Covered California Insurance Options

Obamacare plans in California are offered through Covered California. Get insurance benefits through the California Health Exchange in order to qualify for government assistance. Health Care Reform Plans are offered through most of the major carriers including Anthem Blue Cross, Blue Shield, Kaiser Permanente, Health Net and Molina.

Quote Calculator: View Costs and Find Rates with Government Assistance

Click California Health Insurance Quotes to view rates and benefits online. Choose the plan that fits you and your family based on cost and benefits, and then apply online. Enrollment is fairly easy and usually takes people around 30-60 minutes.

Live Support Options

You can get live assistance from Covered California Insurance Representatives, directly from health care carriers, or from agents, brokers, assisters and certified enrollment counselors (CEC). For assistance, choose from the following options:

Or, lookup the license of a particular Covered California insurance agent.

Providers

California consumers often ask, “What doctors are available in my provider network?” Provider networks vary by carrier and by plan. The provider network may differ based on the following:

  • Whether your plan is on/off exchange
  • Whether your plan is an individual/group plan
  • Which carrier you enrolled with

In order to get specific provider network information related to your Covered California insurance coverage, you will need to contact your carrier by phone or visit their website to search their network of hospitals and doctors.

The Covered California Insurance Card

When you enroll with Covered California, you will receive an insurance card from the carrier that you enrolled with. Often, this card will note that you enrolled “on exchange” or that you enrolled “with Covered California”. However, this card is not truly a Covered California insurance card, but rather a card that is produced and recognized by your medical insurance company.

2017 Renewals

Covered California insurance plan renewals for 2017 will likely be from October 1 to December 15, 2016. During that time you can make changes to your health care plan. Or, you can let it auto-renew.

by Wendy Barnett

Be on the watch for Covered California announcements in October or November 2017 regarding rate changes on the Silver Plans, or more specifically the “cost-sharing-reduction (CSR) surcharge.” Covered California already announced their proposed rates for 2018 which will have a weighted average increase of 12.5%. Howev...

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Posted: September 29th, 2017 under Covered California Insurance

by John Hansen

The Affordable Care Act (ACA) was intended to be just that…affordable. However, many are arguing that Obamacare has really just caused rates to rise. For some who are receiving the benefits of expanded Medicaid or large subsidies through the exchanges, health insurance has become attainable and/or has become more affordable. However, for many Americans prices went up.

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Posted: August 11th, 2017 under Covered California Insurance

by John Hansen

The Question of Health Care Centers around Risk Management and Maintaining Healthy Pools of Members

If people didn’t get sick, health care would be cheap, but it would also be unnecessary. As legislators are trying to deal with the issues surrounding health care in America, one of the key issues is how to deal with the incredibly high costs of servicing people with serious health conditions.

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Posted: August 4th, 2017 under Covered California Insurance

by John Hansen

If consumers have are under 200% of the Federal Poverty Level (FPL), they qualify for Cost Sharing Reduction (CSR), which means better benefits at the same cost if you enroll on a Silver Plan through Covered California, the California Health Exchange. However, these benefits are being threatened by Republican leaders in Washington DC as they consider the future of health care in America.

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Posted: July 26th, 2017 under Covered California Insurance

by John Hansen

As Anthem and Health Net Drop Market Share, Two Carriers Begin to Dominate the California Individual Market

Up until this year, there have been four leading carriers offered on the California Health Insurance Exchange: Anthem Blue Cross, Blue Shield of California, Kaiser Permanente and Health Net. These four insurance companies split market share somewhat evenly. (more...)

Posted: July 20th, 2017 under Covered California Insurance


by John Hansen

California has one of the most stable health insurance markets in the nation. The Covered California State Exchange is strong, and all regions in the state have at least three carriers offered.

Other states across the country are not fairing so well. Many regions outside of California have only have one carrier offered, and in some areas there is no carrier at all.

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Posted: July 14th, 2017 under Covered California Insurance

by John Hansen

Things are getting shaken up at Molina Health Care. In the last month, the company terminated two top executives from the Molina Family, chief executive J. Mario Molina and his brother, finance chief John Molina. The company blamed this on “disappointing financial performance”. When you put that together with the bold moves Molina Insurance made in California in 2016 (very aggressive pricing, high broker c...

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Posted: June 9th, 2017 under Covered California Insurance , Health Plans in California , Molina Healthcare California

by Wendy Barnett

Covered California applicants commonly wonder how much it will cost to have a baby with insurance. This is a very good question when you are choosing which plan will be your best option on the California Health Insurance Exchange.  Did you know that Covered California has provide...

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Posted: May 26th, 2017 under Covered California Insurance

by Wendy Barnett

Have you received a recent letter from Covered California?  If so, make sure to open it and read it right away. Covered CA notices are always important to read, but if the recent notice sent out to certain enrollees is ignored, members may lose their financial assistance!

In the last week of April, 2017, Covered CA sent out letters called the Consent, Income and Tax Attestation Notice to members who h...

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Posted: May 6th, 2017 under Covered California Insurance

by Wendy Barnett

When you have lost your job, your medical insurance from your employer can end, too.  Being without work can be a stressful time, but understanding your health insurance options doesn’t have to be. There are 4 important things to know when you have lost your job health insurance:

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Posted: April 7th, 2017 under Apply with Covered California , Covered California Insurance

by Wendy Barnett

Are you moving, planning on moving, or have you recently moved?

Qualifying Life Events (QLE) are big life occurrences called triggering life events that allow you to enroll in individual or family health insurance outside of the Open Enrollment Period. There is a whole list of life events that can be applicable, but this article will cover moving.

