What if I Don’t Want Medi-Cal?

A common question we get asked here at Affordable California, is “Covered California, says that I’m only  eligible for Medi-Cal and can’t enroll in a Covered CA health plan.  What if I don’t want Medi-Cal?”

Starting January 1, 2014 eligibility for Medi-Cal is strictly based on your modified adjusted gross income or MAGI.  MAGI is the same as adjusted gross income (AGI), which can be found on line 4 of a Form 1040EZ, line 21 of a Form 1040A or line 37 of a Form 1040.  Medi-Cal eligibility is based at 138% or less of the Federal Poverty Level.

An individual earning less than $15,856, for example, automatically qualifies for Medi-Cal, regardless of their assets.  For a couple, it is $21,403 or less and for a family of four it is $26,951 or less.  If your MAGI falls at or below Medi-Cal eligibility, you are not eligible to receive a premium subsidy from the California Health Insurance Exchange.  However, for example, if your projected income as an individual is $16,000 then you would qualify for a significant premium subsidy as well as an Enhanced Benefits Plan with very low co-pays and no deductibles.  Some might say this is unfair.  Both  California state law and the Affordable Care Act have established the income guidelines for Medi-Cal and premium subsidy eligibility.

So what do you do if you find that you are stuck in Medi-Cal and don’t want it?  You can buy a health plan outside of Covered California, referred to as an ‘off-exchange’ plan, however you will have to pay the full premium.   You might also want to take another look at your projected income for 2014 as Medi-Cal eligibility is based on current monthly earnings and subsidies are based on you annual income.  If your situation has changed (you now project more income than originally thought), you can withdraw your application and enroll in a Covered California health plan.  Call us at 800-788-2197 for more information and assistance.


AUTHOR - Ali Nagy