Not getting health coverage because you think it will be too expensive

In the past, some people found it impossible to find health coverage that was affordable and met their needs. Starting in 2014, there are more options than before. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, and whether you have a disability.

If you have the option of employer-sponsored coverage or public health programs like Medicare or Medi-Cal, they are probably your best bet.

If you don’t, you will probably end up getting an individual plan through Covered California and the government may help you pay for that plan if your family's income is at or below 400% of the Federal Poverty Guidelines (FPG), $48,560 per year for an individual ($100,400 for a family of four).

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

Not looking into Medi-Cal because you think there’s no way you can qualify

Medi-Cal used to be mainly for people with disabilities, seniors, children, and pregnant women. Starting in 2014, it is for anybody with low income (at or below 138% of the Federal Poverty Level (FPL), $16,753 for an individual in 2019 ($34,638 for a family of four).

That means that even if you’ve never qualified for Medi-Cal in the past, you might qualify now. No matter how much money you have in the bank or what your health situation is, you could qualify.

It is easy to check if you can get Medi-Cal: just go to Covered California and fill out an application. They’ll let you know whether you qualify and help you sign up.

If you can’t get Medi-Cal, you can get health coverage through your employer or through Covered California, depending on your situation.

Believing you have to get the same health coverage for every member of your family

There may be situations where it makes more sense for different members of your family to get health coverage in different ways. Do not feel that just because one member of your family gets a certain plan, the entire family needs to get that plan.

For example, let’s say you work for a company that only offers health coverage for you and your children, but not your spouse. You could take the coverage for yourself and your spouse could get coverage on Covered California. Since your employer doesn’t offer coverage for your spouse, your spouse might even qualify to get government help paying for an individual plan through tax subsidies. If your income is low enough, your children could sign up for Medi-Cal, even if you and your spouse don’t qualify for it.

As you can see, in some situations it can make sense for a single family to get totally different types of coverage for different family members.

Dropping or not enrolling in Medicare

If you are eligible for both Medi-Cal as a person with a disability and Medicare, you should enroll in both. If you have both, you’ll have better health coverage, because Medi-Cal covers many services that Medicare does not cover. Medi-Cal may even pay your Medicare Parts A, B, and D premiums, deductibles, and copayments for you.

Not going back to work because you fear losing your Medi-Cal coverage

In the past, people feared that if they got a job while they were on Medi-Cal, they’d lose their Medi-Cal, because they would no longer have low enough income to qualify.

Starting in 2014, if you lose one health coverage option, there will be another one you can get. If you lose your Medi-Cal coverage, you will either become eligible for employer-sponsored coverage or private individual coverage. And, if you can’t afford the individual coverage, the government may help you pay for it.

The bottom line: There is a coverage option for everybody. Do not worry that getting a job will leave you without health coverage.

Basing decisions on misinformation

Most of us usually rely on the experience of others to understand how to deal with similar situations. The real problem with this is that benefits are person-centered. Benefits programs fit each individual differently, based on a variety of facts and conditions, such as:
  • Your work history
  • How much you earn
  • What you own
  • How disabling your condition is
  • How clearly you report the details of your condition to your medical provider
  • How well your medical provider understands or documents these details
  • What benefits an employer provides, and
  • What benefits you have purchased individually.

Not Keeping Complete Earnings Records

It is your responsibility to maintain accurate and detailed records. The earnings you report to Medi-Cal will be verified. Clearly document all communication with Medi-Cal. Make copies of letters and keep records of phone conversations, including the date and time phone calls take place and the name of the individual who was assisting you. These steps can help you avoid pitfalls during the application process and while maintaining eligibility for benefits. Many people keep a journal of Medi-Cal contacts in a spiral notebook.