Financial help

What type of financial help is available?
There are two types of financial help: Cost-sharing reductions and premium help.

• Cost-sharing reductions
  Cost-sharing reductions (CSRs) are subsidies offered through Covered California. If you are eligible, you pay less for your out-of-pocket expenses such as deductibles, copayments, and coinsurance when you use your plan. CSRs are only available if you purchase an Enhanced Silver plan (Silver 94, Silver 87, or Silver 73) through Covered California.
   
• Premium help
  Premium help lowers the cost of your monthly premium, which is your monthly payment amount. It is available from the federal government. The premium help amount depends on the information submitted when you enroll. This may include your income, age, household size, and the cost of plans in your area. Premium help is only available for plans purchased through Covered California. The type of premium help that may be available to you is Advanced Premium Tax Credit (APTC). It can be applied in advance as a monthly credit on your billing statement or at the end of the year in a lump sum when you file your federal income taxes.

How do I qualify for financial help?

A simple way to find out if you qualify is by using our subsidy calculator*. If you learn that you may be eligible, contact your broker to see your options. You can also contact us at (855) 836-9705.

*The results from this tool are based on the information you provided. If you decide to apply for a plan through Covered California, then Covered California will determine your eligibility and actual subsidy amount based on the information you enter in your application.

How do I apply for financial help?
If it looks like you may be eligible for either type of financial help, please contact your broker to discuss your options. You can also call us at (800) 300-1506.

What are Enhanced Silver or cost-sharing reduction (CSR) plans?
These are the Silver 73, Silver 87, and Silver 94 plans. These plans are only available through Covered California because they include financial help. You can only enroll in an Enhanced Silver plan if you qualify based on your income.

I already receive premium help. Will my APTC be the same as it was last year?
Probably not. The APTC amount you will receive each year will most likely be different based on any changes in the health insurance rates in your area and your:

• Household size
• Age
• Income

How can I make sure I get the correct premium help?
To make sure you get the correct premium help, update your household size, income, and other eligibility information with Covered California. Visit CoveredCA.com to make these updates, or call (800) 300-1506.

What kinds of changes should I report to Covered California throughout the year? Why is this important?
You should always report changes to Covered California within 30 days. This will help make sure you get the proper financial assistance and avoid getting too much or too little assistance. Receiving too much or too little assistance can affect your tax refund or balance due when you file your annual tax return.

You should report these changes:

• Change in income (employment, self-employment, income tax deductions, or other types of income). You must give Covered California permission to check your income annually or you may lose any financial help you may be receiving today. (Consent can be provided for one to five years.)
• Adding or removing a household member (birth, adoption, or marriage).
• Change of address.
• Permanent move.
• Corrections to your name, date of birth, or Social Security number.
• Benefits received under another type of health insurance or program like Medicare or Medi-Cal.
• Change in citizenship or immigration status.
• Are incarcerated or released from incarceration.
• Have a change in status as an American Indian or Alaskan Native or change your tribal status.
   

You can report changes:

• Online by logging into your account at CoveredCA.com
• By phone at (800) 300-1506 or TTY (800) 889-4500
• By telling your certified Covered California enrollment counselor, certified insurance agent, or county eligibility worker 

If you have any questions, contact Covered California at (800) 300-1506 or by TTY (800) 889-4500.

What is the Advanced Premium Tax Credit (APTC)?
The APTC is a federal tax credit designed to help lower your monthly costs for health insurance purchased through Covered California and is funded by the federal government.  

How does my APTC affect my federal income taxes? ​
Learn more about how to claim the premium tax credit on your federal tax return, or view the ACA tax provisions for individuals.

How do I claim APTC on my federal tax return?​
For any tax year, if you receive APTC payments in any amount or if you plan to claim the APTC, you must file a federal income tax return for that year.

In the first quarter of the year, Covered California will mail IRS Form 1095-A. This form will help you reconcile the APTC  you received for the current benefit year to the actual amount of Federal Premium Tax Credit you were eligible for in that year based on the actual Modified Adjusted Gross Income you report to the IRS on your taxes.  

For more information, visit our resources for tax season page or the IRS website for tax filing tips and ACA tax provisions for individuals.

Once I update my income, when will my APTC appear on my bills?​
Once you have reported your income, Covered California will decide whether it should adjust your premium help. If there is a change to your premium help, the new amount will be reported to us. Your bill will be updated in one to two billing cycles after the information is received to reflect your most current premium help. In the meantime, please pay the amount billed. We will make any necessary adjustments if you are owed a credit.    

What are the tax penalties for not having health coverage?
Although the federal government zeroed out the federal tax penalty in 2019, California enacted legislation to restore the individual mandate and tax penalty starting in 2020. Those who choose to go without coverage may be subject to a penalty as part of their annual state tax filing if they have access to affordable coverage within the cost limitations set by the state. There can be penalties of up to nearly $2,250 per family, which is based on 2.5 percent of household income or a minimum of $750 per adult and $375 per dependent child under 18 in the household, whichever is greater. The California Franchise Tax Board, which administers the state mandate, will assess the penalties for the coverage year when consumers file their taxes. Californians can file for an exemption due to financial or other hardship with Covered California. Visit Covered California to learn more or, for additional information, visit the California Franchise Tax Board.

If the federal individual mandate penalty is reinstated at any point, the state tax penalty will be adjusted.    
 
To avoid the tax penalty, you must have health coverage for at least nine months of the year. If you're uninsured for just part of the year, one-twelfth of the yearly penalty applies to each month you're uninsured. 

We're not tax professionals and cannot provide tax advice. If you need help, please get advice from a professional tax preparer or adviser.

Need more help? Visit the IRS website for tax filing tips and ACA tax provisions for individuals.