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Covered California premium tax credits (federal help paying for a Covered California health plan): who qualifies, what you get, how to apply, and what happens next

The federal premium tax credit lowers the monthly premium of a health plan bought through Covered California, for households with income from 100% to 400% of the poverty level that have no affordable job-based or public coverage. Cost-sharing reductions and a California subsidy add more help at lower incomes. Apply at CoveredCA.com; the same application checks Medi-Cal.

What Covered California premium tax credits is, in one paragraph

The premium tax credit is a federal tax credit that pays part of the monthly premium of a health plan bought through Covered California, California's health insurance marketplace. It is the only place the credit can be used in California. The credit can be taken in advance, paid each month straight to the insurer (the Advance Premium Tax Credit, or APTC), or claimed when filing federal taxes. Every year it is used, it is reconciled on the federal tax return. The extra help called the Enhanced Premium Tax Credits ended on 31 December 2025; the base credit continues for household income from 100% to 400% of the poverty level (rule:enhanced_ptc_ended, rule:aptc_income_range).

100% to 400%
of the federal poverty level: the household income range for the federal premium tax credit, coverage year 2027 (Covered California, rule:aptc_income_range)

Who may qualify

Four things decide it: expected household income, the tax household, other coverage, and status.

The tax household is the person, a spouse, and anyone claimed as a tax dependent, even people not applying (rule:tax_household). Income is what that household expects to earn this year, not last year.

The income range for the federal credit is 100% to 400% of the federal poverty level; above 400% there is no federal credit (rule:aptc_income_range, rule:above_400_none). Most people up to 138% get Medi-Cal instead (rule:medi_cal_138). Covered California uses the previous year's poverty levels, so coverage year 2027 uses the 2026 figures (rule:fpl_table_2027):

Household size100%138% (Medi-Cal)150%200%250%400% (credit ends)
1$15,960$22,025$23,940$31,920$39,900$63,840
2$21,640$29,864$32,460$43,280$54,100$86,560
3$27,320$37,702$40,980$54,640$68,300$109,280
4$33,000$45,540$49,500$66,000$82,500$132,000
5$38,680$53,379$58,020$77,360$96,700$154,720
6$44,360$61,217$66,540$88,720$110,900$177,440
7$50,040$69,056$75,060$100,080$125,100$200,160
8$55,720$76,894$83,580$111,440$139,300$222,880
each additional+$5,680+$7,839+$8,520+$11,360+$14,200+$22,720

What the household pays toward the benchmark Silver plan rises with income: 0% under 150%, 2.8% to 5.28% over 150% to 200%, 6.78% to 8.66% over 200% to under 250%, 8.66% to 10.22% from 250% to under 300%, and 10.22% from 300% to 400% (rule:expected_contribution). The credit is the difference between that share and the benchmark premium. Cost-sharing reductions lower deductibles and copays at 250% or less, through Silver 94, 87 and 73 plans (rule:csr_250). The California Premium Subsidy adds state money from 100% to 200% (rule:state_subsidy).

Other coverage: the credit is not available to someone offered affordable job coverage that meets minimum value, or eligible for Medicaid (Medi-Cal), Medicare, CHIP or TRICARE (rule:irs_conditions). Married couples must file jointly, except victims of domestic abuse or abandonment (rule:mfs_bar). Status: from 1 January 2027 only certain immigrant groups, such as green card holders, can get financial help (rule:immigration_2027). Status is screened per person: members of one household can qualify for different programs.

How to apply, and what happens after

Apply at CoveredCA.com, with a free certified enroller, or by phone. One application covers Covered California and Medi-Cal, and returns a result for each person in the household.

When: open enrollment runs 1 November to 31 January; enroll by 31 December for coverage on 1 January (rule:open_enrollment). Outside it, a major life change opens a special enrollment period that usually lasts 60 days from the event (rule:special_enrollment_60); after losing Medi-Cal the window is 90 days (rule:lost_medi_cal_90).

After applying, Covered California may ask for documents. From 1 January 2028 financial help is not applied until the proof is accepted (rule:proof_before_help_2028). The person picks a plan, chooses how much credit to take in advance, and pays the first premium.

During the year, report income and household changes in the account (rule:report_changes). At tax time, file a federal return with Form 8962 to reconcile the advance credit, even if not otherwise required to file (rule:reconcile_8962). From tax year 2026, excess advance credit is repaid in full, with no income-based cap (rule:full_repayment_2026). Renewal opens each October; doing nothing re-enrolls the person within 30 days of the deadline on the information on file (rule:renewal_october).

Disagree with a decision? File an appeal, generally within 90 days of the date the notice was mailed (rule:appeal_90). The California Department of Social Services holds the hearing; most appeals are decided within 90 days of a valid request (rule:appeal_decision_90).

The procedure, stage by stage, as data
JSONThe procedure, stage by stage, as data
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"id""stage:discover"
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"name""Discover"
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"timeline""Open enrollment 1 November to 31 January; otherwise 60 days after a life change"
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"id""stage:gather_documents"
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"evidence""Pay stubs, tax return, immigration documents"
"failure_mode""Missing documents leading to a request for proof after applying"
"model_role""List the documents that match the person's situation"
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"id""stage:complete_application"
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"name""Complete application"
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"timeline""One sitting"
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"failure_mode""Mixed-program families surprised that members get different results"
"model_role""Explain mixed-program results before the person applies"
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10 keys
"id""stage:submit"
"order"5
"name""Submit"
"what_happens""Submit online at CoveredCA.com, with a certified enroller, or by phone"
"who_acts""Person"
"timeline""By 31 December for 1 January coverage; within the special enrollment window otherwise"
"evidence""Submission confirmation"
"failure_mode""Missing the window and waiting until the next open enrollment"
"model_role""Give the deadline that applies to the person"
"automation_class""B"
10 keys
"id""stage:interview_verification"
"order"6
"name""Interview / verification"
"what_happens""If information cannot be confirmed, Covered California asks for documents"
"who_acts""Covered California"
"timeline""Stated on the request"
"evidence""The requested proof"
"failure_mode""Not answering the request; from 2028 help is not applied until proof is accepted"
"model_role""Name what proof is asked for and where to send it"
"automation_class""B"
10 keys
"id""stage:decision"
"order"7
"name""Decision"
"what_happens""Eligibility results per person: full-price plan, plan with financial help, or Medi-Cal"
"who_acts""Covered California"
"timeline""At application"
"evidence""Eligibility notice"
"failure_mode""Not reading the notice; it starts the 90-day appeal clock"
"model_role""Read the notice back against the rules"
"automation_class""A"
10 keys
"id""stage:issuance_use"
"order"8
"name""choose_plan_pay"
"what_happens""Choose a plan, decide how much of the credit to take in advance, pay the first premium; the ID card follows"
"who_acts""Person / insurer"
"timeline""First bill usually about two weeks after enrolling"
"evidence""First payment"
"failure_mode""Not paying the first premium, so coverage never starts"
"model_role""Explain the advance-credit choice and the first bill"
"automation_class""D"
10 keys
"id""stage:report_changes"
"order"9
"name""Report changes"
"what_happens""Report income and household changes in the account during the year"
"who_acts""Person"
"timeline""As changes happen"
"evidence""Updated income and household"
"failure_mode""Unreported raises; from tax year 2026 excess credit is repaid in full"
"model_role""Flag changes that move the person across a band"
"automation_class""A"
10 keys
"id""stage:renew_recertify"
"order"10
"name""Renew / recertify"
"what_happens""Renewal opens in October; doing nothing re-enrolls the person in the same plan with the information on file"
"who_acts""Person"
"timeline""Each October; auto re-enrollment within 30 days of the deadline"
"evidence""Updated income"
"failure_mode""Auto re-enrollment on old income"
"model_role""Remind the person to update income before renewal"
"automation_class""B"
10 keys
"id""stage:overpayment_exit"
"order"11
"name""reconcile_taxes"
"what_happens""File a federal tax return with Form 8962 using Form 1095-A to reconcile advance credit against actual income"
"who_acts""Person / tax preparer"
"timeline""Tax filing season after the coverage year"
"evidence""Form 1095-A, Form 8962"
"failure_mode""Not filing Form 8962, which delays refunds and can end future advance credit"
"model_role""Point to free tax preparation and Form 8962"
"automation_class""B"
10 keys
"id""stage:denial_response"
"order"12
"name""Denial response"
"what_happens""Read the eligibility notice; decide between appeal and complaint"
"who_acts""Person"
"timeline""Immediately; the appeal window runs from the mailing date"
"evidence""Eligibility notice"
"failure_mode""Filing a complaint when an appeal is needed"
"model_role""Separate an eligibility dispute (appeal) from a service problem (complaint)"
"automation_class""A"
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"id""stage:appeal_fair_hearing"
"order"13
"name""Appeal / fair hearing"
"what_happens""Mail the appeal form; Covered California may resolve it; otherwise the California Department of Social Services schedules a hearing"
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"timeline""Appeal generally within 90 days of mailing; decision usually within 90 days of a valid request"
"evidence""Appeal form, notice"
"failure_mode""Missing the 90 days"
"model_role""State the deadline and how to file"
"automation_class""B"

The same facts open other programs

Expected annual income and tax household size are the facts this credit runs on. The same two facts decide Medi-Cal at the low end and tax credits like the EITC, and a job loss changes all of them at once.

