How to Get Marketplace Health Insurance in California
In Spanish | Most Californians can purchase health insurance through California coveredthe states Affordable Care Act (ACA) Marketwhen open registration begins on November 1.
If you experience a qualifying life event – such as the birth of a child, moving house, marriage, divorce, or loss of your employer-provided health insurance – you may be able to purchase or change your coverage outside of registration open. And you may be able to save money on premiums with expanded federal tax credits available through 2022.
Most people already enrolled in ACA market plans have seen their premiums drop because the US bailout increased tax credits for insurance premiums and increased the number of households that qualify. Every household that pays more than 8.5% of their household income is now eligible for federal tax credits to help pay for health insurance. Before the new law, these tax credits were only available to people up to 400% of the federal poverty level (about $51,000 for one person).
The average American with a market plan can save $50 a month with the new assistance, according to the federal government. As of now, this additional federal financial assistance will only be available until the end of 2022.
Who is eligible?
- Most Californians, including non-US citizens on work or student visas, can purchase health insurance through California coveredwhether or not they are currently insured.
- You can also benefit from Medical, the state Medicaid plan, which provides free or low-cost coverage to low-income individuals and families and those who live in skilled nursing facilities or have certain disabilities. Undocumented non-US citizens may qualify for Medi-Cal coverage if they are pregnant or 18 years of age or younger.
When can I register?
- Covered open registration in California begins November 1.
- You can register outside of open registration if you encounter a qualifying life event, but you usually only have 60 days from that event to register. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
How do I register?
You apply for coverage and choose your plan at the same time. Once your plan is approved, you will need to pay your first monthly premium for your coverage to begin. You can pay online or request an invoice by post, which should arrive in about two weeks. To apply and register:
- By telephone: Submit your name and contact information online and a certified insurance underwriter 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.
You can also call the Covered California Service Center (800-300-1506) or visit a local registration center to help you explore plans, ask questions, and help determine if you qualify for financial assistance.
What is covered and how much will it cost?
Coverage and cost depends on where you live, the type of plan you choose, your estimated household income, your age and disability status and that of your family.
If you are eligible for Medicalyou may be able to get free or low-cost coverage and you may not have to worry about premiums or co-payments, depending on your income level.
All covered plans in California cover 10 “essential” benefitsincluding:
- Emergencies and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counselling)
- Chronic Disease Management and Pediatric Care
- Prescription drugs
Insurance companies cannot deny coverage due to pre-existing conditions. When you apply, you can identify your medical needs and choose a plan that’s financially right for you and your family.
All covered plans in California cover basic dental services for children, including cleanings and examinations. But adults who want dental coverage must add it to their policy. Deductibles and disbursements vary from plan to plan; enrolling in a family plan can reduce costs.
What about federal premium assistance?
Every eligible household that pays insurance premiums greater than 8.5% of its annual income is eligible for federal insurance premium tax credits through 2022.
For example, a 64-year-old single taxfiler earning $51,000 a year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Are there other financial aids?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help pay for personal expenses such as deductibles and co-payments. You must sign up for a Silver level plan to get this support.
What packages are available?
Covered California plans are organized into four categories:
- Bronze plans have the lowest monthly premiums and the highest deductibles and copayments, and cover around 60% of care costs. They are designed to help you in the event of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles, and copayments. They cover between 70% and 94% of child care costs, depending on whether you qualify for a basic plan or a Improved Silver Plan for low-income households. These are the only plans eligible for cost-share grants. If you’ve collected unemployment benefits this year, even for a single week, you may qualify for an upgraded Silver plan, with premiums as low as $1 per person. This additional financial assistance will expire at the end of 2021.
- Gold plans have higher monthly premiums and lower deductibles and copays, and cover around 80% of care costs.
- Platinum plans have the highest monthly premiums and the lowest deductibles and copayments, and cover around 90% of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
California covered Shopping and comparison tool helps you estimate the costs and benefits of various plans and see if you might be eligible for financial assistance. Californians 29 and under can also apply for a minimum coverage or catastrophic plan offering low premiums and covering three doctor visits or emergency care visits per year.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurer, but qualify for lower premiums, you can upgrade to covered California. But you might not be eligible for tax credits if you opt out of your employer’s plan, unless those premiums exceed a certain portion of your household income. Premiums should be more than 9.83% of your household income for single coverage or more than 8.27% for family coverage to qualify for tax credits.
If you lose your coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to enroll in a Covered California plan during a special 60-day enrollment window. Try to apply and select your plan before your COBRA coverage ends to ensure there is no gap in coverage. If you are unsure whether this change is right for you, you can seek free advice from a certified recruiter or insurance agent.
If you already have a market plan and want to adjust your coverage, you will have to wait for the renewal period opens this fall. If you do not take action during the renewal period, you will automatically be re-enrolled to your existing plan.
Will I need a new doctor?
It depends. Major insurers, including Anthem Blue Cross and Kaiser Permanente, offer covered California plans, but not all doctors accept them. You can talk to your GP or use the Shopping and comparison tool to see if a certain doctor or practice will accept a market plan.
Will my family members be eligible for the same health plan as me?
It depends. You can register as a family. But in some cases, some family members may also be eligible for grants or other programs, depending on age, income and disability, or caregiver status. These families can choose to enroll as “mixed program families” and still be able to see the same doctor or go to the same doctor’s office, depending on the types of insurance plans accepted.
This guide was updated on February 18 with more information on open registration.