Covered California Health Insurance
If you have lost your job or benefits, work for yourself or your employer doesn’t offer benefits, you can still get health insurance. There are a lot of California healthcare options and you can sign up for a healthcare plan directly with Covered California.
Covered California is the government marketplace where you can buy individual and family health insurance. Covered California provides standardized healthcare plans from well-known health insurers, and you might be eligible for financial aid to help you pay for the plan or for the state’s Medi-Cal program.
If you need healthcare in California, and you aren’t able to get it through an employer, the Covered California health plans are affordable and offer great coverage.
What Is Covered California?
Covered California was created under the Affordable Care Act (also known as Obamacare). It provides health care plans for all Californians, no matter if you have a pre-existing condition. If you have a low income, you can get financial aid to get care at a more affordable price, or for free.
You can shop for your plan at the Covered California website: CoveredCA.com. The site is sponsored by Covered California and the Department of Health Care Services. It is fairly easy if your needs are simple (you put in your information, shop and check out). But if you have a significant amount of specific financial needs, family health needs or become approved for Medi-Cal, it is known to get confusing. Often you will start at the site, then follow up with more details, and for Medi-Cal, you will need to follow instructions in the mail to go through a local county office, where you are given different plan options. You can learn more about Covered California plan options here and more about Medi-Cal options here.
Free Resource: Certified Enrollment Counselors
You can always call or chat with one of Covered California’s representatives on CoveredCA.com. But if you have very specific healthcare or health insurance needs, United Way has a free resource of Certified Enrollment Counselors who are there to help you with more complex questions. You can reach out to a Counselor directly here.
Latest Covered California News
Covered California normally has a fair amount of restrictions like enrollment deadlines, but thankfully there are a number of adjustments to accommodate COVID-19 needs.
- Special Enrollment Period: Covered California is currently in a special-enrollment period so that you can sign up for coverage through August 31, 2020. Typically enrollment is only available December – January, unless you have a qualifying life event.
- If you are a senior or otherwise vulnerable, The Department of Health Care Services (DHCS) may expedite your health care enrollment.
- All Covered California and Medi-Cal plans now provide telehealth, so that you can have a phone or video visit instead of going to the doctor’s office or hospital.
- COVID-19 screening and testing (if considered “medically necessary”) is free on any Covered California plan. This could be via telehealth, an in-person doctor visit, or at an emergency room or urgent care center. If you need treatment or hospitalization for COVID-19, your health plan will assist in covering those costs.
- Most Covered California plans offer “first-dollar” coverage right now to help make things more affordable. This means that you won’t have to meet your deductible in order to access outpatient services.
- If you have lost income from COVID-19, you can report the change to Covered California and potentially get financial assistance, or more assistance, on your plan.
- There are new state subsidies to help more people get financial assistance on their plans — meaning if you didn’t meet requirements for assistance in the past, it might now be available to you.
- If you have Medi-Cal and need to renew or discontinue your plan, there is a temporary halt on the California review process — making it possible for you to take action now.
How to Enroll
If you want extensive help in selecting a plan or navigating the health insurance process, reach out to United Way’s free Certified Enrollment Counselors. Reach a Certified Enrollment Counselor here. You can also connect with a Covered California representative via phone or chat on CoveredCA.com.
Steps for enrolling
- Shop. First look at your plan options with the Shop and Compare tool. It will ask for some basic info like your income and household size so that it can help you look at the best plans. Then when you’re ready, you can hit the apply button.
- Fill out an application. You can do this through the site or you can call or receive a call from Covered California.You’ll need: Income information, ID, proof of citizenship or lawful presence, Social Security number and ZIP code.
- Optional: Add dental insurance. If you want to get dental coverage for the adults in your family, you can sign up at the same time (or go back to the marketplace later). Vision plans are different. Your kids are already covered on your general health plan, so this is just if you want dental coverage for adults.
- Make your first payment. If you got a Covered California plan, you will start your cycle by paying the first bill directly to the company. You can do this online right away or after you receive your first bill.If you qualify for Medi-Cal, you will get a letter from your county Medi-Cal office with all the information.