References (6)
What this article shares with the graph
JSONWhat this article shares with the graph
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"program_id""B012"
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"related_programs" 6 keys
"B011""Medi-Cal (Medicaid)"
"B080""State-only Medi-Cal categories for immigrants (incl. pregnancy & emergency)"
"B054""Free tax preparation: VITA / TCE + Free File + CalFile"
"B013""Medicare Savings Programs (QMB / SLMB / QI / QDWI)"
"B017""County indigent health programs (CMSP, Healthy San Francisco, county clinics)"
"B027""Unemployment Insurance (UI)"
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Official addresses

References (7)
Related pages
Beside
Medi-Cal (California Medicaid health coverage): who qualifies, what you get, how to apply, and what happens nextState-only Medi-Cal for immigrants (California-funded coverage by immigration status, including pregnancy and emergency care): who qualifies, what you get, how to apply, and what happens nextFree tax preparation: VITA / TCE + Free File + CalFile (free ways to prepare and file federal and California returns): who qualifies, what you get, how to apply, and what happens nextMedicare Savings Programs (the state pays Medicare premiums: QMB, SLMB, QI, QDWI): who qualifies, what you get, how to apply, and what happens nextCounty indigent health programs (CMSP, Connect to Care, Healthy San Francisco: county care for uninsured adults): who qualifies, what you get, how to apply, and what happens nextUnemployment Insurance (California weekly benefit after job loss): who qualifies, what you get, how to apply, and what happens next
References (22)
  1. Financial Help — Covered California“Financial help lowers what you pay for a Covered California health plan.”
  2. Financial Help: APTC range — Covered California“Available if your income is between 100% FPL to 400% FPL.”
  3. Financial Help: cost-sharing reductions — Covered California“Available if your income is 250% FPL or less.”
  4. Financial Help: California Premium Subsidy — Covered California“Available for households that qualify based on income, agreement to file taxes and enrollment in a Covered California health plan.”
  5. Financial Help: household size — Covered California“Household size: You, your spouse, and anyone you claim as a tax dependent, even if they are not applying for health insurance.”
  6. Program Eligibility by Federal Poverty Level for 2027 — Covered California“Consumers with income above 400% FPL are not eligible for a federal premium tax credit.”
  7. Program Eligibility by Federal Poverty Level for 2027: Medi-Cal note — Covered California“Most consumers up to 138% FPL will be eligible for Medi-Cal.”
  8. Important Changes: premiums — Covered California“Before, many people had extra financial help through Enhanced Premium Tax Credits, but that help ended on Dec. 31, 2025.”
  9. Important Changes: immigrants — Covered California“Only certain immigrant groups, like lawful permanent residents (green card holders), will be eligible for financial help to help pay for their insurance.”
  10. Important Changes: repayment — Covered California“Beginning with the 2026 tax year (filed in 2027), people who get too much financial help may need to pay back the full amount they owe.”
  11. Important Changes: proof before help — Covered California“You’ll need to prove that you qualify for financial help before you get it.”
  12. Important Changes: phone — Covered California“Call (800) 300-1506”
  13. Open Enrollment — Covered California“It lasts from Nov. 1 to Jan. 31.”
  14. Open Enrollment: special enrollment — Covered California“This period usually lasts 60 days from the date of the event.”
  15. Major Life Changes: lost Medi-Cal — Covered California“Within 90 days of your Medi-Cal ending”
  16. Major Life Changes: report a change — Covered California“If your income or household changes, sign in to your account and report the change.”
  17. Renew Your Plan — Covered California“If you don’t do anything, you’ll be re-enrolled into your current plan within 30 days of the renewal deadline, using the most recent household and income information on file.”
  18. File an Appeal or a Complaint — Covered California“You generally must file your appeal within 90 days of the date Covered California mailed your eligibility decision.”
  19. File an Appeal: timeline — Covered California“For most appeals, the hearing process and decision take up to 90 days from the date we get a valid appeal request.”
  20. The Premium Tax Credit: The basics — Internal Revenue Service“you must file a federal income tax return and attach Form 8962, Premium Tax Credit (PTC), to your return.”
  21. The Premium Tax Credit: who qualifies — Internal Revenue Service“Are not able to get affordable coverage through an eligible employer-sponsored plan that provides minimum value.”
  22. The Premium Tax Credit: filing status — Internal Revenue Service“Do not file a tax return using the filing status of Married Filing Separately.”