Covered California
CoveredCA is the official health insurance marketplace for the state of California. It offers health insurance plans to individuals, families, and small businesses through the Affordable Care Act (ACA), also known as Obamacare. CoveredCA allows residents of California to compare health insurance plans and prices, and to enroll in a plan that fits their needs and budget. It also offers financial assistance to eligible individuals and families to help them afford the cost of health insurance premiums. CoveredCA is a valuable resource for residents of California who are in need of health insurance.
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FAQs
Why do I need health insurance?
Having health insurance is important because it can help protect you and your family from high medical costs. Medical care can be very expensive, and even a minor illness or injury can result in significant bills. Health insurance can help cover the cost of medical care, so you don't have to pay for it out of pocket.
In addition to helping you pay for medical care, health insurance can also provide access to a wider range of medical services. Many health insurance plans provide coverage for a variety of services, including preventive care, such as annual check-ups and vaccines. This can help you maintain good health and catch any potential health problems early on, when they are more likely to be treatable.
Lastly, having health insurance can give you peace of mind. Knowing that you have coverage can help you feel more secure and able to focus on your health and well-being, rather than worrying about the cost of medical care.
Is there a penalty for not having health insurance in 2023?
The penalty for not having coverage the entire year will be at least $850 per adult and $425 per dependent child under 18 in the household when you file your 2022 state income tax return 2023. A family of four that goes uninsured for the whole year would face a penalty of at least $2,550.
What is open enrollment?
Open enrollment is a period of time during which individuals and families can sign up for health insurance or make changes to their existing coverage. In the United States, open enrollment typically occurs each year from November 1 - January 31, and it is the only time of year when individuals and families who do not have employer-sponsored health insurance can enroll in a new plan or make changes to their existing coverage. Open enrollment allows individuals and families to compare health insurance plans and prices, and to choose a plan that fits their needs and budget. It is an important opportunity for those who need health insurance to sign up for a plan or make changes to their existing coverage.
What is special enrollment?
You can apply for a health plan outside open enrollment (or make changes to your current plan) if you’ve experienced one of these qualifying life events, usually within the last 60 days. The effective date of the insurance is the 1st of the following month after submitting the application.
Lost existing health coverage, including job-based individual plans
Turned 26 and lost coverage through a parent’s plan
Moved to/within California
Married or Entered a Domestic Partnership
A Child is Born, Adopted, or Received into Foster Care
Gained U.S. Citizenship or Lawful Presence
Lost eligibility for Medicaid/Medi-Cal
Returned from active-duty military service
Released from incarceration
Why there are different premiums for the same coverage plan among different insurance companies?
Different insurance companies have different contracted medical networks. Usually, a larger medical network will have relatively higher premiums. The premiums in different regions are also different due to the medical claim ratio.
What is Medicaid / Medi-Cal?
Medi-Cal is California's Medicaid program. Medi-Cal gives people with low incomes access to health services without paying insurance premiums and medical expenses. However, the contracted medical network is very limited and usually, the waiting period for the medical appointment is longer.
*In some cases, a monthly premium for children under 18 yrs old may be required.
How can I change my Medi-Cal plan to a subsidized health insurance?
Subsidized health insurance and Medi-Cal insurance cannot exist at the same time. If you currently hold Medi-Cal insurance, you need to contact the Department of Social Services to cancel your Medi-Cal insurance, even if it is not during the open enrollment period of health insurance. After the Medi-Cal insurance is canceled, then it is eligible for a special enrollment period. You can apply for subsidized health insurance within 60 days. After the application is submitted, it will be effective on the 1st of the following month.
How many subsidies you can get from Covered California?
Covered California refers to the standards in the Federal Poverty Level to provide premium subsidies according to different household sizes and adjusted gross income on the 1040 tax form. The variety of Silver plans depends on the income range.
View the chart here
What documents are required to apply for subsidized health insurance?
Only California taxpayer residents are eligible to apply for subsidized health insurance through Covered California. For new immigrants, a social security number and legal immigration status documents are required (Employment Card, Permanent Resident Card, Certification of Naturalization, or passport). Your pay stub or tax return is required as proof of income.
What are the differences between HMO/PPO/EPO plans?
HMO plan requires you to designate a Primary physician and a medical network. Except for emergency medical treatment, you need to make an appointment with a Primary physician first, and the Primary physician will determine whether it is necessary to refer you to a specialist or make an appointment for surgery. The medical costs will not be covered outside the contracted medical network.
PPO plan allows you to directly make an appointment with a Specialist doctor without a referral from a Primary physician, and a larger contracted medical network. Some of the medical costs will be covered under a non-contracted medical network.
