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Covered California

Covered California is the health insurance marketplace in California. As an eligible resident, you may qualify for premium subsidies and tax credits. If you’d like to enroll or switch insurance plans, open enrollment period is your only chance all year.

The upcoming open enrollment period is October 15, 2018 to January 15, 2019. Please feel free to contact us for more details. Certified Covered California agents are ready to answer your questions!

Do I qualify for special enrollment?

You qualify for a special enrollment period 60 days following certain life events including:

  • Legal separation or divorce
  • Marriage or domestic partnership
  • Cessation of dependent status (attaining the maximum age to be eligible as a dependent child)
  • Birth, adoption, or placement for adoption
  • Loss of coverage due to termination of employment or reduction in the number of hours of employment
  • Relocating to California
  • Returning from military active duty
  • Release from incarceration
What’s the difference between purchasing insurance through Covered California and purchasing off-exchange insurance?

Whether you buy health insurance through Covered California or through a private insurance market, it fulfills the ACA’s health insurance requirement. If you are within 138% and 400% of the federal poverty line, you might qualify for federal subsidies and can therefore apply through Covered California. If you do not want to provide tax return information or proof of income, you can choose to purchase off-exchange health insurance.

Below is a comparison between Covered California and off-exchange insurance:

Covered California Off-Exchange
10 Essential Health Benefits  ✔︎  ✔︎
Meets health insurance requirement  ✔︎  ✔︎
Open Enrollment Period  ✔︎  ✔︎
Must provide tax return and proof of income  ✔︎
Apply for federal subsidies  ✔︎
What’s the penalty if I don’t have health insurance?

For 2017, the penalty is $695 per adult plus $347.50 per child, or 2.5% of your household income, whichever is higher. The fee will continue to increase each year until you purchase coverage.

Should I choose HMO, PPO or EPO plan?

Here are the main differences among the three plans:

HMO EPO PPO
Must choose a primary care physician Y N N
Referrals are required to see specialists Y N N
Benefits outside medical network N N Y

When choosing a health plan, take into consideration you and your family’s needs. If you have a primary care physician you want to see, make sure your primary care physician is in that network.

When can I buy health insurance?

Unless you qualify for special enrollment, you can only purchase health insurance during the Open Enrollment Period, which occurs only once a year.

The 2019 Open Enrollment period starts on October 15, 2018 and ends on January 15, 2019. If you would like your insurance policy to become effective on January 1, 2019, then you must apply by December 15, 2018. If you apply by December 15, 2018, then your new policy will become effective on February 1, 2019.

Is it required to buy health insurance?

Yes, effective January 1, 2014, the U.S. health care law has mandated that people under 65 years of age are required to purchase health insurance or they would have to pay a penalty. If you live in California and you are not insured in health insurance provided by the government or insured under group health insurance provided by your employer, you may purchase health insurance through Covered California or purchase off-exchange health insurance.

Do I qualify for federal subsidies?

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:

What are the different plans and the different types of coverage I can choose from? (Bronze, Silver, Gold, etc.)

Plans through Covered California are divided into tiers—bronze, silver, gold, platinum, and more. The higher the tier, the more expensive the premium. Everyone’s medical needs and income levels are different so you can choose the plan that best meets you and your family’s medical needs!

Below is the 2019 benefits plan for your reference.

What are the ten essential health benefits?
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription Drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including dental and vision care
When can I apply for health insurance?

The 2019 Open Enrollment Period starts on October 15, 2018. Please feel free to contact us at KCAL we’d be more than happy to help you enroll or switch insurance plans for 2019!