How do I know if I’m eligible for Premium Assistance with Covered California?

January 4, 2023

What is Premium Assistance?

Premium Assistance is the money that the Federal government pays individuals who are income qualified for their health insurance. It helps people pay a portion of their health insurance.

The Federal Government, through the Affordable Care Act, (ACA) has a program that allows individuals premium assistance on their health insurance. The purpose is to help those that make less income, make the burden of purchasing health insurance lower by assisting with paying their healthcare plan premium. This is especially important for those with families to be able to afford their other financial obligations (rent, groceries, etc.).

How is Premium Assistance different from Medicare?

Medicare is a separate Federal program. You’re not eligible for Premium Assistance under the ACA if you’re on Medicare. You’re only eligible for Premium Assistance if you have individual health insurance and are under age 65.

How long has Premium Assistance been around?

The program has been around since January 2014. It is a result of the Affordable Care Act. People who reside in California can access the program by contacting Brad Purcha, a Certified Covered California Agent, at (714) 991-4855.

How do I know I’m eligible for Premium Assistance with Covered California?

If you visit the Covered California website you can access a feature called Shop and Compare. You will be able to enter certain parameters such as:

  • Income
  • Zip Code
  • How Many People Are Insured

The website will calculate how much assistance you qualify for. You will also be given results that show the different healthcare plans that are available. The pricing shown may be a few dollars off what your cost will be after you complete a formal application.

Purcha Insurance Agency Can Check If You’re Qualified for Premium Assistance - Call Now: (714) 991-4855

What are some of the typical eligibility requirements for Premium Assistance?

Premium Assistance is based on several factors: your income, the size of your household, the zip code you reside in and your age.

Is there an age limit for Premium Assistance?

Up to age 65. If you are 65 or older you can qualify for Medicare.

Am I required to have a health insurance plan first before I can apply for Premium Assistance?

No. Once you check to see if you qualify for Premium Assistance and find out that you are eligible, then you’ll have the choice of:

  • Staying with the same health insurance carrier you are currently with
  • Switch to a different carrier (you may find a better plan that fits your needs)

Do you have to be a very low-income earner to qualify for Premium Assistance?

This is a common misconception. The required income levels have been drastically increased by the Federal government to qualify for some Premium Assistance. It’s always worth checking to see if you’re eligible. Many people who are paying full price for their health insurance can qualify for Premium Assistance. Please contact us if you’d like us to check to see if you’re eligible for Premium Assistance.

Can I get Premium Assistance if I get health insurance through my employer?

Only if your work coverage is deemed unaffordable. Purcha Insurance can run the calculations to see if you are eligible for Premium Assistance if you have health care coverage through your employer.

Can I get Premium Assistance if I have an HMO?

If you use an HMO you can still apply for Premium Assistance.

Brad Purcha is a certified enrollment specialist through Covered California. Not all health insurance agents are qualified to help with Premium Assistance.

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