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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.


How to get Covered California for 68 Year-old?

By on | 6 Comments

Question: Is income between 138-150% of FPL is the only condition? Would there be a problem that the person is 68 years old and does not qualify for Medicare? How is the 138% calculated ? Is it based on raw income or after tax income or else?

Answer: If the person in question is not eligible for Medicare at age 68 and has legal status, then this individual is eligible for Covered California coverage. The income calculation is an estimate of 2015 adjusted gross income (AGI) (see line 37 of last 1040 tax form to help estimation). If the estimated AGI is over 138% federal poverty level (FPL) and less than 400% FPL, this individual could be eligible for premium assistance. Whether, he or she can buy coverage now or wait for open enrollment is dependent on other factors.

6 Comments

Olga, the “federal funds” apply specifically to Medicare or Medicaid. Tax credits are not included.

Phil, Will there be any issues given that the Covered California health premiums subsidies are done on the federal tax return and presumably paid by federal funds (am I wrong here?). And she is not allowed to receive any federal funds for the first 5 years due to me signing the affidavit of support and my income being too high for any subsidies if my income is accounted e.g. would there be income deeming if she submits return and request the premiums subsidy? Thanks a lot!

Olga, If your mom estimates her income at $16.500 or more for 2016, she will be eligible for maximum premium assistance as you outlined.

Phil, thank you for the answer. This is exactly the case. My 68 year old mother is not elligible for Medicare because she arrived in the U.S. Recently. I submitted affidavit of financial support for her and she is under PRUCOL now waiting for her green card interview. She has currently no income and lives with me. I am looking to get her health insurance. I was told that she would qualify for free Medical and not be subject to my income deeming. But I also heard that Medical is not easy to use and is not of the very good quality in San Mateo county. If she is able to secure an income of about 16,500 per year and applies to Covered California to get Kaiser Silver 94 plan, would she be deemed eligible for the discount to get it for $48 per month, given her age, immigration status and my income deeming? Thank you

Yolanda, The typical case is a recent immigrant to California who has legal status but has not paid into Medicare because they have earned little or no income in the US.

Phil on 7/6/15. Someone asked about a senior who was 68 years old, and not eligible for Medicare, Can you explain how he would not be eligible? I can think of only one instance, he is continuing to work, and that only means that Medicare is secondary but still with coverage. Please explain the condition this would take place.

Yolanda Webb Medicare Agent

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