Individuals who are unable to complete the remotie identity proofing process over the phone can instead upload documents online or meet with an assister.



Individuals who are unable to complete the process online can instead call the remote identifying proofing help desk to complete the process over the phone.



The applicant is likely eligible for Medi-Cal based on their Modified Adjusted Gross Income (MAGI).



Applicants who already have affordable health insurance, such as coverage offered through a job, cannot receive Covered California subsidies. They may, however, qualify for Medi-Cal or be able to purchase insurance through Covered California without subsidies.


In this scenario, Larry is offered health insurance through his job. Based on the information he enters about the amount he would have to pay for that insurance and the amount of income he receives, the system calculates that the insurance available through his job is affordable. As a result, Larry does not qualify for premium tax credits or cost-sharing reductions. Larry completes the application in order to see if the health insurance available for purchase through Covered California is a better deal than the health insurance offered through his job.



Applicants who already have affordable health insurance, such as coverage offered through a job, cannot receive Covered California subsidies. They may, however, qualify for Medi-Cal or be able to purchase insurance through Covered California without subsidies.



The primary contact for the household is the person who can make changes to coverage. Covered California will verify this person's identity.



The primary contact for the household is the person who can make changes to coverage. Covered California will verify this person’s identity.



Applicants may choose a different primary contact, call the help desk, or meet with an assister/agent to verify the primary contact's identity.



Individuals who are unable to confirm identity online may submit a paper application or meet with an assister/agent to apply.



Consumers can compare premiums (net of applicable tax credits), cost sharing, and benefits for all available health plans.


In this scenario, Larry does not qualify for Covered California subsidies because he has an offer of affordable health insurance from his employer. After comparing the health plans available for purchase through Covered California, he decides that his employer plan is the better deal. He chooses not to purchase health insurance through Covered California.



When data provided by applicants are not reasonably compatible with federal or state data, applicants must provide additional information before getting a final eligibility determination. Applicants may need to submit documents, such as documents that confirm income or immigration status. In the meantime, applicants who are conditionally eligible for health insurance offered through Covered California may enroll in a plan.



The applicant is likely eligible for Covered California subsidies. Premium tax credits lower the monthly price of insurance. Cost-sharing reductions lower the amount the individual pays when getting health care.



Applicants must specify income from all sources (earned income, self-employment income, other income), and allowable deductions, for all household members. Medi-Cal eligibility is based on current monthly income, while eligibility for Covered California subsidies is based on projected annual income. The system will calculate each based on the data entered and verified.


In this scenario,Gloria states that she earns $3,140 per month (about $37,700 per year) in self-employment income. Based on that information, the system calculates that she and her daughter Gabriela (a household of two) are at 229% of the federal poverty level (FPL). Because Gloria recently lost her job and her income fluctuates, her income cannot be verified electronically. She will need to provide income documents before receiving a final eligibility determination.


Based on this FPL, Gloria falls within the income limits for a premium tax credit and cost-sharing reductions to lower the costs of health insurance offered by Covered California. Because Gabriela is under age 18, she falls within the income limits for Medi-Cal.



Applicants must specify income from all sources (earned income, self-employment income, other income), and allowable deductions, for all household members. Medi-Cal eligibility is based on current monthly income, while eligibility for Covered California subsidies is based on projected annual income. The system will calculate each based on the data entered and verified.


In this scenario, Larry states that he earns $36,420 per year. Based on that information, the system calculates that he is at 300% of the federal poverty level (FPL). His income is verified electronically.


Based on this FPL, Larry falls within the income limits for a premium tax credit to lower the costs of his health insurance offered by Covered California.



Applicants must specify income from all sources (earned income, self-employment income, other income), and allowable deductions, for all household members. Medi-Cal eligibility is based on current monthly income, while eligibility for Covered California subsidies is based on projected annual income. The system will calculate each based on the data entered and verified.


In this scenario, Manuel states that he earns $18 per hour and works 30 hours per week. Medi-Cal would consider them a household of three (Manuel, Marcella, and her pregnancy), while Covered California would only consider them a household of two. When considered as a household of three, the system calculates that they are at 129% of the federal poverty level (FPL), which falls within the income limits for Medi-Cal. Manuel's income is verified electronically.


However, Marcella is an immigrant who has been in the United States for less than five years, which disqualifies her from full Medi-Cal benefits. Her pregnancy qualifies her for pregnancy-related Medi-Cal benefits, however.



