Any one insured under CoveredCA, and receiving subsidies, should be aware of a recent development that may impact them.

CoveredCA subsidy eligibility is based on the household’s Modified Adjusted Gross Income (MAGI) and is available for those whose annual income meets certain Federal Poverty Level (FPL) criteria. For 2015, the Federal Poverty Level Guidelines from 2014 are being used to determine subsidy levels.  However, Medi-Cal eligibility is based on the new 2015 Federal Poverty Level Guidelines and the income threshold was increased.

In California, households with incomes below 138% of the FPL guidelines are automatically enrolled into Medi-Cal. Children can slip into Medi-Cal unexpectedly if the household’s income is 266% or less of the FPL. Though the income threshold increase was slight, it still may impact those with incomes that straddle the line. To see the full Federal Poverty Level income chart, please click here: 2015 Federal Poverty Level Guidelines.

As a result of the increase to the FPL income threshold, some people have received a letter from CoveredCA stating they and/or their family members have become eligible for Medi-Cal and their existing subsidy benefits will end as a result. If you have received one of these letters, and Medi-Cal is not a desired choice, it is critical you contact CoveredCA directly to discuss options other than Medi-Cal.

Here are a few other ways that subsidy levels can be affected without realizing it:

  • A move to a new county (even though it’s in the same CoveredCA region)
  • A family member moving on or off a plan (remember, assistance is based on number of family members)
  • A dependent child earning income (all family income is taken into account)

For more information, contact CoveredCA at 800-300-1506 or online at

Phil Dougherty