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Basic Insurance Plan Benefits 

$75*Primary Care Visit | $105*Specialist Visit | $40 Blood Test
Outpatient surgery and inpatient hospitalization, full cost until deductible is met
Individual Annual Out-of-Pocket Maximum $7,000

(*First three visits each year are not subject to deductible)

$35 Primary Care Visit | $75 Specialist Visit | $35 Blood Test
After deductible is met, inpatient hospitalization is 20% of total cost;
Outpatient surgery, 20% of total cost

Individual Annual Out-of-Pocket Maximum $7,000

$25 Primary Care Visit | $55 Specialist Visit | $35 Blood Test
Outpatient surgery and inpatient hospitalization 20% of total cost
Individual Annual Out-of-Pocket Maximum $6,000

$15 Primary Care Visit | $30 Specialist Visit | $15 Blood Test
Outpatient surgery and inpatient hospitalization, 10% of total cost

Individual Annual Out-of-Pocket Maximum $3,350

Low Income Individual and Family Insurance Plan Benefits

$5 Primary Care Visit | $8 Specialist Visit | $8 Blood Test
After deductible is met, outpatient surgery and inpatient hospitalization is 10% of total cost;
Individual Annual Out-of-Pocket Maximum $1,000

$10 Primary Care Visit | $25 Specialist Visit | $15 Blood Test
After deductible is met, outpatient surgery and inpatient hospitalization is 15% of total cost;
Individual Annual Out-of-Pocket Maximum $2,450

$30 Primary Care Visit | $75 Specialist Visit | $35 Blood Test
After deductible is met, outpatient surgery and inpatient hospitalization is 20% of total cost;
Individual Annual Out-of-Pocket Maximum $5,850

$35 Primary Care Visit | $75 Specialist Visit | $35 Blood Test
After deductible is met, outpatient surgery and inpatient hospitalization is 20% of total cost;
Individual Annual Out-of-Pocket Maximum $7,000

Do I qualify for federal subsidies? How can I calculate this?

Covered California and the IRS are connected in the sense where Covered California uses the household income and household size on the 1040 tax form to calculate health insurance premiums and check for eligible federal subsidies for the applicant.

Based on your annual household income, you may qualify for federal subsidies in the form of Medi-Cal, premium assistance, or cost-sharing reductions.

As long as you are a resident with a taxable income, you are required to have health insurance whether it’s through your employer, Covered California, etc. If you do not, you will be penalized and fined. To determine whether you qualify for premium assistance, please refer to the chart below:

federal poverty level

How can I save on premiums?

2018 Covered California rates increased 12.5% on average. The average increase in Southern California alone was 15.6%. Some insurance companies even rose more than 50%. If you qualify for subsidies, then you can purchase health insurance through Covered California.

If you are currently using a PPO plan, you might want to consider switching to HMO to save more on premiums. Downgrading your plan is another way to save. If you have a Platinum plan and find it too expensive, you can consider downgrading to the Gold or Silver plans.

When is the earliest possible date for my insurance to be effective?

The 2018 Open Enrollment Period starts on November 1, 2017 and ends on January 31, 2018.

If you would like your insurance policy to become effective on January 1, 2018, then you must apply by December 15, 2017. If you apply by January 31, 2018, then your new policy will become effective on March 1, 2018.

I heard that several major insurance companies are withdrawing from California. Does this affect me?

Anthem Blue Cross will be withdrawing from Southern California and several Blue Shield grandfathered plans (if you applied before March 23, 2010) will no longer be available. If you are currently insured under these two, you need to find a new insurance plan.

If you are receiving subsidies and insured under Covered California (on-exchange) and do not take action or make any changes, you will not be able to find the same low price at a plan with the same benefits. If you purchase insurance directly from the insurance company (off-exchange), your insurance will automatically terminate at the end of 2017 without a new plan.

With that being said, take advantage of this open enrollment period and switch plans as soon as possible!

I do not have a Social Security Number (SSN). How can I buy health insurance?
Because you do not have a SSN, you won’t be able to purchase general health insurance used by United States citizens. Basic travel insurance also won’t be able to cover pre-existing conditions such as diabetes, high blood pressure, pregancy, and more. However, we recommend taking a look at our “MYT” health insurance. (Click here for more information.)
Can I cancel Medi-Cal coverage and purchase health insurance on my own?
No, you must provide your proof of income to the county office where you reside to cancel your Medi-Cal coverage before you can apply for general health insurance.
I am not exactly sure what my income is for 2017 and I cannot provide proof of income. How can I get subsidies for my insurance?
If you have your paycheck statement, you can use it as proof of income. If you do not have any valid documents, you can ask your accountant or employer to provide you with a signed proof of income statement.