A lot of young people don’t know much about cash and health care benefits. Sometimes parents take care of applying for benefits and managing money. Some people are embarrassed they get benefits. Others think that benefits are just too confusing to understand. Some don’t get benefits because they don’t know they qualify.

It is very important that you understand benefits, even if your parents do most of your benefits paperwork. You need to know how benefits can help you live independently and pursue your dreams, which can include going to college and getting a job.

Benefits Lead to Independent Living

As a person with a disability, you have more opportunities than you might think. People with disabilities are living in their own homes, graduating from college, working at good jobs, getting married, and having children. Getting jobs, studying, living on your own, making friends, and all of the other activities in life are all part of independent living!

One major reason that people with disabilities can live independently is the support that benefits give them. Benefits are keys that will give you the support you need as you decide what to do in life and get started with adulthood.

The most important disability benefits you will get are money and health care. The money will help you pay your rent, let you have a social life, make affording college possible, and help you buy food and other necessities. The health care benefits will keep you as healthy as possible and prevent health care expenses from putting you into debt. These benefits mean that you can think about your future and explore life, instead of constantly worrying about paying bills.

Benefits Help You Get a Job or Go to School

Benefits are designed to help you get an education and a job. You may be worried that getting a job will cause you to lose your cash benefits, but the reality is that when you get a job, your income will almost always go up.

Depending on the benefits you get, your cash benefits may go down as your work income goes up, though your job income will more than make up for the lower amount in benefits.

With other benefits programs and thanks to some work incentives discussed later, you may be able to keep getting the same amount of cash benefits after you get a job! Some of the best work incentives are actually ways for you to save money for an education or make money while you’re in school.

Benefits Give You Access to Health Care

Did you know that the average cost of an emergency room visit is more than $1,000 and that medical expenses are the number one cause of personal bankruptcy in the United States? Make sure you have health care benefits!

When you get a job and your income goes up, you will still be able to get health care coverage. In many cases you will continue getting the exact same coverage as you have now. In other cases you may have to enroll in a different program that will also cover your medical expenses.

Are You Eligible for Benefits?

In order to get the benefits designed to help people with disabilities, your disability has to “qualify.” This means that it has to meet certain standards. Depending on your age, who supplies the benefits, and what the benefits are, these standards vary and your disability may or may not qualify you for the benefits.

Even if your disability qualifies, just having a disability doesn’t automatically mean you will get cash benefits or health care coverage. In addition to having a disability, you must also either have low income or have paid into an insurance program. How programs decide if your disability qualifies and whether you have a low enough income or will get insurance coverage is explained on the Eligibility for Key Programs page of this article.

Income-Based Benefits

Income-based benefits help you if your family doesn’t earn a lot of money. Depending on your age and the benefits program, there may also be a limit on your assets.

For most young people with disabilities, the income-based benefits programs that help the most are Supplemental Security Income (SSI), which supplies you with cash income support, and Medi-Cal, which gives you health care coverage.

More information on both programs, click here.

Insurance

Insurance programs are programs you pay into regularly. If something comes up and you need help, the money becomes available.

For example, if you have private health insurance, you, your employer, or your parent pays money each month, and when you need to go to the doctor, the insurance pays most of the expenses.

Private health care coverage is described in greater detail in this article in the Key Programs section and the Private Health Care Coverage for Young People section.

Why You Should Take Charge of Your Benefits

It is important that you understand and manage your benefits, because your money and your health care will be your responsibilities during adulthood.

Managing Your Benefits Gives You More Options

What role does money play in your life? You might think of money as something that you need to buy the things you want, but money is also used to pay bills, buy groceries, and take care of everyday concerns. We need money to carry out our day-to-day lives.

However, money can be more than that. It can pay for your education, for your own apartment, or for a car that you can drive to work. It can be the key that opens the door to a brighter future – a future in which you feel in charge and enjoy your life because of the path you have chosen.

Learning to take control of your money will help you realize your dreams and achieve your goals. Part of this involves learning how to deal with benefits. Cash benefits are a portion of your income that will help you during your transition to adulthood. Health care benefits will save you money that you can use for other purposes and at the same time will keep you healthy!