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Posted: March 31st, 2017 under Apply with Covered California , Covered California Insurance

by Wendy Barnett

Covered California recently sent out an e-mail to members with “Helpful Tips.” The March 2017 e-mail includes guidelines on what services are free and how to get started using the plan. As a health insurance agent I am surprised that I commonly hear from members that they have never used their plan. This is really unfortunate since there are free benefits that members can use to help them stay healthy. I really encour...

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Posted: March 25th, 2017 under Covered California Insurance

by Wendy Barnett

Covered California offers Small Business and Group Health Insurance in California to businesses with 1-100 employees at any time throughout the year and seeks to better the program experience by listening to customer concerns. For instance, the concern about a delinquency notification policy was recently addressed.

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Posted: March 16th, 2017 under Covered California Insurance , Small Business Health Insurance

By Wendy Barnett

No Consent = No Tax Credit

In late December of 2016 Covered California found a bookkeeping error where certain consumers were erroneously told that they would receive a tax credit for their renewed Covered CA plan when in fact their tax credit would be removed entirely. The removal of the tax credit had to do with wh...

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Posted: March 10th, 2017 under Covered California Insurance

by Wendy Barnett

Covered California confirmed that they gave erroneous tax credit information to insurers for approximately 25,000 policy holders. This resulted in members receiving incorrect bills for the month of January, 2017. Covered California has, since then, corrected the wrong tax credit information with the insurance carriers. They have also aggressively reached out to affected m...

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Posted: March 10th, 2017 under Covered California Insurance

by Wendy Barnett

Near the end of February, Covered California sent out notices to members receiving tax credits as reminders that they should have received an important tax document – their IRS Form 1095-A.

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Posted: March 6th, 2017 under Covered California Insurance

by Wendy Barnett

Trumps Executive Order regarding Obamacare Repeal

President Trump wasted no time in beginning his administration’s goals to repeal Obamacare. On inauguration day, he signed an executive order to begin steps to do so.  The directive states President Trump’s intention to seek the prompt repeal of the Affordable Care Act (ACA) and in...

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Posted: March 3rd, 2017 under Covered California Insurance

by Wendy Barnett

Uninsured Californian’s are receiving notices from the IRS urging them to get health insurance so that they will not have to pay a tax penalty. Notices went out in December ’16 and January ’17; and are the first time the IRS is reaching out to uninsured consumers since the Affordable Care Act went into effect. Consumers are being reminded that they can still apply for Obama Care during the a...

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Posted: January 26th, 2017 under Apply with Covered California , Covered California Insurance

by Wendy Barnett

Many people are anxious for their 1095-A Forms. This form is a Covered California statement that shows what months you had health insurance during the year and how much tax credit you received. Most people who were enrolled on a Covered CA plan in 2016 will receive their 1095-A Form from Covered CA. If you were enrolled on a Minimum Coverage Plan (Ca...

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Posted: January 20th, 2017 under Covered California Insurance

by Wendy Barnett

Did you forget to apply for your health insurance for January 1st?  Or maybe you encountered difficulties submitting your application and could not get the assistance you needed to complete it. Don’t worry, you still have time to apply for Covered California. Open Enrollment is still open!

<...

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Posted: January 12th, 2017 under Apply with Covered California , Covered California Insurance

By Jessica Howland

24,000 at Risk

Approximately 24,000 members with health plans through Covered California are at risk of losing their financial assistance, which is the tax credit provided by the Federal Government in January, if they don’t give Covered California permission to verify their income. 

An email has been sent to all those at risk along with phone outreaches to try and communicate this message to as many ...

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Posted: December 30th, 2016 under Covered California Insurance

by Jessica Howland

Local Assistance Expanded

On November 17th the Covered California Website, released the new Help On-Demand tool for consumers looking for local assistance at the click of a button. This tool has been added this year on top of the already success...

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Posted: November 30th, 2016 under Apply with Covered California , Covered California Insurance

By Wendy Barnett

Obamacare in the California exchange has been operational for nearly 3 years. Many people are wondering if the Affordable Care Act (ACA) is working.  Let’s take a look at Covered California’s

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Posted: November 22nd, 2016 under Covered California Insurance

By John Hansen

Covered California’s Open Enrollment began on November 1, and the State Exchange kicked off their 2017 tour this weekend, Saturday, November 12 in San Diego. The tour will continue through major areas of California and will conclude in Santa Cruz on November 19.

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Posted: November 11th, 2016 under Apply with Covered California , Covered California Insurance

By John Hansen

Covered California Responds to this Week’s Election Results

With the election results and Donald Trump having sworn to repeal Obamacare, many Californians are concerned. Surprisingly, the Republicans kept control of both the House and the Senate, which may give President-Elect Trump the opportunity to make massive changes to healthcare in America. Consumers are afraid they may lose their (more...)

Posted: November 10th, 2016 under Covered California Insurance


By Wendy Barnett

The presidential candidates for 2016 are at odds in so many areas.  But where do they stand on Obamacare for California?  What about other pressing health care issues concerning Californians and the nation?

The chart below shows some of the ways where Trump and Hillary have different s...

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Posted: November 6th, 2016 under Covered California Insurance

by Jessica Howland

Today marks the start of Covered California’s 4th annual Open Enrollment Period for the 2017 benefit year. Mark your calendar! The dates for this year’s “Open Season” as some are calling it are:

November 1st-January 31

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Posted: November 1st, 2016 under Apply with Covered California , Covered California Insurance

By Wendy Barnett

When Covered California announced that there would be a rate hike for 2017 that averaged 13.2%, Californians were understandably upset. But residents don’t have to look far to realize that it could be a whole lot worse.

