Health Insurance Premium Payment Program California Benefits and Options

If you're a California resident struggling to pay your health insurance premiums, there's good news: the state offers several programs to help. The Health Insurance Premium Payment Program (HIPP) can help you cover your costs.

This program is designed for low-income individuals and families who are eligible for Medi-Cal, but need help paying their private health insurance premiums. The HIPP program can pay up to 100% of your premiums, depending on your income level.

To be eligible for HIPP, you must be a California resident, have a private health insurance plan, and meet certain income requirements.

The health insurance premium payment program in California is designed to help low-income individuals and families pay for their health insurance premiums.

Eligible individuals can receive assistance with their premium payments through the program.

The program is funded by the state of California and is administered by the California Department of Health Care Services.

Premium payments can be made through the program's website, by mail, or in person at a local county office.

If you're eligible for the Health Insurance Premium Payment (HIPP) program, you'll receive a notification from DHCS indicating that your application has been approved.

The EW (Eligibility Worker) is responsible for deleting the private health insurance premium in CalSAWS, allowing for a 10-day notice if the SOC (State of Care) will be increased. They must also check to ensure the OHC (Other Health Coverage) is already entered in CalSAWS and that MEDS is coded correctly.

To verify HIPP eligibility, you can check the [HIAR] screen in MEDS. If you're enrolled in the HIPP, the "Source" field will indicate "HIPP."

Here's a summary of the steps the EW must take when a HIPP application is approved:

If the client has voluntarily disenrolled from the Organized Health Care (OHC) plan, the Enrollment Worker (EW) must take immediate action. The EW should notify the Department of Health Care Services (DHCS) by calling 1-866-298-8443.

DHCS will verify the disenrollment and notify the EW to discontinue the client from Medi-Cal (MC) with a timely 10-day Notice of Action (NOA). The EW must then take the following steps:

The good news is that MC benefits will continue for members of the family unit who are unable to enroll on their own behalf.

Medicare Savings Programs can help pay for Medicare premiums, copayments, or deductibles. These programs are designed to support individuals with limited income.

To qualify for the Qualified Medicare Beneficiary (QMB) program, you must be eligible for Medicare Part A and Part B, have countable income at or below 100% of the Federal Poverty Guidelines ($1,255 per month, $1,704 for couples), and meet other Medi-Cal requirements besides income. This program pays for Medicare Part A and Part B premiums, coinsurance, and deductibles.

The Specified Low-Income Medicare Beneficiary (SLMB) program pays for Medicare Part B premiums, and to qualify, you must have countable income at or below 120% of FPG ($1,506 per month, $2,044 for couples).

The Qualified Individual-1 (QI-1) program also pays for Medicare Part B premiums, and to qualify, your countable income must be between $1,506 and $1,695 per month for individuals, and between $2,044 and $2,300 for couples.

You may be eligible for the Qualified Disabled Working Individual (QDWI) program if you're less than 65 years old, still disabled, and eligible for Medicare under a work incentive program. This program pays for Medicare Part A premiums, and you must have countable income at or below 200% of FPG ($2,510 per month for individuals, $3,407 for couples).

To learn more about these programs and determine which one you may be eligible for, you can call your county Health Insurance Counseling & Advocacy Program (HICAP) office.