Managing your benefits will let you be the person who decides what you want to do with your life and help you fulfill your goals and dreams.

You Are Approaching or Have Already Arrived at Adulthood

You are an adult or soon will be an adult. You need to know how to manage your benefits, your health, and your money. Your parents or other family members have probably helped you with benefits in the past, and up to this point in your life, they have made many choices about the direction of your life. As a young adult, it is important for you to set goals for yourself, so that you can live an independent life. Your parents and family will still be able to help you, but as an adult, it will be your responsibility to lead your life and make the final decisions on how to live it.

You might feel anxious or scared about taking more control of your life and that’s okay. It’s a lot of work, and handling your benefits is hard, but there is also a lot of information available and many people who can help you make informed decisions. Begin with looking at Key Programs to get a brief introduction to the most important programs that can help you.

There are many different disability benefits programs. This section explains 3 of the most important ones:

• Supplemental Security Income (SSI)
• Medi-Cal
• Medi-Cal's Working Disabled Program

Make sure you understand why these programs are important by reading the introductions to them below. Private health care coverage is also discussed, as it is an important health coverage alternative.

Supplemental Security Income (SSI)

Supplemental Security Income (SSI) is the most important income support benefit for young people with disabilities. Even if you have never had a job, you may be able to get SSI. Even if you are under 18 and live with your parents, you may be able to get SSI.

Who It Helps

People who are disabled or blind may not be able to work or afford to live on their own. If you have a disability, don’t have enough money for your basic needs, don’t have much income, and have limited assets, you may be able to get SSI. If you have a disability, are under the age of 18, and your parents have low income and limited assets, you may also be eligible for SSI.

What You Get

If you qualify for SSI, you get a monthly check. This money helps you pay your expenses, like food and rent. If you get SSI, you also qualify automatically for Medi-Cal.

To learn more, read the section on SSI Eligibility for Young People.

Medi-Cal

Medi-Cal is the most important public health benefit for young people with disabilities.

Who It Helps

Medi-Cal is for people who cannot afford medical expenses, including people who are disabled, young, or pregnant. To get it, you and your family must have low income. If you’re on SSI, you automatically qualify for Medi-Cal.

What You Get

If you qualify, Medi-Cal pays for your medical expenses, including visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services.

To learn more, read the section on Medi-Cal Eligibility for Young People.

Medi-Cal's Working Disabled Program (WDP)

Medi-Cal’s Working Disabled Program (WDP) lets you get a job and keep your Medi-Cal health coverage.

Who It Helps

The WDP program is for people with disabilities who have jobs. There is an income limit, but it is higher than the income limit for regular Medi-Cal. Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.

What You Get

The WDP program pays for the same services that regular Medi-Cal covers, including visits to the doctor, hospital stays, medical equipment, and other medical services.

To learn more, read the section on Working Disabled Program Eligibility for Young People.

Private Health Care Coverage

Private health insurance is the most common way people get health coverage.

Who It Helps

People get private health coverage in different ways. Some get it through their jobs, others get it from their parents’ employers, and some sign up for it on their own at Covered California. If you get an individual health plan, the government may help pay your monthly premium through tax subsidies. 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.

What You Get

Private health care coverage pays for some of your medical costs when you see a doctor or other health care provider, or get prescription medicine at a pharmacy. Depending on your private health care coverage plan, the plan may pay for almost the entire cost of your medical expenses, or it may pay only a portion of those expenses.

To learn more, read the section on Private Health Care Coverage for Young People.

Now that you’ve read some basic information about Supplemental Security Income (SSI), Medi-Cal, Medi-Cal’s Working Disabled Program (WDP), and private health care coverage, we can begin to look at the factors that will impact your eligibility for these key programs.

The rules for eligibility can seem very complicated. They are different for different programs and they can also be different depending on your age. In addition, you may be going through a period in your life during which you’re moving out of your parents’ home, going to college, or getting a job. Each of these changes can impact your benefits too!

The good news is that the DB101 website explains a lot. If you have more questions about these programs, talk to a benefits planner.