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Posted: October 28th, 2016 under Covered California Insurance

by Wendy Barnett

On the Nov. 8, 2016 California General Election ballot is Proposition 64 also known as the Adult use of Marijuana Act.  This measure would legalize the recreational use of Marijuana for adults aged 21 and older.  Adults would be able to grow, possess, and use marijuana for nonmedical purposes with some restrictions.  State agencies would be required to license and regulate marijuana growing businesses...

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Posted: October 24th, 2016 under Covered California Insurance

By Wendy Barnett

The Drug Price Standards Initiative, Proposition 61, will appear on the ballot this November as an initiated state statute for Californian voters.  A “Yes” vote on Prop 61 supports regulating drug prices by requiring state agencies to pay the same prices that the U.S. Department of Veterans Affairs (VA) pays for prescription drugs. While a “No” vote on Prop 61 opposes this measure.

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Posted: October 19th, 2016 under Covered California Insurance

by John Hansen

If you are a health insurance broker in California, you need to know about this new up and coming health insurance company. Currently, Oscar is only available in Orange County and part of Los Angeles County, but in 2017 they will be expanding to include San Francisco, San Mateo and Santa Clara counties. We expect them to keep expanding their reach in the golden state, especially in big cities and more populated areas.

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Oscar Health Care CEO, Mario Schlosser, is known for being super smart and very tech-savvy. However, he hasn’t been the biggest advocate of the broker.

Schlosser has made some anti-broker comments. He spoke of agents as if they were a necessary evil. Light on the necessary, heavy on the evil. He went so far as to say that brokers make a “shit load of money”, and he acted like broke...

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Simple. Intuitive. Easy. These are not usually words you see connected with health insurance. However, Oscar Health Care, a new up and coming carrier of health insurance in California, is making medical care easier in the golden state. When you get to the Oscar website, you are immediately greeted… “Hi, we’re Oscar. Smart, simple health insurance.”

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Posted: September 23rd, 2016 under Oscar Insurance


by John Hansen

Oscar health insurance claims to offer better plans, better health care and a better experience for their members. Basic question… Is this true? Obviously, that may depend on who you are comparing them to.

So… Let’s discuss these three bold claims that you can find on the home page of the Oscar website.

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

After Leaving Dallas and New Jersey, What Is the Future of Oscar in California?

In a meeting with Oscar California Healthcare Sales Leader, Dennis Negron, on Wednesday, August 24, I asked him why the carrier is pulling out of the Dallas and New Jersey markets. I wanted to know how stable the company was going to be in California.

Recently, we found out that UnitedHealthcare was pulling out of the California Health Exchange. In light ...

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Who is this new startup health care company and what makes them so special?

When you land on the Oscar insurance official website home page, there is a humble, yet bold greeting: “Hi, we’re Oscar.”  The health plan was founded in 2012 by Mario Schlosser, Kevin Nazemi and Joshua Kushner.

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Lower Prices, Great Networks, Better Technology, Better Service, and Other Perks

Anthem Blue Cross and Blue Shield of California better watch their back. The new guy is coming. And, he’s coming on strong.

So far, Oscar Plans are only in a handful of California regions. However, in every region where they exist, they are becoming more and more competitive. They have already been competitive in the 2016 off-exchange markets, but in 2...

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Easy is not a term most people associate with health care, but Oscar health insurance is revolutionizing the market by simplifying the process of getting service and using a health plan. They offer excellent customer service and innovative, easy-to-understand and easy-to-use plan designs.

Live support from representatives and medical personnel is easy to access for e...

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Posted: September 23rd, 2016 under Oscar Insurance

by John Hansen

Oscar Health Care offers two categories of medical plans: Market Plans and Simple Plans. The Simple Plans are designed to be super easy to understand. The Market Plans are designed to be offered in the California Health Exchange, through Covered California.

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Posted: September 23rd, 2016 under Oscar Insurance

Obamacare plans in California are offered through Covered California. Get insurance benefits through the California Health Exchange in order to qualify for government assistance. Health Care Reform Plans are offered through most of the major carriers including Anthem Blue Cross, Blue Shield, Kaiser Permanente, Health Net and Molina.

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Posted: September 20th, 2016 under Covered California Insurance

by Wendy Barnett

Health Insurance Brokers in California take note! If you are a certified agent with Covered California, they have provided a tool chest of information to assist you in your success.  Not only can you access your book of business, view notices sent to consumers, obtain job aids but also watch a webinar that you missed. Follow these basic tips that show how to navigate Covered CA’s websit...

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Posted: September 6th, 2016 under Covered California Insurance

By Esmeralda Mercado

If you’re currently enrolled on a private health plan, your rates are likely to increase by a lot. In California, the weighted average increase is 13.2%. Because this is a transitional due to factors affecting rates, everyone is encouraged to weight their options and go shopping. Most consumers will only see a rate increase of no more than 5% if they switch plans.

What can I do?

If you’re not already en...

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Posted: September 6th, 2016 under Covered California Insurance

by Esmeralda Mercado

Effective January 1st 2017, most California private health insurance rates will increase an average of 13.2%. The actual rate change will vary, based on:

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Posted: September 6th, 2016 under Apply with Covered California

by Wendy Barnett

Beginning in August 2016, Covered CA will be sending notices to employers about their employees who have enrolled in Covered CA and are receiving the Advance Premium Tax Credit (APTC). The notice serves to inform employers that their employees may have indicated that their employer has not offered “affordable, minimum value standard coverage” and that they may be subject to the “employer shared responsibility payment” otherwise known as the tax penalty.

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Posted: September 6th, 2016 under Covered California Insurance

by Wendy Barnett

In August Covered California added some new features to the Covered California Application . One feature provides easier access to non-health benefit services to consumers with income less than or equal to 200% of the Federal Poverty Level. Some of the programs  tha...

