En Español | Most Californians are eligible to buy health insurance through Covered California, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, Covered California’s enrollment window is open through the end of 2021.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for a single person).
The average family with a marketplace plan can save $50 per person per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Most Californians, including non-U.S. citizens with worker or student visas, are eligible to buy health insurance through Covered California, regardless of whether they are currently insured.
- You may also qualify for Medi-Cal, the state’s Medicaid plan, which offers free or low-cost coverage to low-income people and families and to those who live in skilled nursing facilities or have certain disabilities. Non-U.S. citizens without documentation can get some Medi-Cal coverage if they are pregnant or are 18 or younger.
When can I enroll?
- Anytime through the end of 2021
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. You can pay online or ask to receive a bill in the mail, which should arrive in about two weeks. To apply and enroll:
- Online: Go to Covered California’s website and click “Apply Now.”
- By phone: Submit your name and contact information online and a certified insurance enroller will call you back, usually within 15 minutes during normal business hours. You can also call Covered California’s service center at 800-300-1506.
- In person: You’ll need to meet with a certified enroller or licensed insurance agent, whom you can find through Covered California’s website. Or visit a local enrollment center, although in-person access and hours may be impacted by COVID-19.
You can also call Covered California’s service center (800-300-1506) or visit a local enrollment center for help with exploring plans, to ask questions and to help determine if you qualify for financial assistance.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medi-Cal, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Covered California plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Covered California plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of their annual income now qualifies for federal tax credits for insurance premiums.
For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for out-of-pocket expenses such as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
Covered California’s plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover between 70 and 94 percent of care costs, depending on whether you qualify for a basic plan or an Enhanced Silver plan for lower-income households. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
Covered California’s Shop and Compare tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. Californians 29 and younger can also apply for a minimum coverage or catastrophic plan offering low premiums and covering three doctor visits or urgent care visits per year.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Covered California. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you can switch to a Covered California plan. Be aware that if you don’t cancel your COBRA plan before your new plan kicks in, you may face a financial penalty.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the renewal period opens this fall. If you don’t take action during the renewal period, you’ll automatically be reenrolled in your existing plan.
Will I need to get a new doctor?
That depends. Major insurance providers, including Anthem Blue Cross and Kaiser Permanente, offer Covered California plans, but not all doctors accept them. You can talk to your primary care physician or use the Shop and Compare tool to see whether a certain doctor or practice will accept a marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Such families may choose to enroll as “mixed-program families” and still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
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