SSI pays a monthly check to people who have low income and are disabled or blind. To get SSI, you have to meet certain rules. Some rules are the same, regardless of your age. For example:

• You must be a U.S. citizen or a qualified alien

However, other rules change a lot depending on your age. The biggest changes involve:

• How SSI decides whether you have a disability
• Whose income and assets are counted when SSI decides if your income and assets are low enough for you to get benefits

We’ll explain these changes below.

How to Apply for SSI

You can apply for SSI at your local Social Security office or by calling 1-800-772-1213 or 1-800-325-0778 (TTY). Talk to a benefits planner to learn more about how to apply.

If you apply for SSI and qualify, you will also automatically qualify for California’s State Supplemental Payment (SSP) program, which gives you an additional cash benefit, and Medi-Cal, which will give you health coverage.

Eligibility Details

Our description of SSI eligibility below is divided into 4 parts. Click on the appropriate sections you want to read:

• SSI if you are younger than 18
• If you get SSI and are turning 18 soon
• SSI if you are already 18 or older
  
• Incentives that help you go to school, work, and save money
  

SSI if You Are Younger than 18

If you are under 18, SSI says you are a child and have a disability if:

• You have a physical or mental impairment or combination of impairments
• Your impairments cause severe limitations in your daily life, and
• Your condition has lasted or is expected to last for at least 12 months.

Not everybody with a disability automatically gets benefits. You must also have no other way to pay for basic expenses like food, rent, and utilities. If you are under 18, SSI decides whether you need help by looking at the money you and your parents earn and the assets you and your parents have, including savings accounts, stocks, and real estate.

Note: You can open an ABLE account where over time you can save up to $100,000 in resources and not have them counted by SSI. Learn more about ABLE accounts.

If you or your parents make too much money or have too many assets, you will not get SSI. The exact limits depend on the size of your family. For example, if you live with both your parents and you have no siblings, the earned income limit is usually $4,329 per month and the asset limit is $2,000.

A complete table of income limits for families with a disabled child is listed near the bottom of Social Security’s SSI for Children webpage.

If your income and assets and your parents’ income and assets don’t exceed the limits, you will get a monthly SSI check, which will include an additional cash benefit supplied by California’s State Supplemental Program (SSP). If you live with your parents or other relatives, the maximum check you can get is $1,003.07.

If you live with one parent, and get child support from your other parent, SSI counts two-thirds of the child support as income.

Sometimes child support comes in the form of food or shelter, instead of a check. In that case, SSI will figure out how much money that support is worth and count two-thirds of it as income. In the case of food and shelter, your benefits check could be reduced by a maximum of $304.67.

If You Get SSI and Are Turning 18

If you get SSI and then you turn 18, the biggest change in SSI eligibility rules is that you are considered an adult, not a child. When SSI decides whether you have a disability, SSI will not use their definition of disability for children. Instead, as an adult, SSI looks at your ability to work, not just your physical or mental limitations. That means that some people stop getting SSI benefits after they turn 18.

During the first year after you turn 18, SSI will automatically check to see if they still consider you disabled. This is called the SSI Age-18 Redetermination. They will say you have a disability if:

• You have a physical or mental impairment or combination of impairments
• Your impairments limit your ability to work, and
• Your condition has lasted or is expected to last for at least 12 months.

SSI may also look at your work and school record to see if you are able to work and may even talk to your teachers, counselors, or employers.

If SSI decides that you are not disabled because you don’t meet the adult definition of disability, you will no longer be able to get SSI. They will keep sending you SSI checks for 2 months, but then your benefits will end. In this situation, if you still want to get SSI, you have two options:

1. You can appeal. When SSI sends you the letter telling you that your benefit is ending, you have 10 days to request an appeal. During the appeal process, you can ask that SSI continue your benefits until they make a decision. For more information about appealing, click here.
2. If you are participating in an employment support program, like Vocational Rehabilitation (VR), an Individualized Education Program (IEP), a Plan to Achieve Self-Support (PASS), or any other program approved by SSI that will help you get a good job in the future, you can apply to continue getting benefits through a special rule called Section 301.