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Posted: September 6th, 2016 under Covered California Insurance

By Wendy Barnett

Covered CA implements Web Browser Log-in Restrictions

CalHEERS 16.7, the newest version of the Covered CA online application, now restricts users to one account log-in per web browser. Health Insurance Brokers in California who are certified with Covered CA or enrollment counselors will not be able to open a new browser tab...

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Posted: September 1st, 2016 under Apply with Covered California

By Wendy Barnett

E-Verification of Medicare begins in August, 2016

The Covered CA application, known as CalHEERS, will now electronically verify an applicant’s Medicare eligibility and enrollment. Previously, when the question on the application asked if you are currently enrolled in Medicare or receiving Medicare benefits, it would allow you to self-attest ...

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Posted: September 1st, 2016 under Apply with Covered California

By Wendy Barnett

Covered California announced that beginning in August 2016 a new notice will be sent out to enrollees who are approaching or are over their 65th birthday.  The notice is titled “You may now qualify for Medicare” and discusses important steps regarding the transition from Covered CA to Medicare. These steps include important info...

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Posted: September 1st, 2016 under Apply with Covered California

by Wendy Barnett

“Good changes are just around the corner” was the message given by Covered California in a webinar on August 4, 2016 put out by the Covered CA Outreach and Sales team reviewing their online application feature release 16.7.  Various updates were reviewed, including changes regarding the “Shop and Compare” tool.  This tool is featured on the Covered...

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Posted: September 1st, 2016 under Covered California Insurance

by Wendy Barnett

On August 1, 2016, the Covered CA online application, called CalHEERS, made changes on their Remote Identity Proofing (RIDP) pages.

Text changes will appear in the description of the RIDP pages and the drop down menus to improve clarity and readability for applicants. The newest version, 16.7, of the Covered CA application aims to remove confusion about “the function of the RIDP page...

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Posted: September 1st, 2016 under Apply with Covered California

by Wendy Barnett

Covered CA gets serious with Qualifying Life Events

Beginning the week of August 1st, Covered CA’s Office of Consumer Protection (OCP) will start a new Special Enrollment verification process. They will select a random sample of their members who enrolled during the Special Enrollment Period

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Posted: September 1st, 2016 under Apply with Covered California

by John Hansen

The 2017 Obamacare Open Enrollment Period begins November 1, 2016 and goes until January 31, 2017. For health insurance consumers, they will have three months to apply for Obama Care.

During the 2017 Covered California open enrollment period, consumers can apply for health insurance or change pl...

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Posted: August 31st, 2016 under Apply with Covered California , Covered California Insurance

by John Hansen

The health insurance penalty in 2017 will continue to be the same as in 2016 with one difference. The flat dollar amount will be adjusted for inflation and calculated based on the Cost of Living Adjustment (COLA).

The Penalty in 2016 Serves as the Baseline

In 2016, Americans paid a tax penalty of 2.5% of the household income, or they paid a flat dollar amount of $695 per adult and $347.50 per child up to $2,085 per household, whichever wa...

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Posted: August 31st, 2016 under Covered California Insurance

by Wendy Barnett

Member Level Plan Selection for APTC Eligible Households

A recently announced feature on the Covered CA application significantly affects the plan selection process by adding much needed versatility. Covered California now gives families who are eligible for Advanced Premium Tax Credits (APTC) the option to choose different plans for different members in their house...

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Posted: August 19th, 2016 under Apply with Covered California

by John Hansen

With Varying Products and Consumer Types, Getting Callers to the Right Place Can Be Difficult

Obama Care California and the new world of the Affordable Care Act (ACA) has made it difficult for health insurance call centers to get people to the right place when they call for support. Clients are eligible for or enrolled on various products. Offerings include individual coverage, group health in...

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

Consideration #1: There’s government money on the Health Exchange.

The big question is, “Do you qualify for a subsidy?” If yes, then you go where the money is, and that’s on health benefit exchange through Covered California. If you make less than 400% of the Federal Poverty Level (FPL), then you qualify for government assistance if you enroll on the California Health Insurance Exchange.

Consideration #2: Enrollment is easiest o...

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Posted: July 25th, 2016 under Apply with Covered California

by John Hansen

Before the implementation of Obama Care in California, health insurance enrollment lasted all year long. There was no Open Enrollment Period. Consumers could purchase health plans and Agents could sell them throughout the year. However, since the Affordable Care Act (ACA), a three month Open Enrollment Period has been established.

For consumers, this means you have to be on your A-game. No longer can you purchase health insurance throughout the year. If you do not apply during the Open Enro...

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Posted: July 25th, 2016 under Apply with Covered California

by John Hansen

If a group has under 50 employees, there is no penalty for not offering small business health insurance. With subsidies available and no denials for the individual and family plans, many expected a mass exodus in the small group health insurance California market. Many feared that a lot of small groups would cancel their health plans and send their employees to the exchange to get subsidies. However, far fewer groups have departed from t...

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Posted: July 25th, 2016 under Small Business Health Insurance

by John Hansen

The State Exchange is expected to start offering Covered California agency contracts in 2017. Since the beginning of Health Care Reform, the California Health Exchange has been offering agent contracts, but as of yet they have not offered brokerages the ability to have their own contract or to have an agency online account with Covered California. The State Health Exchange is expected to offer agency contracts within the next 12 months, poss...

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

There are two main ways California carriers pay their health agents. Either they pay on a percentage basis or a Per Member Per Month (PMPM) basis. Anthem Blue Cross has gone to paying medical insurance brokers on a PMPM basis for individual sales, and Blue Shield of California is considering following suite.

