1-877-752-4737

Should I Enroll On/Off the California Health Insurance Exchange?

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 off of the Insurance Exchange.

If you make too much money, usually you want to enroll off of the California health insurance exchange. When you enroll in health insurance in California through an agent or directly through a carrier, there are three main benefits:

  • Easier application
  • No financial/tax questions
  • Less hassles
  • Cost is the same on like plans
  • Additional plan options

As an agent, I enrolled a family with a household income of over $250,000 per year through the Covered California marketplace. My client had extra red tape and hassles to deal with because I enrolled him through the California Health Insurance Exchange. In hindsight, I would have enrolled him directly through the carrier, and that would have saved him some frustrations.

Other Considerations: Native Americans, Medi-Cal and the Special Enrollment Period

Are you a Native American or are you Medi-Cal eligible? If either of these apply to you, you may enroll through the Covered California health insurance exchange for lower prices and better benefits. Also, you may enroll any time of the year, and you will not have to wait for the Open Enrollment Period.

During the Special Enrollment Period, there has been an advantage to enrolling on the state benefit exchange because Covered California has not required document proofs for life events. However, that changed this month, so whether you apply through the California health insurance exchange or outside the exchange, you will still have to submit documentation to prove that you have a legitimate life event.