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Is Covered California the best option for me?

Covered California is a marketplace where you can purchase a health plan, with or without financial help. What you pay for insurance depends on your income. Some people don’t qualify for financial help, so for them, it might be more cost-effective to enroll in a plan directly through a health insurance company. Find out if Covered California is the best option for you. Shop & Compare Plans below.

Before you buy

Covered California Sets New
Enrollment Record as Thousands Get Lower Premiums From the American Rescue Plan, new updates for 2023.

 

INDIVIDIALS & FAMILIES

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Apply now and see if you qualify for free or low-cost health insurance through Covered California  and Medi-Cal on one application. Verify Program Eligibility by Federal Poverty Level for 2022. Open Enrollment Period ends Jan 31st, 2022, and let the door open for (SEP) Special Enrollment Period till next Open Enrollment, if they're not any changes. Medical all year round.

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Covered California is a marketplace where you can purchase a health plan, with or without financial help. What you pay for insurance depends on your income. Some people don’t qualify for financial help, so for them, it might be more cost-effective to enroll in a plan directly through a health insurance company. Find out if Covered California is the best option for you by using the Shop & Compare Tool Use Agent or Broker License for your enrollment.
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No. Covered California is where Californians can get brand-name health insurance under the Affordable Care Act and see if they qualify for financial subsidies to help them pay their monthly premiums. 

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The cost of health insurance varies. The best way to get a quick estimate of the price you would pay is to use the Shop and Compare Tool. The price is based on your estimated income for the coverage year, your ZIP code, your household size and your age.

If you are a low- or moderate-income Californian, you may get help buying insurance from Covered California through monthly subsidies that lower your premium costs so that you pay less for top-quality, brand-name insurance. The majority of our customers get financial help. Learn more about who qualifies for a subsidy.

 

Financial help comes in two forms: the Premium Tax Credit, and reductions in what you pay for your health care (known as cost-sharing reductions).

The Premium Tax Credit lowers the cost of your premium: the monthly bill you pay for your Covered California plan. You can choose to get the Premium Tax Credit each month, (before tax time) or you can claim it when you file your taxes.

If used before tax time , it will be applied to your premium each month and it will lower your monthly bill. This is known as Advanced Premium Tax Credit, or APTC. 

Or, you can pay the full price of your premium each month and then claim the Premium Tax Credit when you file your taxes, which may result in your getting a refund. In addition, if you received Advanced Premium Tax Credit to lower your monthly bill, if the government determines at tax time that you should have received more Premium Tax Credit than was given to you, you may get a refund. And if the government determines that you received too much APTC (because your income changed and you didn't tell Covered California), you may have to pay back some of the money you received. This is called “reconciliation.”

In addition, if your household earns 250 percent or less of the federal poverty level, you can receive cost-sharing reductions with an Enhanced Silver plan. Cost-sharing reductions lower how much you pay for your deductible, copays and coinsurance, as well as the out-of-pocket maximum that you’ll pay before your insurance pays for all other health care you receive this year — but you can only get cost-sharing reductions with an Enhanced Silver plan (Silver 73, 87 or 94).

To understand what you’ll pay for your deductible, copays and coinsurance, see our Health Benefits Table

 
 

What You’ll Pay

There are many factors at play when it comes to how much you’ll pay for health insurance —things like your location, age and family size. You can get an estimate of costs by using the Shop and Compare Tool. 

 

But how are these costs broken down? 

Premiums: Your premium is the bill you get for having a health plan that is usually paid monthly. You or your employer, or both, pay it monthly, quarterly or yearly. 

Out-of-pocket costs: a non-reimbursable expense paid by a patient. This could include any medical benefits that a plan doesn't consider "covered services." Your “out-of-pocket maximum” is a limit on how much you’ll have to pay for covered health services in a year. After that, your plan covers 100 percent of costs. 

Deductible: The amount you owe for health care services your health insurance plan covers before your plan begins to pay. For example, if your deductible is $1,000, your plan won't pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services. 

Copay: A fixed amount (for example, $15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service. 

Coinsurance: Your share of the costs of a covered health care service, calculated as a percentage (for example, 20 percent) of the allowed amount for the service. You pay coinsurance plus any deductible you owe. For example, if the health insurance plan's allowed amount for an office visit is $100, and you have met your deductible for the year, your coinsurance payment of 20 percent would be $20. The health plan pays the rest of the allowed amount. 

 

What is Medi-Cal?
 

Medi-Cal is a program that offers free or low-cost health coverage for children and adults with limited income and resources. If you qualify, you can enroll in Medi-Cal year-round.

Covered California offers a streamlined application process that will determine the consumers eligibility for Medi-Cal or Covered California.

 

Medi-Cal offers low-cost or free health coverage to eligible Californian residents with limited income. Covered California is the state’s health insurance marketplace where Californians can shop for health plans and access financial assistance if they qualify for it. Health plans available through Medi-Cal and Covered California both offer a similar set of important benefits, called essential health benefits. You can apply for both programs at the same time when you use our single application.

 

Beginning in 2020, most Californians are required to have health insurance or pay a penalty. If you choose to remain uninsured, you may face a penalty unless you qualify for an exemption. Most importantly, not having health insurance means you would have to pay the full cost of any medical services you need if you are sick or injured.

Penalty Details and Exemptions

Having health coverage is the law. If you don’t have coverage, you may have to pay a penalty to the California Franchise Tax Board, unless you qualify for an exemption.
Select the links in this section to read more on this topic.

Penalty Details and Exemptions

Having health coverage is the law. If you don’t have coverage, you may have to pay a penalty to the California Franchise Tax Board, unless you qualify for an exemption.
Select the links in this section to read more on this topic.

 

Other Options for Limited Medical Services

If you are uninsured and are not eligible for Medi-Cal or a plan through Covered California, you may qualify for limited health services offered by your county. These programs are not insurance plans and do not provide full coverage. Each county has different rules and services for these programs.   

 

Does Covered California offer health coverage for small businesses?

Yes. Visit the Covered California for Small Business to learn about the benefits for small businesses and their employees. 

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You can add or remove an agent by calling our service center at

COVERED CALIFORNIA PHONE NUMBER (800) 300-1506.

MY FAVORITE INSURANCE.ORG (877-395-6691) Speak to Agents.

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COVERED CALIFORNIA FOR SMALL BUSINESS VIDEO.

 

Medicare Part A,B,C,D

  1. Medicare and What It Covers

  2. Covered California and Medicare

  3. Covered California, Medi-Cal, and Disabilities

  4. Before You Are Automatically Enrolled in Medicare

  5. As Soon as You Are automatically Enrolled in Medicare

  6. What to Do Next When You Become Eligible for Medicare

  7. Things to Know

  8. Related Links

  9. Covered California Individual & Family

  10. Covered California for Small Business