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

Physicians Who Discriminate Against Covered California Will Face Disciplinary Actions by the State Exchange

Many Covered California consumers have complained during the first couple years of the Affordable Care Act that they are having trouble getting their doctors to accept their health insurance coverage. Physicians and clinics have made the following statements.

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

The Newly Eligible Qualified Alien Program (NQI) is going into effect. In order to meet the requirements, you must be a qualified alien and the following must be true:

  • You must be under 21 years of age.
  • You may not be pregnant.
  • You may not currently have children.

43,000 people are expected to meet these criteria. They can enroll through the

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Posted: July 25th, 2016 under Apply with Covered California

by John Hansen

1. Enrollment numbers will likely be similar to 2016.

The Covered California Open Enrollment 2016 turned out 200,000 new enrollees and 300,000 people switching from one California health care plan to another. In 2017, we expect these numbers to be about the same. 

2. The subsidy market is likely to plateau.

The subsidy market is plateauing. There are still a lot of uninsured, but many may r...

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

Gap Health Insurance Covers People While Waiting for Open Enrollment or for Employer Sponsored Coverage

Short term health insurance sales have gone up since the implementation of the Affordable Care Act (ACA). There has been a lot of upset in the market including people losing coverage and individuals needing gap health insurance to cover them while they’re waiting for Open Enrollment or waiting for their new job to start.

Due to H...

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Posted: July 25th, 2016 under Apply with Covered California

by John Hansen

Despite the Promises of Obama Care, California Health Insurance Companies Keep Raising Rates

We were promised the Affordable Health Care Act, but for many it seems like it should just be called the “Care Act”. If you’re not poor and on subsidies, prices have actually risen. Health care in our state is actually less affordable than it was before Obama Care California came to...

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Posted: July 25th, 2016 under Covered California Insurance

by John Hansen

Already, the Covered California Health Exchange is requiring all carriers (even Blue Cross/Blue Shield PPO’s) to assign all members a Primary Care Physician (PCP). They want everyone to have a doctor, and they want everyone to be getting their checkups and preventative tests.

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Posted: July 25th, 2016 under Apply with Covered California

by John Hansen

Health Care in California is Expected to Get Real Personal

You’ve heard of soda taxes and bagel taxes in New York. Even a fat tax was proposed. “Weigh in, buddy. Uh oh, you’re weight’s up, so that means that your taxes are going up as well.” This sounds like a preposterous idea from a George Orwell science fiction book, but it may just be the reality that we will be facing with regard to health care in California in the future.

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Posted: July 25th, 2016 under Covered California Insurance

by Wendy Barnett

I got enrolled on an Obamacare plan during the Covered California Open Enrollment, and now I find out that I have been terminated for lack of documentation. Can I get reinstated? What do I do?

In the last couple months, Covered California and their licensed insurance agents have been following up with clients who need to submit supporting documentation....

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Posted: July 21st, 2016 under Apply with Covered California

by Wendy Barnett

You may have an issue with your enrollment application, with the health plan, or with the Covered California website, etc. When you contact Covered California as a consumer (800-300-1506) or as an agent (855-777-6782), you will get one of two responses.

  • Resolution: The representative may resolve your issue right over the phone.
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Posted: July 21st, 2016 under Apply with Covered California

by Wendy Barnett

At times a consumer has issues with their Obamacare California health plan or their application, and they need to file an appeal. Perhaps you were denied coverage for some reason that you thought was not legitimate. In cases like these, you can go file an appeal either by email or by phone.

In one case, one of our agents, Wendy Barnett, filed an appeal on behalf of a client. The agent said, “It was a lon...

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

Illegal immigrant adults who do not have lawful presence in California can now get restricted Medi-Cal health insurance coverage by enrolling through the California Health Exchange, Covered California. They must have a household income that is less than or equal to 138% of the Federal Poverty Level (FPL) to qualify.

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

Minors without lawful presence can now qualify for child health insurance coverage through Medi-Cal if the household income is no more than 266% of the Federal Poverty Level (FPL).

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

At the CAHU Capital Summit 2016, the California Association of Underwriters (CAHU) explained their views on various California health care bills that are before Congress now in Sacramento. They encouraged agents who sell health insurance in California to lobby on behalf of consumer and broker interests.

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

At the CAHU Summit 2016 on May 18, Mike Belote prepped California health agents before they went to meet with political leaders in the Sacramento State Senate and Assembly. He said, “We are lobbyists and story tellers. We deliver a narrative.” That narrative is one aimed at communicating the interests of brokers who sell health insurance in California.

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

At the CAHU Capital Summit on May 18, a California insurance agent asked Mary Watanabe, Deputy Director of the Department of Managed Health Care, about the difficulties he is having finding providers for the mental health care that is supposed to be included on the Obamacare California plans.

The insurance broker questioned, “Regarding the mental health component of new ACA plans, I’m finding it challeng...

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

Dropping Commissions, Fewer Agents and the Question of Appropriate Commission Levels

Since the implementation of the Affordable Care Act (ACA) commissions for health insurance agents have drastically decreased. This has caused many brokers to rethink whether or not they want to stay in the industry.

Michael Lujan, the current President of CAHU, says that by 2018 they are expecting that the amount of agents in the California market wi...

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

Mary Watanabe, Deputy Director of the Department of Managed Health Care, spoke to a room full of California health insurance brokers on May 18. At the beginning of her talk, she said, “Remind me to talk about broker commissions if I forget.” Someone from the crowd called out, “Don’t worry. We will.” To which people responded with laughter.