If SSI says that you meet the adult definition of disability and that you will continue to get benefits after you turn 18, these are things that could impact the monthly amount you get:

• Parent-to-Child Deeming ends. This means that SSI will no longer count your parents’ income and assets when considering your eligibility for benefits. This may help you get a higher benefits amount than before you were 18.
• If you or your family gets child support for your living expenses, SSI will now count all of it as income. This may cause your benefits to go down.
• You living situation: If you live alone or pay your fair share of expenses as a roommate with others, your benefits amount may be higher than if you would live with others who help pay for your food and shelter.
• Cooking facilities: If you live in a home or a hotel, for example, without cooking facilities, your benefits amount may be higher.
• In-Kind Support and Maintenance: If someone else helps to pay for your food or rent, your benefits amount may go down by up to one-third ($304.67. This is called a Value Third Reduction (VTR).

If you have any questions about this, talk to a benefits planner.

SSI if You Are Already 18 or Older

If you are 18 or older and did not get SSI before turning 18, SSI says you are an adult and have a disability if:

• You have a physical or mental impairment or combination of impairments
• Your impairments limit your ability to work, preventing you from earning Substantial Gainful Activity ($1,470 per month if you’re not blind), and
• Your condition has lasted or is expected to last for at least 12 months

Note: If you are blind, you could be able to earn more than $1,470 per month.

Not everybody who meets the adult definition of disability automatically gets benefits. You must also have no other way to pay for basic expenses like food, rent, and utilities. If you are over 18, SSI decides whether you need help by looking at your income and how many assets you have, including savings accounts, stocks, and real estate.

If you have more than Substantial Gainful Activity (SGA) in earned income, or too much unearned income, or if your assets are above the asset limit, you will not get SSI. If your income and assets don’t exceed the limits, you’ll get monthly benefits. The amount of money you get each month will depend on your income.

If you don’t have more assets than the limit and SSI sees that you don’t have any money to spend on your basic needs, they’ll send you the maximum benefit amount each month, which will include an additional cash benefit from California’s State Supplemental Payment (SSP) program.

In 2023, the maximum benefit is $1,133.73 ($1,211.00 if you’re blind). If SSI looks at your income and sees that you have some money, but not enough for all of your basic needs, they’ll give you less money than the maximum.

If you live in another person’s household and don’t pay your share of rent, food, and other expenses, the maximum benefit is $833.89 ($911.16 if you’re blind).

Incentives That Help You Go to School, Work, and Save

SSI and many other government benefits programs have strict limits on how much income and savings you can have. If you go over the limits, you will no longer get benefits. The problem is that sometimes these limits end up preventing people from working and saving.

When the government realized that these limits were actually stopping people from getting jobs, saving money, and living better, they created work incentives like the Student Earned Income Exclusion (SEIE), Plans to Achieve Self-Support (PASS), Individual Development Accounts (IDAs) and ABLE Accounts that help you earn and save money without losing your benefits.

Student Earned Income Exclusion (SEIE)

Usually, if you make too much money, your SSI benefits will either go down or be stopped altogether. There are some exceptions to this rule, however, which SSI calls “exclusions.”

One of those exclusions is the Student Earned Income Exclusion (SEIE). This exclusion allows students to earn up to $2,220 per month, and up to $8,950 per year, without having those wages count as part of their countable income.

In order to qualify for the SEIE, you have to be under 22, working, and “regularly attending school.” That usually means you have to go to school more than:

• 8 hours a week for college students
• 12 hours a week for grades 7-12, or
• 12-15 hours a week for employment training.

Plan to Achieve Self-Support (PASS)

Usually, if you have too many assets or too much income, you will no longer qualify for SSI. Setting up a Plan to Achieve Self-Support (PASS) is one way for people getting SSI to save money without having it count against their benefits eligibility.

To set up a PASS, you must qualify for SSI, have a specific work goal, and have expenses that you need to pay to reach your job goal. You must also show that you’ll have enough income to pay for your basic living expenses after you’ve set up your PASS.

There are a couple of big advantages to having a PASS:

• You can use unearned income to save money, which means that you can start saving even if you don’t have a job yet.
• SSI does not count the money that you place in a PASS account as income or assets. So you can earn and save more with a PASS without having your SSI benefits lowered.

The limitation is that the money you save with a PASS must be used for an employment-related expense. However, those expenses can include things like money for school, transportation, books, and services.

For more information, read DB101’s article on Plan to Achieve Self-Support (PASS) or contact a PASS Cadre.

