In this post, we are going to explain in detail Covered California’s Enhanced Silver Benefits plans. We will cover how to qualify for the enhanced silver plans, income limits, and, who may choose a silver health plan under Covered California.
Types of Silver Plans Under Covered California
There are four levels of Silver Plans under Covered California. They are:
- Silver 70
- Silver 73
- Silver 87
- Silver 94
The Silver 70 Plan covers standard benefits.
The other silver plans are called “Enhanced Silver Plans” or “Enhanced Silver Benefits”.
What are Enhanced Silver Benefits Plans?
The Enhanced Silver Benefits Plans – Silver 73, 87, and 94 offer better out-of-pocket savings through lower copays, coinsurance, and deductibles if you are eligible.
They have the same great benefits as the plans available at other coverage levels, but they differ when it comes to how much you pay for monthly premiums and medical services.
The Silver plans are a popular choice because they tend to have affordable monthly premiums and mid-sized deductibles.
Also, they also have discounted fees for common medical services.
The California Silver Plans may be best suited for those who are relatively healthy, mainly receive routine care during doctor visits, and take generic drugs.
Additionally, many people who are eligible for a tax credit in Covered California are also eligible for an Enhanced Silver plan.
How do Silver Health Plans compare to other Plans?
According to the Healthcare.gov website, of the 4 categories of Health Insurance Marketplace plans (Covered California Plans). Silver plans fall about in the middle:.
With Silver plans, you pay moderate monthly premiums and moderate costs when you need care.
Also, if you qualify for “cost-sharing reductions” (or “extra savings”) you can save a lot of money on deductibles, copayments, and coinsurance when you get care — but only if you pick a Silver plan.
As a result, Silver plans are the most common choice of Marketplace shoppers under Covered California.
How do I qualify for Enhanced Silver Benefits?
Not everyone qualifies for enhanced silver plans.
Eligibility is based on income, age, family size, and zip code.
Generally, adults with an income of just above 138% to 250% of the Federal Poverty Level may qualify for enhanced silver benefits.
What are the Enhanced Silver Benefits Income Limits?
As stated above, if your income is just above 138% to 250% of the Federal Poverty Level (FPL), you qualify for enhanced silver benefits plans. Here’s how:
If you make >138 to 150% of the FPL, you will qualify for the Silver Enhanced 94 Plan, which covers 94% of the average annual cost of health care.
Furthermore, if you make >150 to 200% of the FPL, you will qualify for the Silver Enhanced 87 Plan, which covers 87% of the average annual cost of health care.
Also, if you make >200 to 250% of the FPL, you will qualify for the Silver Enhanced 73 Plan, which covers 73% of the average annual cost of health care.
The income limit table below provides a breakdown of the enhanced Silver Benefits income limits based on household size:
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Covered California Programs (If ineligible for Medi-Cal)
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Plans that qualify for Premium Assistance (Tax credit continues beyond 400% of FPL) | ||||||||||
| American Indian/Alaska Native (AIAN) Zero Cost Sharing Plans | AIAN Limited Cost Sharing | ||||||||||
| Silver 94 (100%-150% of FPL) | Silver 87 (> 150%-200%) | Silver 73 (> 200%-250%) | |||||||||
| Persons in Family/Household | 0% | 100% | 138% | 150% | 200% | 213% | 250% | 266% | 300% | 322% | 400% |
| For individuals | $0 | $12,880 | $18,755 | $19,320 | $25,760 | $28,947 | $32,200 | $36,150 | $38,640 | $43,760 | $51,520 |
| For a family/Household of 2 | $0 | $17,420 | $25,268 | $26,130 | $34,840 | $39,001 | $43,550 | $48,705 | $52,260 | $58,959 | $69,680 |
| For a family/Household of 3 | $0 | $21,960 | $31,782 | $32,940 | $43,920 | $49,054 | $54,900 | $61,260 | $65,880 | $74,157 | $87,840 |
| For a family/Household of 4 | $0 | $26,500 | $38,295 | $39,750 | $53,000 | $59,108 | $66,250 | $73,815 | $79,500 | $89,355 | $106,000 |
| For a family/Household of 5 | $0 | $31,040 | $44,809 | $46,560 | $62,080 | $69,162 | $77,600 | $86,371 | $93,120 | $104,554 | $124,160 |
| For a family/Household of 6 | $0 | $35,580 | $51,323 | $53,370 | $71,160 | $79,215 | $88,950 | $98,926 | $106,740 | $119,752 | $142,320 |
| For a family/Household of 7 | $0 | $40,120 | $57,836 | $60,180 | $80,240 | $89,269 | $100,300 | $111,481 | $120,360 | $134,951 | $160,480 |
| For a family/Household of 8 | $0 | $44,660 | $64,350 | $66,990 | $89,320 | $99,322 | $111,650 | $124,036 | $133,980 | $150,149 | $178,640 |
| For a family/Household of 9+: add | $0 | $4,540 | $6,514 | $6,810 | $9,080 | $10,054 | $11,350 | $12,556 | $13,620 | $15,199 | $18,160 |
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Medi-Cal Programs
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Medi-Cal for Adults | Medi-Cal for Pregnant Women | Medical Access Program (For Pregnant Women) | ||||||||
| Medi-Cal for Kids (0-18 Years) | CCHIP (for San Francisco, San Mateo, and Santa Cruz county residents) | ||||||||||
Covered California FAQs
Here are some of the most frequently asked questions about Covered California health plans:
Do I qualify for a subsidy for Covered California Plans?
Generally, you may qualify for a government subsidy if your gross family income is no more than 400% of the Federal Poverty Level (“FPL”).
How do I calculate my Modified Adjusted Gross Income (MAGI) for Covered California?
For most individuals, your Adjusted Gross Income (line 11 on Form 1040) is the same as your Modified Adjusted Gross Income (MAGI).
This rule applies unless you are receiving Social Security, Foreign Earned Income, or Tax Exempt Interest.
If you are receiving any of these types of income, then use the calculation method below to determine your MAGI for Covered California.
- Start with your Adjusted Gross Income (line 11 on Form 1040)
- Add any Tax-Exempt Interest (Line 2a on Form 1040)
- Add any Foreign Income & Housing Deduction amounts (lines 45 and 50 on Form 2555)
- Add the Non-taxable Social Security benefits, which is the difference from subtracting line 6b from line 6a on Form 1040
What are the dates of 2023 Open Enrollment for Covered California?
2023 Open enrollment for Covered California plans begins November 1, 2022, and ends January 31, 2023
Plans are effective based on the following deadlines:
- December 15th for a January 1st effective date
- January 15th for a February 1st effective date
Enhanced Silver Benefits Summary
We hope this post on Enhanced Silver Benefits under Covered California was helpful.
Questions?
If you have further questions about Medi-Cal, please let us know in the comments section below.
Be sure to check out our other articles about Medi-Cal and California Medicaid program, including:
