En Español | Most Californians are eligible to buy health insurance through Covered California, the state’s Affordable Care Act (ACA) marketplace, when open enrollment begins on Nov. 1, 2022.
If you experience a qualifying life event — such as the birth of a child, a move, a marriage, a divorce or the loss of your employer-provided health insurance — you may be able to enroll or change your coverage outside of open enrollment.
Most people already enrolled in ACA marketplace plans have seen their premiums go down because the 2021 American Rescue Plan Act (ARPA) increased tax credits for insurance premiums and expanded 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. These enhanced subsidies are now available until 2025.
Prior to the 2021 law, such tax credits were only available to people making less than a certain salary ($54,360 for one person). Most Americans with a marketplace plan can save an average of about $800 per year, according to the federal government.
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.
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.
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income qualifies for federal tax credits for insurance premiums through 2025.
According to Megan O'Reilly, AARP vice president of government affairs for health and family, subsidy recipients ages 50 to 64 have already seen average annual savings of over $950.
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.
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.
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 9.12 percent of your household income for individual coverage to qualify for the tax credits.
If you lose coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), you may be able to sign up for a Covered California plan during a 60-day special enrollment window. Try to apply and select your plan before your COBRA coverage ends to make sure there's no gap in coverage. If you’re not sure about whether making this switch makes sense for you, you can ask for free advice from a certified enroller or insurance agent.
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.
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.
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.
This guide was updated on Aug. 23 with more information about open enrollment.
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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