Some Californians, individuals, and families enrolled in Covered California (Covered CA) plans are eligible for financial assistance to lower the cost of their health insurance. Anyone who receives financial assistance with Covered CA is required to file a federal tax return as a condition of eligibility.
Covered CA offers two main ways to get assistance with health care coverage costs:
- Premium Assistance (formally called the Advanced Premium Tax Credit or APTC) is a tax credit to reduce an individual’s monthly premium.
- Cost-Sharing Reductions is a subsidy to reduce an individual’s out-of-pocket costs (their copay’s, coinsurance, deductible and out-of-pocket maximum).
Important Information Regarding Premium Assistance and Tax Filing
All Covered CA consumers who receive Premium Assistance/APTC, must file federal taxes for each calendar year they receive the assistance. If they fail to file their taxes, they will lose their eligibility for Premium Assistance/APTC. The consumer will then be responsible for paying the full premium amount and will have a higher cost-sharing for health care services.
Covered CA has mailed warning notices to those who are at risk of losing their Premium Assistance/APTC. These notices were sent to consumers who in 2017:
- Received Premium Assistance/APTC in the calendar year but did not file a federal tax return for that year;
- Filed a federal tax return but did not include IRS Form 8962; or
- Requested an extension to file a federal tax return but did not end up filing the return.
Covered CA consumers who fall within any of these categories will have until May 15, 2019, to preserve their Premium Assistance/APTC by reconciling their premium assistance and contacting Covered California to attest to having done so.
If consumers fail to take these steps, they will receive another notice, in a pink envelope, that tells them when their financial assistance will end if no action is taken. Covered CA consumers who fail to take corrective action will lose their current financial help starting July 1, 2019.
This year’s health insurance enrollment cycle began on October 15, 2018, and ends on January 15, 2019. Enrolling is easy and may be done a number of ways:
Covered CA Basics
Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.
Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including outpatient care, hospitalization, prescription drugs, laboratory tests, mental health care, and emergency services. There are five health carriers who offer a variety of plans in the County of San Francisco: Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, and Oscar.
Sign Up and Renewal Dates
- Sign up by December 15, 2018, for coverage starting January 1, 2019
- Sign up by January 15, 2019, for coverage starting February 1, 2019
Need Help Paying For Health Insurance Costs?
Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The AIDS Drug Assistance Program (ADAP) and Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.
Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident who needs assistance in exploring your options and/or enrolling in healthcare you can contact PRC for additional help and information: 415-777-0333.
On May 15, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) announced the implementation of an employer-based health insurance premium payment (EB-HIPP) Program. New and existing ADAP clients who are enrolled in an employer-based health insurance plan are now eligible to receive premium assistance for their portion of their insurance premium.
EB-HIPP will pay medical and dental premiums, and it will also pay for vision premiums that are included in a medical or dental premium. EB-HIPP It will also pay the even pays for medical out of pocket (MOOP) expenses!
Eligibility for EB-HIPP is based on the following requirements:
- Be enrolled in ADAP
- Be employed and enrolled in an employer-based insurance program
- Employment verified with paystub dated within last three months
- The employer must agree to participate in the EB-HIPP program
Medicare Part D Premium Payment Program (MDPP) Now Offers Medigap Premium Payment Program for ADAP Clients
Effective June 14, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) has also expanded their MDPP Program benefits to include payment of Medigap premiums. Medigap insurance is private insurance that helps pay for some of the health care costs that are not covered by traditional Medicare, such as copayments, coinsurance, and deductibles. New and existing MDPP clients will now be eligible to receive assistance with their Medigap insurance premiums, as well as medical out of pocket (MOOP) expenses for Medicare outpatient claims.
Note: EB-HIPP must pay the client’s portion of their premium in order for the client to receive MOOP benefits
Each Mind Matters1(EMM) recently collaborated with a group of LGBTQ+ community leaders and stakeholders to come together and create informational materials on mental health issues faced by Latinx LGBTQ+. The materials focus on three key segments: young adults, older adults, and providers working with Latinx youth.
Latinx LGBTQ+ Youth Mental Health Provider Fact Sheet2
This fact sheet helps providers working with Latinx LGBTQ+ youth address the complex connections that can have an impact on a young person’s life, such as sexual orientation, gender identity, race/ethnicity, and immigration status. The fact sheet provides relevant resources and best practices within a culturally responsive framework.
EMM also created a fully bilingual in Spanish and English resource online, which covers key terms for providers working with Latinx LGBTQ+ youth, things to consider as mental health professionals serving Latinx LGBTQ+ immigrant youth, and seeking benefits. At this time there are no printed copies available; however, the pamphlet is available free to download3.
EMM website is a resource for mental health and LGBTQ+ topics: