What is Covered California?

Covered California is California’s health insurance marketplace. It was created under the Affordable Care Act to connect Californians to health and dental insurance from private companies — no matter their income or health history.

Covered California is the only place where you can get financial help to lower the cost of your insurance. Most people who apply qualify for some amount of savings.

Through Covered California, you can:

• Compare plans from well-known insurance companies.
• See if you qualify for financial help or free or low-cost Medi-Cal.
• Apply and enroll in one place.

How are Covered California and Medi-Cal different?

Covered California and Medi-Cal share an application and the goal of getting all eligible Californians covered.

Covered California helps connect people to affordable health plans, most of the time with financial help. Medi-Cal is free or low-cost insurance for people who qualify based on income. When you apply, we will let you know which program you qualify for. Either way, your health plan will cover services like doctor visits, hospital care and prescriptions.

Covered California

Private health and dental insurance plans, often with financial help.

Medi-Cal

California’s official Medicaid program. Free or low-cost insurance for people who qualify.

Who can get covered?

Anyone who lives in California can apply for insurance through Covered California. That includes:

• People who work for themselves.
• People whose jobs do not offer health insurance.
• People who are between jobs.
• People with low, middle or high incomes.
• Immigrants with an eligible status.

If your job offers health insurance, you can still apply through Covered California. But you may not qualify for financial help if your employer’s plan is considered affordable and meets certain standards.

How Financial Help Works

Most people who apply through Covered California qualify for financial help to make health insurance more affordable. There are two main types:

1. 1.
   Premium tax credits help lower the cost of your monthly premium: the bill you pay for your health plan.

   • You can use this help right away to lower your monthly bill. This is called the Advanced Premium Tax Credit (APTC).
2. 2.
   Cost-sharing reductions lower what you pay when you get care: like your deductible, copays and prescriptions.

   • These extra savings are only available if you qualify based on your income and choose an Enhanced Silver plan (Silver 73, 87 or 94).

You can use the Health Benefits Table to see what your costs and savings might look like.

How to Choose a Plan

Finding the right plan is not just about cost — it’s also about what fits your health needs.

Plans come in four levels, called metal tiers: Platinum, Gold, Silver and Bronze. The metal tier you choose affects how much you pay each month.

Each tier includes different plan types, like HMO and PPO. These plan types determine which doctors and hospitals you can use and whether you need a referral to see a specialist.

It’s also important to consider which doctors and hospitals are in a particular plan’s network and how prescriptions are covered.

When to Apply

You can apply during open enrollment, which happens each year from Nov. 1 to Jan. 31. Medi-Cal is open year-round for those who qualify.

Outside of that time, you can apply during special enrollment if you have a major life change, like:

• Losing or changing jobs.
• Getting married or divorced.
• Having a baby.
• Moving to a new area in California.

What Happens After You Apply

Here is what to expect after you apply:

1. 1.
   Find out what programs or savings you qualify for.
2. 2.
   Choose a plan and enroll.
3. 3.
   Pay your first bill directly to your health insurance company to start your plan
4. 4.
   Start using your insurance.

If you qualify for Medi-Cal, your county will contact you directly. You do not need to pay a monthly bill.

Once you are enrolled, your plan will send you a welcome packet and ID cards.