INDIVIDUAL COVERAGE AT PETERS & MILAM
Need help navigating the confusing world of individual insurance? In addition to offering a complete line of Individual products available here in Santa Barbara County, the service you will receive at Peters and Milam is second to none. Let us help you navigate through the oftentimes confusing world of individual medical insurance!
SPEAK WITH A PETERS & MILAM INDIVIDUAL ADVISOR AT 805-687-3225 OR INFO@PETERSMILAM.COM
THE AMERICAN RESCUE PLAN
ENHANCED PREMIUM CREDITS SET TO END
A provision of the Inflation Reduction Act of 2022 extended the enhanced subsidies for Individual ACA plans through December of 2025. Unless Congress acts, the increased help will end on Dec. 31, 2025. New federal rule changes may affect your health insurance through Affordable Care Act marketplaces like Covered California.
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On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021. The new law increases premium assistance available through exchanges and removes the “cliff” that makes people ineligible for subsidies if their income exceeds 400% of the Federal Poverty Level. Off-exchange consumers must apply for an on-exchange plan through Covered California to take advantage of the federal premium tax credits. People who may have earned too much to get financial help in the past may now be eligible.•Clients enrolled in Covered California health plans will not have to pay more than 8.5% of their household income for the second lowest cost silver plan
•Clients who are below 400% of the FPL can get additional government financial assistance (the 8.5% cap still applies for household income)
•Any person in 2021 who received unemployment insurance for one week or more, and their total income qualifies for coverage through Covered California, will receive federal premium tax credit available for 138% of FPL for the duration of the Public Health Emergency in 2021
•100% federal premium subsidy for COBRA coverage.We thank you for your patience as we navigate this new legislation together!
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Financial help will still be available next year, but many enrollees could receive less than they did before.
In 2021, the federal government increased financial help for some people through Enhanced Premium Tax Credits. The Enhanced Premium Tax Credit is scheduled to end on Dec. 31, 2025.
Earlier this year, Congress passed and President Trump signed House Resolution 1 (the “One Big Beautiful Bill”). House Resolution 1 could have but did not extend the Enhanced Premium Tax Credit.
Unless Congress acts, the increased help will end on Dec. 31, 2025.
INDIVIDUAL LIFE
INSURANCE
INDIVIDUAL HEALTH INSURANCE
Life insurance will enable a surviving spouse to raise your children, or provide the funds to care for an aging parent or other dependent. It can also ensure that you final expenses, debts or taxes are properly managed. When considering purchasing life insurance, it is suggested you buy protection equivalent to five to eight times your annual income, though your needs may vary according to your financial assets and liabilities. Life insurance can solve your heirs' immediate and long-term needs.
You can only sign up for Individual health insurance plans that start the 1st of January or February. The exception to this would be if you have an event that creates a Special Enrollment Period (SEP). The most likely SEPs are loss of employer sponsored coverage, moving to a new service area, birth, and loss of Medi-Cal coverage. CLICK HERE to see other SEPs & required documents. When eligible for individual health insurance there could be premium subsidies based on family size & income.
BLUE SHIELD OF CA
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Plans at a Glance Side by Side PPO
Plans at a Glance Side by Side HMO
Blue Shield PPO Plans
Minimum Coverage PPO
Bronze 60 HDHP PPO
Bronze 60 PPO
Silver 70 PPO
Silver 73 PPO
Silver 87 PPO
Silver 94 PPO
Silver 1750 PPO
Silver 2600 HDPD PPO
Gold 80 PPO
Platinum 90 PPO
Blue Shield Trio HMO Bronze 7500 Trio HMO
Silver 70 Trio HMO (Off-Exchange)
Silver 70 Trio HMOSilver 73 Trio HMOSilver 87 Trio HMOSilver 94 Trio HMOGold 80 Trio HMO
Platinum 90 Trio HMO -
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COVERED CALIFORNIA RESOURCES
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When you apply for a Covered California health insurance plan with premium assistance, you will be asked to enter your current sources of household income. Only certain kinds of income are considered, such as: Annual income, including wages, salaries and tips. Business or self-employment income, including rental income. Interest received or accrued. Lottery and gambling income. Capital gains. Pensions. Social Security retirement benefits. Foreign-earned income. Alimony income. Bartering income (i.e., exchange of goods or services without exchanging money).
DELEGATE YOUR BROKER
Covered California consumers who are new to our brokerage can choose to delegate our office as their broker through their existing Covered California account. This allows Peters & Milam to assist with your application, enrollment process, and future plan renewals.
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Covered California compares the information you enter on your application with government data sources or information you have provided before. If the data is inconsistent, we ask you to submit documents to confirm the new information. The button below links to examples of documents you can submit to support your application.
To determine eligibility for premium assistance and cost-sharing reductions, Covered California uses the household modified adjusted gross income (MAGI). For most taxpayers, MAGI is the same as adjusted gross income (AGI), which can be found on line 4 of a Form 1040EZ, line 21 of a Form 1040A or line 37 of a Form 1040. Taxpayers who receive non-taxable Social Security benefits, earn income living abroad or earn non-exempt interest should add that income to their AGI to calculate their MAGI. It’s important to remember that if an individual claims their spouse or children as dependents, their incomes count toward the household income. Also, in order to receive premium assistance through Covered California, spouses are required to file their income tax returns jointly.
DOCUMENTS TO CONFIRM ELIGIBILITY -
Household size, income and ZIP code are the items on this list that are most likely to change during the year. If you move, it is important to notify Covered California so we can update your mailing address. Additionally, if your ZIP code is in a new plan region, you will need to pick a new plan, and your premium amount and premium assistance will likely change.
It’s also really important to tell Covered California about changes in your household size and income, because these are part of how your premium assistance is calculated. If your household size and projected income change a lot during the year, the amount of premium assistance you are eligible for will change. So, during the year, it’s important to consider the income you entered at the time of your application and to notify Covered California if your income changes significantly, so that we can adjust your premium assistance.
You can report changes in your income through your online account, with the help of a certified enroller or by calling Covered California at (800) 300-1506.
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Covered California requires at least 14 days advance notice to process this request. Please call our office at (805) 687-3225 to cancel your plan or call Covered California at (800) 300-1506.
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Signing up for Med-Cal? You can submit an application online or visit one of the three offices throughout Santa Barbara County.You can also call Department of Social Services toll-free telephone number (866) 404-4007, or visit their website for more information. cription
2026 Covered California Benefit Design Chart and Income Guidelines
READ THE BLOG • Individual Health Insurance
