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Covered California FAQ - Frequently Asked Questions

Frequently Asked Questions

Find FAQs below about Healthcare Reform and the Affordable Care Act. View questions and answers related to California Health Insurance, Covered California, The SHOP and Obamacare.

General Questions

Can I get health insurance now?
You can still get medical protection now for health plans that are available today. Note that you may need to switch to a Healthcare Reform qualified health plan effective January 1, 2014.
When can I get quotes and apply for a Healthcare Reform Plan?
October 1, 2013 is the soonest you can get Covered California quotes and apply for a January 1, 2014 effective date.
I might be on a grandfathered plan. What should I do?
Being on a grandfathered health plan puts you in the best position for Healthcare Reform because the rates for grandfathered plans are not expected to be as high as for the new 2014 medical plans. If you’re on a grandfathered plan, consider staying on it. If you are interested in comparing rates and benefits, you can get quotes for the 2014 Healthcare Reform plans starting October 1, 2013.Your plan is probably in a grandfathered status if you have been on the same medical plan since March 23, 2010 or prior and there have been no significant changes to the plan. Contact your insurance company or health insurance agent to verify and to compare rates.

Small Business

Am I required to offer health insurance to my employees?
You are not required to offer health insurance to your employees if you employ under 50 full-time equivalent employees. This would consist of employees who work a minimum of 30 hours a week. It would also include part-time employees who collectively work a minimum of 130 hours a month. For example: 10 part time employees who work 20 hours a week would translate to 6.6 full-time equivalent workers.
Is there government funding for small business health insurance?
Small groups of 24 or fewer employees may qualify for a small business tax credit for up to two years. The tax credit is 35% in 2013 and 50% in 2014. (The credit is lower for non-profit.) 
Does my small business qualify for a tax credit?

To qualify for a small business tax credit, the following must be true for the small group

  • The annual average wage must be less than $50,000.
  • At least 50% of the employee-only premium must be paid by the employer.
  • Group insurance must be purchased through the California Exchange Marketplace.

Click Small Business Health Care Tax Credit for details.

What if we already have group health insurance?
If you already have group health insurance, consider keeping the group plan. Then, on October 1, 2013, get quotes for the new individual and family Healthcare Reform plans to compare costs. Generally, group health insurance rates are anticipated to be less expensive than the 2014 individual and family rates for the Healthcare Reform plans. An exception may be for people who qualify for subsidies and reduced cost sharing.

If you are on a group health plan that is on grandfathered status, be sure to get well-informed on your options before switching plans. A grandfathered health plan is a medical policy that was in effect on March 23, 2010 or prior, which did not undergo major policy or contribution changes. Price increases on grandfathered plans are not expected to be as substantial as for the 2014 medical plans. Consult your insurance representative to verify if your health plan is in grandfathered status.

Individuals and Families

Do I have to get health insurance?
Starting January 1, 2013, most American citizens and legal residents must get qualified health insurance.
Do I qualify for a subsidy?
Generally, people will qualify for a government subsidy if their gross family income is no more than 400% of the Federal Poverty Level (“FPL”). In October 1, 2013, you’ll be able to contact certified enrollment counselors who can verify eligibility.
How do I calculate my subsidy?
October 1, 2013, certified enrollment counselors will be able to help you determine if you are eligible for a subsidy and the actual amount of the tax credit. In the meanwhile, click Calculate Potential Insurance Cost to get an idea of your estimated savings.
What if I’m not currently insured?
It is always a good idea to have medical protection. Click Get Quotes and apply today. If you applied but were denied due to medical reasons, or you were unable to enroll because the premium was unaffordable, there is hope! In 2014, you can’t be denied for pre-existing conditions and you may qualify for reduced rates and cost sharing if you meet Covered California income requirements. Revisit this website on October 1, 2013 to get quotes and enroll for the Healthcare Reform plans that will be effective January 1, 2014.