Who is Not Eligible for Covered CA?

When it comes to health insurance in California, Covered California is a popular choice for many people. It’s the state's official health insurance marketplace, offering coverage to those who need it and helping families get financial assistance to lower their costs. But, who exactly isn’t eligible for this program? Let’s dive in and make it easy to understand!

What is Covered California?

Before we jump into who doesn’t qualify, let's make sure we understand what Covered California is. Covered California is a place where you can shop for health insurance and apply for subsidies (financial help) based on your income.

1. People with Employer-Sponsored Health Insurance

If you already have health insurance through your employer, you typically won’t be eligible for Covered California’s subsidies. Covered California is designed for people who don’t get affordable coverage from their job.

But what does “affordable” mean?

If your job offers health insurance that costs less than 9.12% of your household income in 2024, the government considers that “affordable.” So, no subsidies for you! However, if your job's plan costs more than that, you might be eligible for financial help.

2. People Who Qualify for Medi-Cal

Medi-Cal, which is California’s Medicaid program, offers free or very low-cost health insurance to people with low incomes. If you qualify for Medi-Cal based on your income, you won’t be eligible to receive Covered California’s subsidies or plans.

How do you know if you qualify for Medi-Cal? It’s simple: If you earn less than $20,121 a year as a single person or $41,400 for a family of four, you’re likely Medi-Cal eligible. Covered California will help you figure it out when you apply.

3. Undocumented Immigrants (Some Exceptions)

Covered California is available to U.S. citizens and lawfully present immigrants, but undocumented immigrants are generally not eligible for most Covered California plans. However, there’s some good news!

Starting in 2024, some undocumented individuals may qualify for Medi-Cal based on income, especially if they’re younger than 26 or older than 50. While this doesn’t mean access to Covered California plans, it does open a door to other affordable health care.

4. People Living Outside of California

This one seems obvious, but if you don’t live in California, you won’t be eligible for Covered California. Covered California is specifically for California residents. If you move out of state, you’ll need to find coverage through that state’s health insurance marketplace or other options.

5. People Incarcerated

If someone is currently in jail or prison, they are not eligible for a Covered California plan until they are released. After release, they can apply and may qualify for coverage or subsidies like anyone else.

6. People with Certain Immigration Statuses

Covered California is for lawfully present immigrants. This includes those who have a green card, work visas, or other approved immigration statuses. However, some immigrants, like those on temporary visitor visas (tourists) or those without legal status (undocumented, except for certain categories mentioned earlier), won’t be eligible.

If you’re unsure, it’s worth checking with a certified enrollment counselor or going directly to the Covered California website to see if your status qualifies.

What to Do If You’re Not Eligible

If you find out you’re not eligible for Covered California, don’t worry! There are still options out there. Here’s what you can do:

• Look into Medi-Cal: Even if you don’t qualify for Covered California, you might qualify for Medi-Cal.

• Seek Employer Coverage: If you have a job, see if you can get coverage through them.

• Consider Private Insurance: You can buy private health insurance outside of Covered California, though it might not come with the same financial help.

Conclusion

So, who isn’t eligible for Covered California? To sum it up:

• People with affordable employer coverage

• Those who qualify for Medi-Cal

• Undocumented immigrants (with some exceptions)

• People who live outside California

• Those who are currently incarcerated

• People with certain immigration statuses

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If you don’t fall into one of these categories, there’s a good chance you can apply! And even if you don’t, there are still health coverage options out there.

At Infini Insurance Services, we specialize in helping you navigate the Covered California system and find the best health insurance options for your needs. Give us a call or visit our website for personalized advice.

Now you know the answer! Stay healthy and make informed choices about your health insurance!