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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


Eligible for Medi-Cal but Prefers Exchange Plan

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Question: I’ve been on a sabbatical for a couple of years so my income has been close to 0 this past two years. I’m assuming that this could make me eligible for Medicaid, although I doubt it because my net worth is significant. Will I still be able to buy insurance from the exchanges if I qualify for Medicaid but I prefer one of the plans offered there?

Answer: Only your current modified adjusted gross income (MAGI) and not your assets will be taken into account in determining your eligibility for coverage in Covered California. If you are eligible for Medi-Cal you cannot also be eligible for a premium subsidy in the Marketplace. However, you may opt out of Medi-Cal and purchase unsubsidized coverage either in Covered California or in the market outside the exchange.

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I am in the same (very low) income and (high) asset situation and I’m apprehensive of the traditionally welfare quality coverage of MediCal. Can I just claim that I anticipate having income, say 150% FPL, get a subsidized exchange plan, and then somehow have my income fall short at the end of the year (below the MediCal level)? Would I then be required to back pay the full unsubsidized premiums since it turns out I should have qualified for MediCal and opted out?

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