Applicants must specify income from all sources (earned income, self-employment income, other income), and allowable deductions, for all household members. Medi-Cal eligibility is based on current monthly income, while eligibility for Covered California subsidies is based on projected annual income. The system will calculate each based on the data entered and verified.



Generally, an applicant must be a U.S. citizen or have satisfactory immigration status to qualify for full Medi-Cal benefits or for health insurance offered through Covered California.



Generally, an applicant must be a U.S. citizen or have satisfactory immigration status to qualify for full Medi-Cal benefits or for health insurance offered through Covered California.


In this scenario, Manuel legally immigrated to the United States more than five year ago. He provides information about his satisfactory immigration status, but the system is unable to verify the information electronically. He will be required to provide immigration documents before he can receive a final eligibility determination. Marcella legally immigrated to the United States less than five years ago, which means she cannot qualify for full Medi-Cal benefits. Her immigration status is successfully verified electronically.



Pregnancy increases the calculation of household size for Medi-Cal, which in turn lowers the calculation of the household’s federal poverty level (FPL) and may effect Medi-Cal eligibility for the household. In addition, Medi-Cal may cover pregnancy-related services for some people who would not otherwise be eligible for Medi-Cal, including those with higher incomes.



Pregnancy increases the calculation of household size for Medi-Cal, which in turn lowers the calculation of the household’s federal poverty level (FPL) and may effect Medi-Cal eligibility for the household. In addition, Medi-Cal may cover pregnancy-related services for some people who would not otherwise be eligible for Medi-Cal, including those with higher incomes.


In this scenario, Marcella is pregnant. While her immigration status prevents her from being eligible for full Medi-Cal benefits, her pregnancy qualifies her for pregnancy-related Medi-Cal benefits.



Tax filing status and dependent information are used to help determine the individual's household size.



Gloria Garcia, 40, is a single mom. She and her daughter Gabriela, 14, live in Fremont. Gloria was laid off 18 months ago from her job at an auto supply company, where she had a salary of $55,000 and health benefits for her and her daughter. She has been working part time since then and paying for continuation coverage (COBRA), but it is expiring. Gloria expects to earn $3,140 this month, which is her monthly average.



Manuel Marcos, 32, is an immigrant with a visa from the Philippines. He has worked as a health aide for the past 6 years. His wife Marcella, 30, is in her first trimester of pregnancy. She is a lawful permanent resident who has been in the U.S. for three years. The couple live in Riverside. Manuel earns $18 an hour and works 30 hours per week. Marcella is unemployed.



Larry Lee, 26, lives in Chico. He works at a brewery and earns $36,420 a year. His job offers insurance, but he is looking for a better deal.



Applying for financial help is optional. Applicants who opt out will not be asked about income and therefore cannot be determined eligible to receive Medi-Cal or Covered California subsidies.











Covered California verifies information entered into the application against other agencies’ records to see if those on the application qualify for health insurance. Covered California asks for applicants’ consent to verify their information.



Applicants must provide the Social Security Numbers (SSNs) of those applying for health insurance if they have one. Providing SSNs is optional for others.



Applicants may provide immigration document information for the household members they indicate are not U.S. citizens.



Applicants have the option to register to vote at the same time they submit their application.



Applying for financial help is optional. Applicants who opt out will not be asked about income and therefore cannot be determined eligible to receive Medi-Cal or Covered California subsidies.



Identifying information, including name, date of birth, gender, and address, must be provided for each household member. Applicants over age 64 generally are not eligible for Modified Adjusted Gross Income (MAGI) Medi-Cal or for Covered California subsidies.



The applicant is likely eligible to purchase health insurance through Covered California without subsidies.



Individuals who are unable to successfully complete the remote identity proofing process online will have to provide documents proving their identity before they can complete or submit an online application. Identifying documents will be allowed to be provided in person, by mail, or electronically.



The Affordable Care Act provides unique benefits to American Indians and Alaska Natives who are members of federally recognized tribes.



Primary contacts are required to verify their identities by correctly answering a set of automatically generated questions based on historical information (former residences, vehicle records, etc.).



Social security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents providing the correct information before the eligibility determination can be finalized.



Social security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents providing the correct information before the eligibility determination can be finalized.


In this scenario, Manuel’s immigration status cannot be verified electronically. His eligibility for Medi-Cal is pending; proof of immigration status must be provided before coverage can begin.



Social security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents providing the correct information before the eligibility determination can be finalized.


