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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.

Choices for Medi-Cal Eligible Consumers

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Question: I am a 63 year old, long time Kaiser individual-pay member, and wish to stay on Kaiser, but I will be classified as Medi-Cal eligible due to not working for 2 years. Since I won’t be eligible for a premium subsidy in the Marketplace, will Kaiser offer a similar plan for Medi-Cal individuals? If so, will it have comparable coverage and co-pays? I did read your posts at Feb. 20th, 2013 9:54 AM and also Feb. 4th, 2013 2:46 PM, but they seem to contradict each other suggesting that if I was Medi-Cal eligible I’d have to pay full fare if I wanted to be covered in the Marketplace. Yet on Feb 4 you seem to indicate I could stick with Kaiser in some plan. Lots of us low income Kaiser members who will want to know the precise answer to this. Other wise, not wanting to leave Kaiser, we’ll be paying full fare without even getting a subsidy that moderate income people get. BTW, You have a great site with wonderful questions and answers to so many of the questions that affect us. If I call Kaiser, they seem to know nothing.

Answer: You are correct. If your income makes you eligible for Medi-Cal (less than 138% FPL), you cannot opt for subsidized coverage in Covered California. However you can choose a Kaiser plan inside the Exchange or directly from Kaiser without premium subsidy or cost sharing assistance. Kaiser coverage in 2014 be more comprehensive on the whole than todays plans due to ACA requirements. Unfortunately, the cost of coverage will be higher as well. Hang in there. You’ll be on Medicare soon.


The California State Senate Bill- SB X1 1 - is winding its way through the legislature right now.

I assume it will pass, but time is passing quickly. It is meant to bring California’s Medi-Cal plan into compliance with the ACA.

A analysis is here…


—Bottom of page 9 and onto page 10—

“Effective January 1, 2014, the ACA requires states to change the way they calculate income for purposes of determining Medi-Cal
eligibility. Under the ACA, state income disregards and asset or resource tests would no longer apply when calculating income

“Instead, the income eligibility for an individual or a family would be measured based on MAGI. MAGI is defined as the
Internal Revenue Code’s Adjusted Gross Income, which allows a number of income deductions, including trade and business
deductions, losses from the sale of property, and alimony payments. MAGI is increased by tax-exempt interest and income earned by U.S. citizens or residents living abroad ”

If I read this correctly, those with very low income, but with assets, will be eligible for Medi-Cal and via Medi-Cal eligible for some health care plans such as Kaiser, which Medi-Cal already uses for some of its enrollees.

I will follow up on this part of the new ACA in California.

It appears that any single individual with a income under $15,857 will be designated as Medicaid (Medi-Cal) under the Covered California calculator.

Currently in 2013, with zero income, many of us who have more than $2,000 to our name, are NOT be eligible for Medi-Cal in California.

One wonders, for 2014, in the October through December enrollment period, will Medi-Cal have new criteria for those of us who are pushed out of the subsidized Marketplace into being Medi-Cal only?

The calculator does not count assets when figuring the subsidies in the Marketplace.

It seems impossible to imagine that a person with zero or low income can possibly be charged more for health care than a low income person under the subsidized Marketplace. I am told by Medi-Cal that they currently send Medi-Cal individuals to Kaiser for their care. They become members.

It would seem that unless the system is amazingly perverse, that those with zero income would NOT be punished for having some assets, even tiny ones, when the rest of those in Covered California do NOT have their assets counted when calculating their subsidy.

Another important question. What year is used for calculating income? If a person has no income in 2012, and the first 8 months of 2013, but then gets a job paying $3,000 a month in September 2013, which income will they use for calculating their income and subsidy?

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