Medi-Cal helps people with low incomes pay for their visits to the doctor, hospital stays, prescription drugs, medical equipment, and other medical services. Depending on your income, your age, and whether you are disabled, blind, or pregnant there may be more than one way for you to qualify for Medi-Cal. If you qualify for Supplemental Security Income (SSI), you also automatically for Medi-Cal qualify and do not need to fill out an additional application.

To get Medi-Cal, you have to meet certain rules.These rules can seem confusing initially, but are actually pretty simple. First we will present the rules for young people under the age of 19, then we’ll present the rules for anybody 19 or older. Read the section that is appropriate for you.

Medi-Cal if You Are Younger than 19

If you are under age 19, there are 2 common ways to get Medi-Cal. You can qualify:

1. If you get Supplemental Security Income (SSI) benefits
2. If your family has low income, regardless of whether or not you have a disability

If you get SSI, you will automatically qualify for Medi-Cal and do not have to fill out an additional application. You can read more about how to qualify for SSI on the SSI Eligibility page of this article. If you have more questions about how this works, talk to a benefits planner.

If you don’t get SSI, you can still qualify for Medi-Cal if:

• You live in California
• You and your family have low to moderate income (at or below 266% of FPG, which is $79,800 per year for a family of four)
• You are a U.S. citizen or an eligible noncitizen:
  • All immigrant children and young adults who are 25 years old or younger can get Medi-Cal coverage, if they meet all other program requirements. (All immigrants 50 or older also can.)
  • Undocumented adults who are 26 to 49 years old do not qualify for full Medi-Cal coverage, though they may qualify for Medi-Cal coverage for emergencies or during pregnancy.
  • If you have questions about how your status may affect your eligibility, contact Disability Rights California at 1-800-776-5746 or 1-800-719-5798 (TTY)

The key here is that you and your family must meet the income limit for your family situation.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$14,580
	$5,140
	$14,580
	$5,140
	$14,580
	$5,140
Income-based Medi-Cal, adults (138% FPG)
Income-based Medi-Cal, children (266% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

Add to favorites

Add to favoritesAdd to favoritesOne of my favorites

Medi-Cal if You Are 19 or Older

The rules for Medi-Cal if you're 19 or older are a little more complicated than the rules used for people under 19. If you're 19 or older, you may qualify for Medi-Cal if you are in at least one of these situations:

1. You have income below 138% of the Federal Poverty Guidelines (FPG) ($20,120 per year if you are single).
   
   

   Health Coverage Income Limits for Your Family

   Your family size:	123456789101112
   Income limits for your family:
   	$14,580
   	$5,140
   	$14,580
   	$5,140
   	$14,580
   	$5,140
   Income-based Medi-Cal, adults (138% FPG)
   Income-based Medi-Cal, children (266% FPG)
   Subsidized private plans, reduced fees (250% FPG)
   Subsidized private plans (no income limit)	--
   If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

   Add to favorites

   Add to favoritesAdd to favoritesOne of my favorites
2. You are pregnant and have income below 213% of FPG ($42,004 per year if you are single and pregnant with your first child; the baby is counted as a member of the family).
3. You get Supplemental Security Income (SSI). In this case, you automatically qualify for Medi-Cal and do not have to fill out an additional application (see the SSI Eligibility page of this article).
   • If you're on SSI and your income goes up so much that you stop getting an SSI benefit each month, you may still be able to keep getting Medi-Cal through an SSI rule called 1619(b), as long as you make $57,251 per year or less ($59,105 if you’re blind).
4. You have low income, low assets, and you have a disability or are blind.

There are other ways to qualify, but these are the most common for young adults.

How the Eligibility Rules Based on a Disability Work when You're 19 or Older

The fourth situation listed above is the most complicated. When Medi-Cal looks at your eligibility based on your disability, your income will be counted, but your parents’ income will not be counted once you turn 19. The exact income limit will depend on your situation, such as whether you are single or married. Usually, if you have a disability and you’re single, the income limit is $1,677, and it’s $2,268 for couples. What's tricky is that not all of your income will be counted by Medi-Cal, so it’s important to go ahead and apply, because you might qualify even if you think you won’t qualify. You can read more about how income is calculated in DB101's Medi-Cal article.