In this scenario, Gloria’s income cannot be verified electronically. As a result, she must provide proof of income before she and Gabriela receive a final eligibility determination. Meanwhile, Gloria is conditionally eligible for Covered California subsidies; she can immediately pick a health plan and enroll. Gabriela’s eligibility for Medi-Cal is pending; proof of income must be provided before coverage can begin.



Social security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents providing the correct information before the eligibility determination can be finalized.



Consumers can opt to enter information about their health care needs in order to see estimated total out-of-pocket costs for each plan.



This information helps determine household size. Household size affects the calculation of federal poverty level (FPL), which in turn affects the kind and amounts of financial help that may be available. People who live together are often part of the same household.



This information helps determine household size. Household size affects the calculation of federal poverty level (FPL), which in turn affects the kind and amounts of financial help that may be available. People who live together are often part of the same household.



The applicant is likely eligible for premium tax credits that lower the monthly price of health insurance offered through Covered California.



The applicant is likely eligible for premium tax credits that lower the monthly price of health insurance offered through Covered California.


In this scenario, Larry falls within the income limits for a premium tax credit to lower the costs of health insurance offered by Covered California.



Consumers can compare premiums (net of applicable tax credits), cost sharing, and benefits for all available health plans.



Consumers can opt to enter information about their health care needs in order to see estimated total out-of-pock costs for each plan as well as whether or not certain doctors or hospitals are in a plan's network.



Applicants may specify enrollment groups (household members who enroll in the same plan together) and select adults who need dental coverage.



The Covered California provider directory enables individuals to specify their preferred health care providers and facilities. Covered California uses this information to display whether those providers and facilities are covered by each plan. The directory is updated monthly and may not be a current or complete list.



Individuals can specify how many prescriptions they anticipate needing during the year. Covered California uses this information to estimate the total annual amount the individual would pay for each plan.



Individuals can specify how much medical care they anticipate needing during the year. Covered California uses this information to estimate the total annual amount the individual would pay for each plan.



For most plans, consumers can pay their first health insurance premium online after enrolling in the plan.



Applicants can choose to be referred to other benefits available in California, such as CalFresh, CalWORKs, and others.



Applicants must provide the primary contact’s address and may provide the primary contact’s Social Security Number (SSN) and other contact information to assist in verifying identity.



Before starting an online application, an individual will be asked some questions through the remote identity proofing service used by Covered California. These questions, and the correct responses that verify a person's identity, are largely drawn from that person's credit history.



The rules engine considers all of the information provided by the applicant, the results of the verification process, and calculations of the household size, Modified Adjusted Gross Income (MAGI), and federal poverty level (FPL) to determine the eligibility of each person on the application who wants health insurance.



Application data for all individuals who are determined eligible or pending eligible for MAGI Medi-Cal, or whose application data suggests they may be eligible for non-MAGI Medi-Cal, are automatically forwarded to the applicant’s county of residence for final processing.



Applicants who indicate they are disabled can finish the online application to determine the kind and amount of financial help they may qualify for based on their Modified Adjusted Gross Income (MAGI). In addition, their completed application will be forwarded to their county of residence for a determination of whether they may qualify for Medi-Cal on the basis of their disability (a “non-MAGI Medi-Cal” determination).



Applicants must identify relationships among household members.



Applicants must assign primary caretakers for all children.



Applicants must specify which of their household members want health insurance.



Social Security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents proving the correct information before the eligibility determination can be finalized.



In this scenario, Gloria's income cannot be verified electronically. As a result, she must provide proof of income before she and Gabriela receive a final eligibility determination. Meanwhile, Gloria is conditionally eligible for Covered California subsidies; she can immediately pick a health plan and enroll. Gabriela's eligibility for Medi-Cal is pending; proof of income must be provided before coverage can begin.



Applicants who already have affordable health insurance, such as coverage offered through a job, cannot receive Covered California subsidies. They may, however, qualify for Medi-Cal or be able to purchase insurance through Covered California without subsidies.



Social Security numbers, citizenship and immigration status information, income, and health insurance information provided by the applicant are compared to data held by federal and state agencies. If they are not reasonably compatible, the applicant can finish the application, but will need to provide documents proving the correct information before the eligibility determination can be finalized.



In this scenario, Manuel's immigration status cannot be verified electronically. His eligibility for Medi-Cal is pending; proof of immigration status must be provided before coverage can begin.



Applicants who already have affordable health insurance, such as coverage offered through a job, cannot receive Covered California subsidies. They may, however, qualify for Medi-Cal or be able to purchase insurance through Covered California without subsidies.



Identifying information, including name, date of birth, and gender, must be provided for each household member.