Common Pitfalls

In the past, some people found it impossible to find health coverage that was affordable and met their needs. 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. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.

Note: If you do not have coverage, you may have to pay a tax penalty on your California taxes.

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), $20,783 for an individual in 2024 ($43,056 for a family of four). 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.

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.

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 (or Medi-Cal's Working Disabled Program) may even pay your Medicare Parts A, B, and D premiums, deductibles, and copayments for you.

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.

Most of us usually rely on other people’s experiences to understand how to deal with our own situations. The problem with this is that disability and government benefits are person-centered. Benefits programs fit each person differently, based on a variety of facts and conditions, such as:

• Your work history
• How much you earn
• What you own
• What your disability is and the extent of your impairment
• 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.

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.