Here are a few reasons you might be able to keep getting Medi-Cal even if your income is above this limit:

1. When Medi-Cal looks at your income, it'll only count about half of what you earn at a job. Example: If you make $1,000 per month at a job and have no other income, that's only about $457.50 in countable income.
2. When Medi-Cal calculates your income, it will also reduce the amount stated on your paycheck by the amount you spend on any Impairment Related Work Expenses (IRWEs) or Blind Work Expenses (BWEs). That means that if you pay for certain things that you need in order to do your job, such as medications or accommodations, you should tell Medi-Cal about them, because it might help you qualify for Medi-Cal health coverage.
3. If you make more than the Medi-Cal income limit, even after IRWEs have been deducted, you may still qualify for Medi-Cal’s Working Disabled Program (WDP), which has higher income limits. The WDP program is described in detail later in this article.

You can also get an idea of whether you would qualify for Medi-Cal by using DB101's School and Work Estimator.

Medi-Cal’s Working Disabled Program (WDP) supplies health coverage to people with disabilities who get jobs. If you get a job and are making too much money to get regular Medi-Cal coverage, you might be able to keep your Medi-Cal through the WDP program.

To qualify for the WDP program, you must:

• Be certified disabled by the Social Security Administration (SSA)
• Be working
• Not be eligible for standard Medi-Cal coverage, including qualifying through the 1619(b) rule
• Have income lower than 250% of the Federal Poverty Level ($3,038 per month for individuals, $4,108 for couples)
  • Note: These are countable income limits, which is your gross income minus certain deductions. Your gross income can be much higher than your countable income. For example, an individual with no unearned income or IRWEs can make $73,920 a year in gross income and still be eligible for this program.
• Have less than $130,000 in assets if you are single, $195,000 if you’re a couple
• Note: Medi-Cal's Working Disabled Program used to have a monthly premium. Starting on July 1, 2022, there is no more premium. Learn more about this change.

The WDP program is a great option if you like your current Medi-Cal coverage and get a job. You don’t have to be afraid you will lose your health coverage!

How to Apply for the WDP Program

There are different ways to apply for Medi-Cal's Working Disabled Program:

• Online using BenefitsCal. BenefitsCal lets you apply for other programs like CalFresh or CalWORKs at the same time.
• Online using Covered California, an online one-stop shop where you can learn about your public and private health coverage options.
• In person at your local county social services agency.
• Using a paper application (available in 11 languages) and mailing it in to your local county social services agency.

When you submit your application, you should specify that you are applying for the WDP program. If you need help completing an application, talk to a benefits planner.

No matter how you apply, it is important to know that if you are not eligible for Medi-Cal's Working Disabled Program, you may be able to get private insurance subsidized by the government through tax credits.

For more information, read DB101’s Medi-Cal article.

In order to get private coverage, somebody—you, your employer, your parents, your parents’ employer—must pay for that coverage. In this section, we will introduce you to the basic ways you can get private health care coverage, as well as some of the expenses you may encounter with private coverage.

Coverage Through Work

Many, but not all, jobs offer health care benefits. That’s why private health care coverage through work is the most common way that Americans get their health care coverage.

If you get your health coverage through your job, usually your employer pays most of the expenses. This means that the employer pays hundreds of dollars each month, so that you have access to health care. Depending on your job, you will also have to pay a monthly amount in addition to what your employer spends. The total monthly expense paid for the private health care coverage is called the premium.

In addition to the premium you and your employer will be paying, you will have to pay various other expenses out of your own pocket. The most common health care expenses are called copayments. A copayment means that every time you have a doctor’s appointment, have a test done, or get a prescription filled you will have to pay some money. With private coverage, copayments generally range from about $10 to $50.

Depending on your health care plan, you may not have to pay anything for certain types of services (testing and vaccinations, for example). But you may have to pay a lot for other types of services. Some plans, for example, may require you to pay for half of all your hospitalization expenses, which can add up to hundreds or even thousands of dollars each day. Other plans simply do not cover certain medical expenses, such as wheelchairs or other durable medical equipment.