- Begin using your insurance. If you have a Covered California plan you’ll work directly with the insurance provider for your care, and you only need to use the Covered California service if you need to make a change.Smart next steps include picking a primary care provider and setting up free preventative care visits.
August 31, 2020
This is an extended deadline for 2020 enrollment so that people can get insurance during the COVID-19 pandemic.
November – January
This is the yearly Open Enrollment Period where you can sign up for your plan. It’s best to sign up by December 15th so that your coverage can start on January 1st and you can get the most out of your plan.
Special Enrollment: Qualifying Life Event and Exceptions
If you experience a qualifying life event like losing income, moving or getting married, or if you are a federally recognized American-Indian or Native Alaskan, you can sign up any at time of the year.
There are no deadlines for signing up for Medi-Cal.
Benefits of Covered California
Essential health benefits
All Covered California health insurance plans provide a standard package of services that cover essential health benefits.
These benefits fall within 10 categories:
- Outpatient services
- Emergency services
- 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
- Children’s dental care
- Children’s vision care
Preventative care is any service that helps detect or prevent health problems. This level of care is free on most Covered California plans, and you don’t need to meet your deductible before your preventative care visit.
These services include:
- Blood pressure screening
- Certain immunizations
- Cholesterol screening for adults of certain ages or at higher risk
- Colorectal cancer screening for adults over 50
- Diabetes (Type 2) screening for adults with high blood pressure
Additional services for women:
- Breast cancer mammography screenings every 1- 2 years for women over 40
- Cervical cancer screening for sexually active women
- Contraception and contraceptive devices
- Osteoporosis screening for women over age 60, depending on risk factors
- Well-woman visits for women under 65, including preconception care, prenatal care and breastfeeding support and equipment
Additional services for children:
- Behavioral assessments for certain ages, until age 17
- Certain immunizations
- Hearing screening for all newborns
- Height, weight and body mass index (BMI) measurements through age 1
- Oral health risk assessments for children of certain ages, until age 10
- Vision screening for all children
Preventative care exceptions:
- Not all plans cover the entire list of services above. You can find more details using the Shop and Compare Tool.
- The doctor needs to be “in-network” with your health insurance plan. Call ahead to confirm with their office.
- If you already have symptoms or are concerned about a problem, it’s not considered preventative care — it falls within diagnostic care.
- Some doctor’s offices will bill you for the doctor’s visit, even if the service is preventative. Or if the doctor finds an issue and treats it, they may bill you for the treatment.
- Be sure to check with your doctor and plan before using the service, especially for extensive services like colonoscopies.
Additional: Vision Benefits
If you want vision benefits for adults, you will need to sign up for a separate vision care plan. Covered California works with EyeMed and VSP, and you will need to sign up directly with the company. Here is some more information about eye insurance. Visit EyeMed here or VSP here.
Additional: Dental Benefits
Adult dental coverage also requires an additional plan, but unlike the vision plans, you can get dental insurance on the CoveredCA.com marketplace. You may like to purchase it at the same time as your health plan. Here is some more information about dental insurance. You can look at plans and prices here.
Coverage for adult children
Children under the age of 26 are eligible to be included in your family health care plan, even if they are married. After that they will need to sign up for their own coverage.
Am I Qualified for Financial Assistance?
Covered California uses the federal poverty level (FPL) to determine eligibility for financial assistance and Medi-Cal. You can view the federal poverty level chart to estimate your percentage. The Shop and Compare Tool will help you see the cost of plans in your area and whether you qualify for financial assistance or Medi-Cal.
What’s the Difference Between Covered California and Medi-Cal
Covered California’s health plans are private health insurance plans that follow a standard that is set by the government. You might be able to get financial assistance from the government to pay for the plan.
Medi-Cal is state-sponsored health coverage that eligible Californians can get for free or for a very low cost. The Medi-Cal plans are different plans than the plans available via CoveredCA.com. You can apply for Medi-Cal on CoveredCA.com, but everything else will be handled by your county office. Once you get approved for Medi-Cal, you’ll get a letter in the mail.
Both Medi-Cal and Covered California plans offer the full list of essential health benefits, but you might be able to get more extensive care with Covered California plans. Medi-Cal is cheaper.
You can learn more about Medi-Cal here.