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

The Powerful Arm of the Department of Managed Health Care to Protect California Consumers

At the CAHU Capital Summit 2016 on Wednesday, May 18, Mary Watanabe, Deputy Director of the Department of Managed Health Care (DMHC), asked the rhetorical question, “Does the DMHC have teeth?” The answer is a resounding yes.

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

The Department of Managed Health Care, which protects 25 million California insured, has a newsletter with helpful information. Sign up for the DMHC’s “Listserv” at www.HealthHelp.ca.gov to receive updates and notifications about public meetings.

On the right side bar of the page toward the bottom, there is box that says, “Keep In Touch”. Simply enter your email and click the “Next” button. Then, you’ll recei...

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

The DMHC Enforces Bills like SB 137, 1052, 282, 546, AB 339, and 374 to Protect California Consumers

The Department of Managed Health Care often plays the role of the enforcement arm of legislation related to health care in California.

According to SB 137, the DMHC regulates provider directories put out by California health insurance carriers like Anthem Blue Cross, Blue Shield of California and Health Net. After reviewing the...

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

60% of Californians Who File an IMR with the DMHC Get Health Care Denials Reversed

The Consumer Help Center at the Department of Managed Health Care (DMHC) has assisted more than 1.7 million Californians resolve complaints and issues with their CA health care plans. Their services are fast, free and confidential. Deputy Director, Mary Watanabe, says that the DMHC is the “best kept secret in California.”

If your California health...

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

The Department of Managed Health Care (DMHC) was established in 2000 through consumer sponsored legislation. It regulates the health care and medical insurance for 25 million Californians including the majority of those on Obamacare California plans insured through Covered California.

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

Deputy Director of the Department of Managed Health Care Offers Help to California Consumers and Agents

Dave Fear, the Vice President of the California Association of Health Underwriters, introduced Mary Watanabe. He couldn’t speak highly enough about her and the California Department of Managed Health Care (DMHC). The DMHC supports agents and consumers with issues related to health insurance in California

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

Bernie Sanders has been the dark horse of the political primaries this year. He came out of nowhere spouting ideas that for many seemed very radical. He is the first significant presidential candidate that actually claims to be a socialist. However, his ideas like free college and no cost health care for all have had a huge appeal amongst young people in the nation and in California.

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Posted: July 21st, 2016 under Covered California Insurance

by John Hansen

Bernie Sanders’ “No Cost Health Care for All” Appeals to Independent and Decline to State Voters

According to political analyst, Gary Dietrich, 20% of Californian’s have chosen a political affiliation as “Independent” or “Decline to State”. Many of these are young people in their 20’s and 30’s. “Instead of choosing a party, the new voters are looking at personalities [and] personal priorities. Party loyalty is going away,” according to Dietrich.

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Posted: July 21st, 2016 under Apply with Covered California

by John Hansen

Political Analyst Comments That It’s Very Difficult to Say Where Hilary and Trump Stand on ACA/Obamacare

At the CAHU Capital Summit, before a crowd of California insurance agents, I asked the following question of political analyst Gary Dietrich: “Can you summarize Hilary Clinton and Donald Trump’s views on the Affordable Care Act (ACA)? And, then tell us how things may be affected based on who is elected president.”

Hil...

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Posted: July 20th, 2016 under Covered California Insurance

by John Hansen

At CAHU Summit 2016 Political Analyst Argues for CA Agents to Commit to the Common Good

Gary Dietrich spoke to a room full of California insurance brokers on Wednesday, May 18, at the Capitol Summit for the California Association of Underwriters (CAHU). Though California agents tend to be Republicans, he argued against partisanship and said that people are looking to hear both sides. He mentioned talks he has hosted regarding various ballot measures. He had both sides of the ...

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Posted: July 20th, 2016 under Apply with Covered California

by John Hansen

Gary Dietrich, the President and cofounder of Citizen Voice, spoke to a group of California insurance agents on Wednesday, May 18 at the CAHU Capitol Summit. Dietrich is a bipartisan political analyst, and this came through loud and clear in his talk to California health care brokers.

He is a graduate from the University of Santa Barbara and he has a Masters from Harvard. Dietrich has served as staff to state assembly and senate politicians.

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Posted: July 20th, 2016 under Apply with Covered California

by John Hansen

With his CAHU Presidency coming to an end, Michael Lujan spoke out Wednesday to a group of health insurance agents in California that he has served. Lujan thanked the agents for their support.

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Posted: July 20th, 2016 under Covered California Insurance

by Wendy Barnett

On Tuesday July 19, 2016, Covered California announced that its subscribers will experience an average rate increase of 13.2% for 2017.  This is quite a jump from the last 2 years, when Covered CA members only received an average rate increase of around 4%.

Peter Lee, Executive director of Covered CA, emphasized that when you average the Covered California rate increase over th...

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Posted: July 20th, 2016 under Covered California Insurance

by John Hansen

Complications Related to Fluctuating Qualifications, Nightmare for Low Income California Families

California insurance agents, consumers and political leaders argue that something needs to be done to relieve the frustrations of low income individuals who have family health plans that fluctuate between qualifying for Medi-Cal and Covered California.

Through 1332 innovation waivers, California (along with every state) can make improve...

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Posted: July 12th, 2016 under Apply with Covered California

by John Hansen

The Challenge of Getting Affordable California Health Insurance

When Employee-Only Coverage = “Affordable”, High Dependent Costs Often Make Insurance Un-Affordable

How can I get affordable California health insurance for my dependents? Due to Obamacare’s definition of “affordable”, often it’s difficult for employed families in California to achieve true affordability in health care.