All plans have an annual limit on the total amount you have to pay in addition to your monthly premium. This limit is called the out-of-pocket maximum. So, if you have a plan with a $2,000 out-of-pocket maximum, once you’ve paid a total of $2,000 in copayments and other medical expenses, you won’t have to pay any copayments or other expenses for the the rest of the year. Note: You will still have to pay your monthly premium.

Coverage Through Parents

Generally, when people get private health care coverage through their jobs, they are allowed to pay an additional amount to have their family members added to the coverage, including their children Federal law says that parents who get new health care plans are allowed to add any children under the age of 26 to their plans.

Buying Coverage

Some people pay a health coverage company directly for their health care coverage instead of getting it through their jobs or parents. This is called individual coverage. With individual coverage, you will usually have to pay a monthly premium, copayments, and a deductible, depending on your plan.

Covered California is the easiest place to apply for individual coverage. It used to be that health insurance companies could deny your application or charge you more if you had a disability, but starting in 2014, that's no longer true. Now, anybody under the age of 65 can go to Covered California and sign up for a private insurance plan.

You should think about getting an individual plan through Covered California if you cannot get health coverage from:

• Your job
• Your spouse’s job
• Your parent’s job
• Medi-Cal, or
• Medicare

If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium via a tax credit. If your family’s income is at or below 250% of the Federal Poverty Guidelines (FPG), ($36,450 for an individual or $75,000 for a family of four), the government also helps you get a silver plan that has lower copayments and other expenses.

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.

Health Coverage Income Limits for Your Family

Your family size:	123456789101112
Income limits for your family:
	$14,580
	$5,140
	$14,580
	$5,140
	$14,580
	$5,140
Income-based Medi-Cal, adults (138% FPG)
Income-based Medi-Cal, children (266% FPG)
Subsidized private plans, reduced fees (250% FPG)
Subsidized private plans (no income limit)	--
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules. Notes: Some types of income do not count against these limits, including SSI benefits. Different programs sometimes use slightly different numbers for the Federal Poverty Guidelines (FPG). For private plans with subsidies, your monthly premium amount depends on your income.

Add to favorites

Add to favoritesAdd to favoritesOne of my favorites

Read more about how to sign up for individual coverage in DB101's Buying Health Coverage on Covered California article.

There are many other benefits programs that you may qualify for. If you don't get Supplemental Security Income (SSI), you may qualify for CalFresh and CalWORKs if your income and assets are low enough.

Depending on your circumstances, two Social Security programs may give you benefits based on contributions your parents made during their careers: Child’s Benefits and Childhood Disability Benefits (CDB).

A third set of programs, including ABLE Accounts, Individual Development Accounts (IDAs) and the Earned Income Tax Credit (EITC), help you save up money or other assets without losing your other benefits.

CalFresh and CalWORKs

CalFresh, sometimes called the Supplemental Nutrition Assistance Program (SNAP), helps people with low incomes and low assets pay for food. CalFresh used to be called Food Stamps, but it changed names and works a little differently now. Instead of using stamps, you get a plastic card called an Electronic Benefits Transfer (EBT) card that looks and works like a debit card. California puts money on the EBT card each month and you use the card to pay for food.

CalWORKs gives money to families who don't have enough to pay for basic needs like food, clothing, and rent. CalWORKs defines a family as 1 or 2 parents living with their child or children under 18. The age limit is 19 for children who are in school full-time. A family could include biological kids, stepchildren, adopted children, and children of relatives. For more details, read DB101's article on CalWORKs.

In order to get CalFresh or CalWORKs, you must have low income and limited assets. There are two ways for you to apply for these programs:

• Apply online using BenefitsCal
• Get the application at your county social services agency and fill it out there

You can apply for CalFresh and CalWORKs at the same time and you can also apply for Medi-Cal. If you need help completing an application, talk to a benefits planner.

Child’s Benefits (only if you are under 19)

The most common way for adults to get Social Security benefits like Social Security Disability Insurance (SSDI) or retirement benefits is to work and pay into Social Security’s trust fund.

For young people, however, a more common way to get Social Security benefits is to qualify for Child’s Benefits. You do not need to have a disability to qualify for Child’s Benefits. To get them, you must:

• Be under the age of 18 (or 19 if you’re attending high school or another secondary education school)
• Not be married, and
• Have a parent who gets Social Security retirement benefits or SSDI. If your parent is deceased, you may also qualify.

