Covered California is the state’s official health insurance marketplace where California residents can apply for health insurance and receive financial assistance if they qualify. If you do qualify for financial assistance, you will either be able to get coverage through a major insurance carrier or through the state’s Medi-Cal.
All of these plans are required to provide comprehensive coverage of essential health benefits that fall into 10 categories:
- ambulatory services
- emergency services
- maternity and newborn care
- mental health and substance use
- prescription drugs
- rehabilitation services
- laboratory services
- preventive, wellness and chronic illness management
- pediatric services, including vision and dental services
The health insurance plans are broken down into standard coverage levels or metal tiers: Bronze, Silver, Gold and Platinum.
Bronze: Covers about 60%, is a high-deductible plan, and offers 3 visits a year between a primary doctor and urgent care, before deductible. This plan also offers the lowest premiums.
Silver: Covers about 70%, carries a deductible but offers more coverage before having to meet the deductible such as primary doctor, specialist, urgent care and more. Premiums are higher, but copays and coinsurances are lower.
Enhanced Silver: The Silver plan breaks down into 3 enhanced sub-categories: Silver73, Silver87 and the Silver94. You may qualify if you fall within certain income limits based on your household size. These enhanced silver benefits, will have lower deductibles, copays and coinsurance than the Silver70 and tend to have more attractive benefits than the Gold and Platinum plans.
Gold: Covers about 80% and has no deductible.
Platinum: Covers about 90% and also has no deductible.
Minimum Coverage: This plan is only offered to those under age 30. It serves as an emergency plan, but still gives you 3 visits to a primary care doctor or urgent care, outpatient mental healthsubstance use coverage and preventive services at no cost. All other services you pay 100% of the negotiated rate until your out-of-pocket expenses total $8550. Any costs after that are covered entirely by the health plan until the end of the year.
When can I enroll?
You can sign up for a Covered California plan during the Open Enrollment which is usually between November 1 to January 31. Depending on when you sign up, your coverage can start either on January 1, Febuary 1 or March 1 of the upcoming year.
If you experience a qualifying life event at anytime during the year, you may qualify to sign up for a Covered California plan through a Special Enrollment.
Some of these qualifying life event could be:
- moving to a new service area
- newly married
- having a baby
- losing employer group insurance
- change in citizenship status
- New! income between 100-150% of the federal poverty level
For more information on qualifying life events, you can visit Covered California.
New!! The enrollment period in California is now open until the end of year. There’s no need to show proof of a qualifying event.
Is there a penalty for not having health insurance?
In California, as of January 1, 2020 it is required to have health insurance otherwise you may be penalized for not having it.
The penalty is $850 for an adult and $425 for a dependent child under 18 for being uninsured the full year. It will be included when you file for your 2022 taxes.
If you didn’t qualify for any subsidies in the past, you should consider getting a quote now. With more financial assistance offered for this year, more people have been able to qualify for federal and/or state subsidies.
See how much subsidies you qualify for with the Kaiser Subsidy Calculator.
Do I qualify for an exemption?
Some individuals are exempt from the penalty:
- Native Americans/ Native Alaskans
- Individuals unlawfully residing in California
- Individuals with a Health Care Sharing Ministry plan
- Citizens living outside of the country
- Residents of another state
- and more…
If you are experiencing financial hardship, you may apply for an exemption.
For more information, go to Covered California.Shop and Compare Now!
This website is owned and maintained by Franco Stella Insurance Services, Inc, which is solely responsible for its content. This site is not maintained by or affiliated with Covered California, and Covered California bears no responsibility for its content. The e-mail addresses and telephone number that appears throughout this site belong to Franco Stella Insurance Services, Inc and cannot be used to contact Covered California.