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Posted: July 12th, 2016 under Covered California Insurance


by John Hansen

Learn About HSA Insurance and the HSA Battle that Happens Every Year at the State Capitol in Sacramento

All the California health plans offer HSA insurance coverage. However, California is one of three states that do not allow HSA contributions to be deducted at a state level. A bill is brought up every year to remedy this, usually by Assembly woman Beth Gai...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

Elizabeth Abbott, from the Office of the Patient Advocate (OPA), spoke to the CA health insurance agents on Tuesday, May 17 at the CAHU Capitol Summit. She has a history of advocating for California health care consumers.

Abbott has directed the OPA for a little over a year. Before that, she was appointed as one of the 16 national consumer representatives to advise the National Association of Insurance Commissioners (NAIC) counseling them on the implementation of the Affordable Care Act (AC...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

The Complaint Department at the Office of the Patient Advocate Gives Consumers an Outlet to Address Quality

The Office of the Patient Advocate (OPA) is a research organization that serves the 16.7 million consumers of health care in California. They research California health plans along with 207 network providers. They also receive and report on complaints ...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

Since the implementation of the Affordable Care Act (ACA), agent commissions for health insurance have been drastically lowered by California health plans. This has threatened the livelihood of California medical insurance agents. It has also made them question how they can survive in this career in the new world of Health Care Reform.

With the institution of Obamacare in California, the amount of work that ...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

At the California Association of Health Underwriters (CAHU) Capitol Summit 2016, speakers considered the issue of whether or not health insurance agents can charge fees. President Michael Lujan argued, “There may be legal remedies to charge feels while we wait for commissions to come back to normal.”

Can agents charge fees to make up for falling commissions?

In the face of dropping commissions since the implementation of the Affordable C...

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Posted: July 12th, 2016 under Apply with Covered California

by John Hansen

Don Cooper, TriFlex President, Addresses Agent Fees for Selling Health Insurance Coverage

Don Cooper, an energetic lively insurance agent, began a panel discussion around agent compensation at the CAHU Capitol Summit while sitting next to Jon Tomashoff (from the DOI) and Steve Young (top California health care lawyer). He said, “On this stage, we have over 100 years of experience in the industry. I’ve been [selling health insurance] for 41 years.”

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Posted: July 12th, 2016 under Covered California Insurance


by John Hansen

Steve Young Addresses Health “Agent” vs. “Broker” Agreements and Speaks to the Issue of Charging Fees

Steve Young, at the CAHU Capitol Summit 2016 addressed the issue of whether or not health agents can charge fees. He began with a discussion regarding the legal differences between the designations “broker” and “agent” relationship.

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Posted: July 12th, 2016 under Apply with Covered California

by John Hansen

Don Cooper Argues that Often IFP Agents Go Above and Beyond Typical Agent Services

Don Cooper, at the CAHU Capitol Summit 2016, argued that California health plans need to make health agent commissions more reasonable. Also, he argued that brokers may be able to legally charge agent fees.

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

At the CAHU Capitol Summit 2016, Don Cooper, President of Triflex, argued, “The best way to pay agents is PMPM.” PMPM payments refer to commissions paid to health insurance agents “Per Member Per Month”.

In the Per Member Per Month (PMPM) payment model for broker compensation, an agent is paid a certain dollar amount for each enrolled member per month. A California health pla...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

Jon Tomashoff, Senior Staff Counsel for the California Department of Insurance, spoke to the issue of California agents charging fees for the sale of health care products. He spoke in a panel discussion at the CAHU Capitol Summit 2016 alongside a lawyer and an insurance agent (Don Cooper, President of Triflex). The lawyer, Steve Young, held up a copy of the California Insurance Code and said (while referring to Tomashoff), “He wrote the book.”

Can an agent fee be applied to the sale ...

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Posted: July 12th, 2016 under Covered California Insurance

by John Hansen

CAHU research suggests that based on the amount of expertise required and the amount of work to service consumers, California insurance agents should get paid 8-10% of insurance premiums for health care enrollments they place. 

The Work of the Insurance Agent

Health insurance brokers acquire clients who want to apply for coverage, enroll customers in health care products, explain benefits and networks, and offer service. According to CAHU, 72% of the ...

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Posted: July 12th, 2016 under Apply with Covered California

by John Hansen

The Honorable Dave Jones Argues “We couldn’t do this without agents!”

The California State Insurance Commissioner, Dave Jones, came out strongly in favor of California health agents in a talk to the California Association of Health Underwriters on Tuesday, May 17th. He argued that since the implementation of the Affordable Care Act, agents and brokers have enrolled “the lion’s share” of newly insured Californians in the...

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Posted: June 20th, 2016 under Apply with Covered California

by John Hansen

During Open Enrollment 2015, the Obamacare California Health Plan market grew by 500,000 new members. However, during Open Enrollment 2016, Covered California enrolled only 200,000 new members. Along with these new members, there were 300,000 switchers, people who changed plans during the Covered California Open Enrollment P...

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Posted: May 24th, 2016 under Apply with Covered California

by John Hansen

Californians are becoming more and more tech savvy, and as a result they don’t want to mess with billing. Many young people have never written a check, and they don’t intend to. They get bills and they immediately set them up on autopay. However, if not set up correctly autopay can cause problems.

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Posted: May 24th, 2016 under Covered California Insurance

by John Hansen

Carriers Are Concerned About High Risk Applicants Received During Special Enrollment Period

California health insurance carriers are concerned about acquiring higher risk members who enroll after Open Enrollment is over. Outside of Open Enrollment, some consumers may apply during the Special Enrollment Period (SEP). However, these applicants are require...

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Posted: May 24th, 2016 under Apply with Covered California

by John Hansen

Covered California, along with being the exchange for Obamacare California, now has 1.6 million individual and family enrollees in the state. That gives California’s state exchange additional clout to advance their agenda, which is affordable, quality care for all in the state of California.

