Eligibility for Affordable Care Act (ACA) plans, often referred to as Obamacare plans, in California primarily depends on your household income and whether you have access to other types of health coverage.
Key Eligibility Criteria for California ACA Plans
To qualify for an ACA plan in California, individuals and families must meet specific requirements related to their income and existing health coverage options. These plans are available through Covered California, the state's health insurance marketplace.
Income Requirements
One of the foundational criteria for eligibility is your household income relative to the Federal Poverty Level (FPL).
- Income Bracket: Your household income must fall between 138% and 400% of the Federal Poverty Level (FPL). This range determines eligibility for premium tax credits and subsidies that help reduce the cost of health insurance premiums.
Lack of Other Coverage
The ACA is designed to provide health coverage to those who do not have access to other forms of affordable insurance. Therefore, eligibility is restricted if you qualify for or have access to certain other types of coverage.
- No Qualification for Government Programs: You must not qualify for California's Medi-Cal program (the state's Medicaid program), Medicare, or military health coverage (such as TRICARE or VA benefits).
- No Access to Affordable Employer-Sponsored Coverage: You must not have access to health coverage through your employer that is considered "affordable" and provides "minimum value" as defined by the ACA. If employer coverage is available but deemed unaffordable or insufficient, you may still qualify for subsidies through Covered California.
Summary of Eligibility Requirements
The following table summarizes the main criteria for eligibility:
| Eligibility Category | Requirement Description |
|---|---|
| Income | Household income between 138% and 400% of the Federal Poverty Level (FPL) to qualify for premium subsidies. |
| Other Coverage | Not qualified for or enrolled in Medi-Cal, Medicare, or military health benefits. |
| Employer Coverage | No access to affordable health coverage that meets minimum value standards through an employer. |
For more detailed information or to check specific income thresholds, individuals can visit the official Covered California website. Learn more about Covered California.
