Apply For Health Insurance Through Covered California

Since the start of the Affordable Care Act, which was initiated in March 2012 and fully implemented in January of 2014, the number of uninsured in California has decreased. In 2013 the uninsured rates were 16%. By 2015, it dropped to 9%. This is due to the effect the health law has made specifically in terms of mandating guaranteed issue plans regardless of health and minimum essential benefits which closed many coverage gaps plans had pre-ACA.

However, there are many who do not have health insurance. One reason is the premium you have to pay for a plan. Another reason is the process for signing up can be intimidating.

There are two methods of applying for Individual and Family health insurance. One is to go directly to a health insurance plan through a health insurance broker or agent. The other is to get it through Covered California. The advantage of getting it through Covered California is, if you qualify based on income, you will get Premium Tax Credits to help offset some of the premiums you pay. An example of this is if you are a  25 year old earning $24,000 a year, you will get approximately $137.00/month in Premium Tax Credits. Covered California will send the Premium Tax Credits to any plan you choose. You will then pay the net amount after it is applied.  As Covered California certified insurance agents, we can assist you in determining what Premium Tax Credit you qualify for and what plan meets your coverage.

There are serious consequences for not having insurance. If you become seriously ill or injured and have to go to the emergency room or get admitted to the hospital you can be tens of thousands or even hundreds of thousands of dollars out of pocket. Needless to say, this is a financial catastrophe for any individual of the family. Also, as of January 1, 2020, the state of California is imposing a penalty for individuals and families who do not have insurance. The penalties will be similar to the penalties the federal government imposed a year earlier.

The good news is that there will be the California State Tax Subsidy Program which will help consumers who previously have not qualified for Premium Tax Credits.

Enrollment Periods

  • Open Enrollment. This is a 3-month window typically starting in either mid-October or the first of November and ending on either January 15 or January 31.
    • The earliest effective date for plans is Jan 1 if the application is completed before Dec 15 of the previous year.
    • You can apply or change plans at this time
  • Special Enrollment. This is the enrollment period outside of open enrollment.
    • In order to enroll or change plans, you have to have a Qualifying Life Event. An example is losing group health insurance or Medi-Cal.

Q&A

  • Who can apply for health insurance through Covered California?
    • Everyone who can demonstrate lawful presence can apply. There is an income criterion to qualify for Premium Tax Credits
  • Who is eligible for Premium Tax Credits (APTC) and Cost Share Reduction?
    • Any household whose income is between 138%-400% of the Federal Poverty Level (FPL) qualifies for APTC
    • Any household whose income is between 138% and 266% of FPL qualifies for CSR
  • What is the California State Subsidy Program? 
    • It is a program that will begin on Jan 1, 2020
    • Any household whose income is between 401%-600% of FPL qualifies for this premium assistance
  • Where can I apply?
    • The only place to get APTC and CSR are with health insurance plans through Covered California. As Certified Covered California Agents, we can help you apply
  • What is Cost Share Reduction?
    • It only applies to Silver plans. A portion of your copays and deductible are paid for by Covered California with you paying the reduced amount.