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Posted: May 23rd, 2016 under Covered California Insurance

by John Hansen

Leading experts in the California health insurance market including Jeff Smith, Vice President of Individual and Family Plans for Blue Shield of California, are predicting 2017 rate increases to be in the double digits. Rate increases will affect Obamacare California coverage through the Covered California Exchange as well as medical plans purchased direct through health insurance c...

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Posted: May 23rd, 2016 under Covered California Insurance

by John Hansen

Californians enrolled in PPO’s are concerned, but do they really have anything to fear?

For many die-hard PPO lovers, this sounds like the sky is falling. Oh, no you’re not! I chose a PPO because I didn’t want someone else to pick my Primary Care Physician (PCP).

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Posted: May 23rd, 2016 under Covered California Insurance

by Stephen Saucier

If you’re shopping for Health Insurance in California you’ve probably got some questions. Or perhaps you have insurance but are having trouble understanding your plan. It can be hard to know where to turn. Regardless of your situation there may be free online resources available to you that can help.

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Posted: October 30th, 2015 under Individual Health Insurance

by Stephen Saucier

Even though open enrollment for 2016 coverage is just about to start, the team at Covered California is already working hard to ensure that customers will have even better plan designs for the 2017 Covered California open enrollment period. A key part of their approach to improve the 2017 open enrollment period is to gather as much information as they can...

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Posted: October 29th, 2015 under Apply with Covered California

by Wendy Barnett

As we enter into fall, we start gearing up for cooler weather and the end of the year… Holidays. This can mean stocking up that wood pile in preparation for a warm fire on a cool evening, shopping for a couple of new sweaters to add to a fall wardrobe, or maybe even experiencing a craving for pumpkin spice lattes or pumpkin pie.  But this year, if you are one of the hundreds of thousands who are now receiving a tax credit through Covered California, it will be important to u...

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Posted: October 16th, 2015 under Apply with Covered California

by John Hansen & Stephen Saucier

Final Deadline to Enroll: January 31st

Every year there is a window of time during which anyone can apply for individual and family health insurance and enroll in the Obamacare health plan of their choice. This period is called Open Enrollment. For 2016 effective dates, Open Enrollment began on November 1, 2015 and will end on January 31, 2016.

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Posted: September 28th, 2015 under Apply with Covered California

by Esmeralda Mercado

Shop for a New Plan or Keep Your Current Coverage

Shortly, consumers will receive renewal notices from Covered California advising them that their health plan will be renewing on January 1, 2016 and they have a window of time to make changes that they wouldn’t otherwise be able to make until next year. Members have from October 12, 2015 to December 15, 2015 to make changes to their Covered California health plan

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Posted: September 24th, 2015 under Apply with Covered California

by Stephen Saucier

August 31st!

Over the last six weeks, CoveredCA.com has been reaching out to some of its customers to verify citizenship or lawful presence. If you purchased Covered California health insurance through the California State Exchange in the last 10 months or so and are not a U.S. citizen or national, you would have had to state on your application that you have satisfactory immigration status. If that...

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Posted: August 27th, 2015 under Apply with Covered California

by Wendy Barnett

So you enrolled in a Covered California health plan. You applied for a plan with a significant premium tax credit, you paid your first premium and received your medical cards, and you think you’re all set.  Not so fast!  You will also need to keep track of your household income in case it changes during the year.  When you enroll on

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Posted: September 22nd, 2014 under Apply with Covered California

by Wendy Barnett

A number of people have reported enrolling into Covered California, but never received a bill from their insurance carrier and are still waiting to pay. Let’s look at what happened to Jose Ortiz in Salinas California, who chose a Silver 94 Health Net PPO plan.

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Posted: September 19th, 2014 under Apply with Covered California

by Esmeralda Mercado

Within the last few weeks Covered California sent out letters and emails advising many members that they need to provide proof of lawful presence, or else… So what happens if Covered California does not receive the documents they requested? What are these documents and is everyone required to provide them?

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Posted: September 17th, 2014 under Individual Health Insurance

by Wendy Barnett

Due to the Affordable Care Act, the way people obtain their health insurance is different now.  They must apply and enroll during an ...

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Posted: September 8th, 2014 under Apply with Covered California

by Wendy Barnett

You may have heard on the news or talked to a family member or friend who is receiving assistance in paying their health insurance premiums. This may have gotten you thinking, “Hey, I could use some help paying for my health insurance!” All of us could use help with this growing annual expe...

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Posted: August 27th, 2014 under Apply with Covered California

If you missed the open enrollment for the Affordable Care Act (ACA), you’re not alone. Millions of Americans miss the open enrollment period every year. The good news is, there’s no need to panic. You may be eligible for special enrollment if you experience, or have recently experienced, a qualifying life event.

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Posted: August 22nd, 2014 under Apply with Covered California

by Holly Davies

As a small business owner in the golden state of California, you may be wondering if you can offer affordable small group health insurance to your employees. The SHOP helps you offer a variety of plans while keeping group administration simple and keeping the cost as low as possible.

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Posted: July 30th, 2014 under Small Business Health Insurance

By Esmeralda Mercado & Stephen Saucier

 

Obamacare 2014 is coming. But what if you need coverage for yourself and/or your family through the end of this year? If you enroll in a health insurance plan now, how will the transition to Obamacare affect you? The last thing you want is to shell out more money than you need to, fail to comply with the new laws, or even experience a lapse in coverage. It may seem like a scary process but the good news is that the information you need is available to you and you certainly have options.

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Posted: October 29th, 2013 under Apply with Covered California