-calculator-container { font-family: 'Arial', sans-serif; background-color: #f9f9f9; border: 1px solid #ddd; padding: 20px; border-radius: 8px; max-width: 600px; margin: 20px auto; box-shadow: 0 2px 4px rgba(0,0,0,0.1); } .covered-california-calculator-container h3 { color: #0056b3; text-align: center; margin-bottom: 20px; } .covered-california-calculator-container p { font-size: 15px; line-height: 1.6; color: #333; } .calculator-inputs label { display: block; margin-bottom: 8px; font-weight: bold; color: #555; } .calculator-inputs input[type="number"] { width: calc(100% – 22px); padding: 10px; margin-bottom: 15px; border: 1px solid #ccc; border-radius: 4px; font-size: 16px; } .calculator-inputs button { background-color: #007bff; color: white; padding: 12px 20px; border: none; border-radius: 5px; cursor: pointer; font-size: 16px; width: 100%; transition: background-color 0.3s ease; } .calculator-inputs button:hover { background-color: #0056b3; } .calculator-result { margin-top: 25px; padding: 15px; border: 1px solid #e0e0e0; border-radius: 5px; background-color: #eaf6ff; color: #333; } .calculator-result h4 { color: #0056b3; margin-top: 0; margin-bottom: 10px; } .calculator-result p { margin-bottom: 8px; } .calculator-result .disclaimer { font-size: 13px; color: #666; margin-top: 15px; border-top: 1px dashed #ccc; padding-top: 10px; }Understanding Covered California Income Eligibility
Covered California is the state's health insurance marketplace, established under the Affordable Care Act (ACA). Its primary goal is to help Californians find affordable health insurance coverage, often with financial assistance to reduce the cost of premiums and out-of-pocket expenses. Eligibility for this financial help is primarily determined by your household's Modified Adjusted Gross Income (MAGI) relative to the Federal Poverty Level (FPL) and your household size.
What is Modified Adjusted Gross Income (MAGI)?
For health insurance purposes, MAGI is a specific calculation of your income used to determine eligibility for subsidies. It's generally your Adjusted Gross Income (AGI) from your federal tax return, plus certain tax-exempt income like non-taxable Social Security benefits, tax-exempt interest, and foreign earned income. It's crucial to estimate your MAGI accurately for the year you need coverage, as this is what Covered California will use.
What is the Federal Poverty Level (FPL)?
The Federal Poverty Level (FPL) is a set of income thresholds used by the federal government to determine eligibility for various federal programs and benefits. It varies based on household size. Covered California uses FPL percentages to determine who qualifies for different types of financial assistance:
- Medi-Cal (California's Medicaid Program): Generally available to individuals and families with MAGI below 138% of the FPL. Medi-Cal provides free or very low-cost health coverage.
- Premium Tax Credits (APTC): These are subsidies that lower your monthly health insurance premiums. Historically, they were available to those with MAGI between 138% and 400% of the FPL. However, recent legislation (like the American Rescue Plan Act and Inflation Reduction Act) has temporarily expanded eligibility, effectively removing the 400% FPL income cliff. This means more people, including those above 400% FPL, may qualify if the cost of a benchmark plan exceeds a certain percentage of their income.
- Cost-Sharing Reductions (CSR): These subsidies reduce your out-of-pocket costs like deductibles, copayments, and coinsurance. They are typically available to those with MAGI between 138% and 250% of the FPL who enroll in a Silver-level plan.
How the Calculator Works
Our Covered California Income Eligibility Estimator uses your estimated annual household income (MAGI) and your household size to calculate your approximate FPL percentage. Based on this percentage, it provides an indication of the type of financial assistance you might be eligible for. Please note that the FPL data used in this calculator is based on 2023 figures, and FPL guidelines are updated annually. This tool provides an estimate, and your final eligibility will be determined by Covered California upon completing an application.
Examples of Eligibility
Example 1: Low Income Household
A single individual with an estimated annual household income (MAGI) of $18,000.
Using the calculator:
- Household Size: 1
- Estimated Annual Household Income: $18,000
Result: For a single person, the 2023 FPL is $14,580. An income of $18,000 is approximately 123.5% of the FPL. This individual would likely qualify for Medi-Cal.
Example 2: Moderate Income Family
A family of four with an estimated annual household income (MAGI) of $65,000.
Using the calculator:
- Household Size: 4
- Estimated Annual Household Income: $65,000
Result: For a family of four, the 2023 FPL is $30,000. An income of $65,000 is approximately 216.7% of the FPL. This family would likely qualify for both Premium Tax Credits (APTC) to lower their monthly premiums and Cost-Sharing Reductions (CSR) to reduce their out-of-pocket costs, especially if they enroll in a Silver plan.
Example 3: Higher Income Individual
A single individual with an estimated annual household income (MAGI) of $55,000.
Using the calculator:
- Household Size: 1
- Estimated Annual Household Income: $55,000
Result: For a single person, the 2023 FPL is $14,580. An income of $55,000 is approximately 377.2% of the FPL. This individual would likely qualify for Premium Tax Credits (APTC) to help lower their monthly premiums. They would not typically qualify for Cost-Sharing Reductions at this income level.
Remember, this calculator provides an estimate. The best way to determine your exact eligibility and explore plan options is to visit the official Covered California website and complete an application.