Financial help comes in two forms: the Premium Tax Credit, and reductions in what you pay for your health care (known as cost-sharing reductions).
The Premium Tax Credit lowers the cost of your premium: the monthly bill you pay for your Covered California plan. You can choose to get the Premium Tax Credit each month (before tax time), or you can claim it when you file your taxes.
If used before tax time, it will be applied to your premium each month and it will lower your monthly bill. This is known as Advanced Premium Tax Credit, or APTC.
Or, you can pay the full price of your premium each month and then claim the Premium Tax Credit when you file your taxes, which may result in your getting a refund. In addition, if you received Advanced Premium Tax Credit to lower your monthly bill, and the government determines at tax time that you should have received more Premium Tax Credit than was given to you, you may get a refund. And if the government determines that you received too much APTC (because your income changed and you didn't tell Covered California), you may have to pay back some of the money you received. This is called “reconciliation.”
In addition, if your household earns 250 percent or less of the federal poverty level, you can receive cost-sharing reductions with an Enhanced Silver plan. Cost-sharing reductions lower how much you pay for your deductible, copays and coinsurance, as well as the out-of-pocket maximum that you’ll pay before your insurance pays for all other health care you receive this year — but you can only get cost-sharing reductions with an Enhanced Silver plan (Silver 73, 87 or 94).
To understand what you’ll pay for your deductible, copays and coinsurance, see our Health Benefits Table.
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