The California Health Exchange
What is Covered California?
Covered California is a state-run marketplace where individuals can buy affordable, high-quality health insurance and find financial assistance to cover the premiums. You can shop for and buy insurance from Covered California in person, by phone or online.
Through Covered California, individuals, families and small businesses can review health plans. Individuals can also learn whether they meet requirements for government subsidies that can lower the cost of their health insurance. Individuals can see if they are eligible for government-sponsored plans like Medi-Cal. Businesses with fewer than 25 employees can check if they qualify for business tax credits that can lower the cost of offering health care to their employees.
What does the California Health Exchange do?
Covered California helps Californians comply with the Affordable Care Act. It’s mainly for people who:
- Don’t have health insurance
- Aren’t offered insurance by their employer
- Aren’t included in their spouse’s employer’s insurance
- Don’t have Medicare
- Have pre-existing medical conditions that have made it hard for them to obtain health insurance elsewhere
- Own small businesses
- Have private insurance but are looking for a more comprehensive insurance plan
For Californians with a household income below 400% of the federal poverty level, Covered California may qualify them to get government subsidies that will reduce their monthly premiums. If income is between 138-percent and 250 percent of the federal poverty level, the marketplace may also qualify them for extra discounts to reduce the cost of their medical services.
These discounts are also called Cost Sharing Reductions. They lower your out-of-pocket costs when you get medical coverage. They’re available only when you buy a silver-level plan. To qualify for a subsidy and potentially for a cost-sharing reduction, you must fall within the specified income limits and not have insurance from your employer or Medicare.
You’ll be eligible if you’re single and have an income of between $11,880 and $47,520 a year, or if you have a family of four and your income is between $24,300 and $97,200 a year. The lower your total income, the more subsidies you’ll receive.
The Obamacare Mandate
The Obamacare Mandate requires that all U.S. citizens and permanent residents sign up for health insurance or pay a penalty if they go without coverage for more than two months. But you don’t need to buy insurance through Covered California if you’re covered by Medicare, Medicaid, TRICARE or employer-offered insurance.
What is a Qualified Health Insurance Plan?
For California residents to comply with the Obamacare mandate, they should be enrolled in a qualified health plan that meets the minimum essential requirements for coverage. The minimum essential requirements include ten benefits, which are:
- Outpatient services such as doctor visits
- Prescription drugs
- Emergency services
- Lab tests
- Drug abuse and mental health services
- Hospital admissions
- Maternity and baby care
- Rehabilitation services
- Preventative and wellness services
- Children’s dental services and eye care
A plan can still be classified as a qualified plan without the minimum essential requirements if it’s a grandfathered plan. A grandfathered plan is any plan that was active before March 23, 2010, when the Obamacare mandate was passed, and has not undergone any significant changes. You can apply for qualified health plans through Covered California, Medicare, Medi-Cal, group insurance, the military and off-plan directly from an insurance carrier.
How do I Enroll in the Covered California Marketplace?
The 2018 open enrollment period began on November 1, 2017, and continues till January 31, 2018, for residents in California. Enroll online at CoveredCa.com or call 800-300-1506 weekdays from 8 a.m. to 5 p.m. You can also get in-person assistance through a certified insurance broker.
To get started, you’ll need to give details about you and your family members. Here’s what you need to provide when you apply:
- W-2 forms
- Social security number
- Citizenship/immigration status
- Tobacco use
- Policy numbers of health plans covering any members of your family
If you don’t enroll during this span, you won’t be able to apply for Obamacare health coverage until the subsequent open enrollment period. There are exceptions when:
- You experience a qualifying event in your life, such as the birth of a child, moving to a new state, losing your job or a change in marital status. You don’t have to wait for the next open enrollment period. You can sign up or change coverage within 60 days of the event.
- You are an Alaska native or American Indian. The open enrollment period won’t apply to you. You may apply for or switch plans once a month, as you wish.
- You are eligible for Medi-Cal. You can sign up any time of the year.
After you fill in and submit your application, you’re not yet enrolled until you make the first premium, which must be submitted before the set date. Covered California will automatically confirm your identity, income and citizenship/immigration status. If the marketplace is unable to confirm your documents this way, one of the following may occur:
- Your application will be marked as “processing,” and you’ll be covered for the next three months as you look for supporting documents for the insurance to be processed.
- Your application may qualify for Medi-Cal instead of the plan you requested. Usually, this happens if your IRS income records from the previous year were lower than the income you listed on the application.
Types of Plans
All Covered California insurance plans are sold by private companies. They offer four types of coverage: platinum, gold, silver and bronze. These plans cover the same benefits. The only difference is how much they pay toward the costs of your healthcare coverage. Another health plan on the marketplace is called “catastrophic.” This plan has less-expensive premiums but offers less coverage. It’s mainly for people under the age of 30.
Finding the Right Health Insurance for You
It can be difficult to find the right individual, family and business health coverage even when you know your needs and budget. We’re here to help you find the best policy. Our online services at healthforcalifornia.com will provide you with free, instant quotes of California health insurance plans from top insurance carriers in the Golden State. Just take a few seconds to fill out our confidential form. No contact information is required, and you’re under no obligation to buy.