Note: You'll get Child's Benefits in any month your parent gets a Social Security disability or retirement benefit. You will also get benefits if your parent is deceased and would have qualified for benefits based on his or her work record. That means that if your parent is in SSDI's Trial Work Period, you'll keep getting Child's Benefits, but during the Extended Period of Eligibility, you'll only get a Child's Benefit in any month your parent gets an SSDI benefit. Make sure to notify Social Security if your family is in this situation.

You can apply for Child’s Benefits at your local Social Security office, or by calling 1-800-772-1213 or 1-800-325-0778 (TTY). If you have questions about this, talk to a benefits planner.

Childhood Disability Benefits (CDB) Benefits (only if you are 18 or older)

If you have a disability, you may be eligible to get money each month through the Childhood Disability Benefits (CDB) program.

CDB is based on your parent’s work record. You can only get CDB if you are 18 or older. In order to qualify for CDB, you must also:

• Have become disabled before you turned 22
• Not be married, unless your spouse also gets SSDI or CDB
• Meet the adult definition of disability, and
• Have a parent who gets Social Security retirement benefits or SSDI. If your parent is deceased, you may also qualify.

You don’t automatically get CDB when you turn 18. You can apply for it at your local Social Security office, or by telephone at 1-800-772-1213 or 1-800-325-0778 (TTY).

If you get CDB, you can also get health coverage through Medicare after a 2-year waiting period.

Click here to learn more about CDB or talk to a benefits planner.

Asset-Building Programs

Asset-building programs are a different type of benefits designed to help you save money you have earned. Instead of sending you a check or paying for your health care expenses, asset-building programs help you save money so that you can afford to pay for your own expenses, such as education, buying a car, or even retirement.

ABLE Accounts

If your disability began before you turned 26, you can open an ABLE account where over time you can save up to $100,000 in resources and not have them counted by SSI. ABLE accounts mean that if you get a job, you can start saving some money without losing your benefits. Additionally, the money in an ABLE account gets tax advantages similar to the way retirement accounts work.

However, ABLE accounts have restrictions:

• They can only be opened through specific programs or institutions.
• You can only open one ABLE account.
  • California's ABLE account program is CalABLE.
  • You can choose to open an account in another state’s ABLE program.
• You and the other people making contributions on your behalf have a limit on how much you can deposit each year. Combined, you cannot deposit more than $17,000 in 2023.
• You can only use money in an ABLE account for specific things, such as:
  • Education
  • Housing
  • Transportation
  • Help getting and keeping work
  • Health care
  • Assistive technology, and
  • Other approved expenses.
• A person can only have one ABLE account.

Learn more about ABLE accounts.

Individual Development Accounts (IDA)

An IDA helps people save money for a specific goal, such as purchasing a home, starting a small business, or paying for education. The great thing about an IDA is that for every dollar you save, the bank or other financial institution where you have your account will match your money. For example, if you save $50 per month, the financial institution might contribute $100 per month. The amount they’ll contribute depends on the institution, but sometimes they will put more money into your account than you do!

Note: There aren't as many IDA programs as there used to be. Some are still active, but it can take a bit of effort to find one that is accepting applications.

To open an IDA:

• You must have low income, and
• The money you contribute must be money that you earned from work, not from a benefits check, your parents, or any other source.

IDAs are a great money-saving tool, but you need to be sure and enroll in the right type of IDA so that you don’t jeopardize your benefits. To learn more, read DB101’s article on Individual Development Accounts.

Earned Income Tax Credit (EITC)

The Earned Income Tax Credit (EITC) gives money to low to moderate income workers and families. Even people who don’t make enough money to owe income taxes may be able to get a check from the IRS if they qualify for this tax credit.

To qualify, the only requirement is that you have had income from employment, self-employment, or employer-paid disability benefits. If your income is too high, you will no longer qualify for the credit.

The amount of your EITC depends on your family size and income. The maximum credit for 2023 (filing by April 2024) ranges from $2 to $7,430. Make sure to file your taxes and apply!

For more details, go to DB101’s Earned Income Tax Credit article.