En Español | Most Californians are eligible to buy health insurance through Covered California, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. Because of the pandemic, Covered California’s enrollment window is open through the end of 2021.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for a single person).
The average family with a marketplace plan can save $50 per person per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
When can I enroll?
How do I sign up?
You apply for coverage and choose your plan at the same time. Once you’re approved for a plan, you’ll need to pay your first monthly premium for your coverage to begin. You can pay online or ask to receive a bill in the mail, which should arrive in about two weeks. To apply and enroll:
You can also call Covered California’s service center (800-300-1506) or visit a local enrollment center for help with exploring plans, to ask questions and to help determine if you qualify for financial assistance.
What is covered, and how much will it cost?
Coverage and cost depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medi-Cal, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Covered California plans cover 10 “essential” benefits, including:
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Covered California plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of their annual income now qualifies for federal tax credits for insurance premiums.
For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for out-of-pocket expenses such as deductibles and copays. You must enroll in a Silver-level plan to get this assistance.
What plans are available?
Covered California’s plans are organized into four categories:
Covered California’s Shop and Compare tool helps you estimate costs and benefits of various plans and check whether you might qualify for financial assistance. Californians 29 and younger can also apply for a minimum coverage or catastrophic plan offering low premiums and covering three doctor visits or urgent care visits per year.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Covered California. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you can switch to a Covered California plan. Be aware that if you don’t cancel your COBRA plan before your new plan kicks in, you may face a financial penalty.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the renewal period opens this fall. If you don’t take action during the renewal period, you’ll automatically be reenrolled in your existing plan.
Will I need to get a new doctor?
That depends. Major insurance providers, including Anthem Blue Cross and Kaiser Permanente, offer Covered California plans, but not all doctors accept them. You can talk to your primary care physician or use the Shop and Compare tool to see whether a certain doctor or practice will accept a marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for subsidies or other programs, depending on age, income and disability, or caregiver status. Such families may choose to enroll as “mixed-program families” and still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.
Also of Interest:
This story is provided by AARP California. Visit the AARP California page for more news, events, and programs affecting retirement, health care, and more.
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