When it comes to health insurance, Californians have options. One of these options is Cover California, which was established in 2010 as part of the Affordable Care Act. Cover California is the state’s health insurance marketplace, where residents can shop for and compare health insurance plans. In this article, we will dive into the details of Cover California, including its history, eligibility requirements, available plans, enrollment periods, and frequently asked questions.
History of Cover California
Cover California was created in response to the Affordable Care Act, which required states to establish their own health insurance marketplaces or rely on the federal marketplace. California decided to establish its own marketplace to have more control over the plans and costs available to its residents.
Since its inception, Cover California has enrolled millions of Californians in health insurance plans, making it one of the largest state-run marketplaces in the country.
The Purpose of Cover California
The purpose of Cover California is to provide affordable health insurance options to Californians. It aims to promote health equity by ensuring that every Californian has access to quality health care regardless of their income, age, race, or health status. It also aims to simplify the process of buying health insurance by offering a one-stop-shop for residents to compare and enroll in healthcare plans that fit their needs and budget.
Eligibility for Cover California
Not everyone is eligible for Cover California. To enroll in a Cover California health insurance plan, you must meet the following eligibility requirements:
Requirement |
Description |
|---|---|
Residency |
You must be a California resident |
Citizenship or Immigration Status |
You must be a U.S. citizen, a U.S. national, or a lawfully present immigrant |
Income |
Your household income must be within a certain range, based on the federal poverty level |
Current Health Coverage |
You cannot be currently enrolled in Medicare, Medicaid, or other public health coverage |
Income Requirements
Your household income will determine your eligibility for financial assistance from Cover California. This assistance can come in the form of tax credits, which can help lower your monthly premiums, or cost-sharing reductions, which can help lower your out-of-pocket costs. The income requirements for 2021 are:
Household Size |
Annual Income Range |
|---|---|
1 |
$17,609 – $51,040 |
2 |
$23,791 – $68,960 |
3 |
$29,973 – $86,880 |
4 |
$36,155 – $104,800 |
5 |
$42,337 – $122,720 |
6 |
$48,519 – $140,640 |
If your household income falls within these ranges, you may be eligible for financial assistance from Cover California.
Cover California Health Insurance Plans
Cover California offers a range of health insurance plans from different insurers. These plans are divided into four categories: Bronze, Silver, Gold, and Platinum. Each category has different levels of coverage and costs. The categories are based on the percentage of costs for covered services that each plan will pay, on average. Below is a breakdown of the categories:
Bronze Plans
Bronze plans have the lowest monthly premiums but the highest out-of-pocket costs. On average, they cover 60% of the costs of covered services. They are a good option if you are healthy and don’t expect to use many medical services.
Silver Plans
Silver plans have moderate premiums and out-of-pocket costs. On average, they cover 70% of the costs of covered services. They are a good option if you want a balance between premiums and out-of-pocket costs.
Gold Plans
Gold plans have higher premiums but lower out-of-pocket costs. On average, they cover 80% of the costs of covered services. They are a good option if you need regular medical services or expect to have higher medical costs.
Platinum Plans
Platinum plans have the highest monthly premiums but the lowest out-of-pocket costs. On average, they cover 90% of the costs of covered services. They are a good option if you need a lot of medical services or have a chronic medical condition.
Enrolling in a Cover California Health Insurance Plan
Enrolling in a Cover California health insurance plan is easy. You can enroll online, by phone, or with the help of a certified enroller. The open enrollment period for 2021 is from November 1, 2020, to January 31, 2021. Outside of the open enrollment period, you can only enroll in a plan if you have a qualifying life event, such as losing your job-based coverage or getting married.
How to Enroll Online
You can enroll in a Cover California health insurance plan online by visiting the Cover California website. You will need to create an account, fill out an application, and choose a plan that fits your needs and budget. You can also see if you qualify for financial assistance and apply for it online.
How to Enroll by Phone
You can also enroll in a Cover California health insurance plan by phone. The phone number is 1-800-300-1506. You will need to provide information about yourself and your household income to a representative, who will help you choose a plan and enroll in it.
How to Get Help from a Certified Enroller
If you need help enrolling in a Cover California health insurance plan, you can get help from a certified enroller. Certified enrollers are individuals who are trained and certified by Cover California to help people understand their options, apply for financial assistance, and enroll in a plan. You can find a certified enroller near you by visiting the Cover California website.
Cover California Health Insurance FAQ
Q: What is the difference between a health insurance agent and a certified enroller?
A: A health insurance agent is a licensed professional who can help you enroll in a health insurance plan. A certified enroller is an individual who is trained and certified by Cover California to help people understand their options, apply for financial assistance, and enroll in a plan. Certified enrollers do not receive commissions from insurers, so their advice is unbiased.
Q: Can I change my Cover California health insurance plan after I enroll?
A: You can change your Cover California health insurance plan during the open enrollment period. Outside of the open enrollment period, you can only change your plan if you have a qualifying life event, such as getting married, having a baby, or losing your job-based coverage.
Q: What happens if I don’t have health insurance?
A: If you don’t have health insurance, you may have to pay a penalty when you file your taxes. The penalty for 2020 is $695 per adult and $347.50 per child, or 2.5% of your household income, whichever is higher.
Q: How do I know if I am eligible for financial assistance from Cover California?
A: You can use the Cover California website to see if you qualify for financial assistance. You will need to provide information about your household income and family size.
Q: Can I get health insurance if I have a pre-existing condition?
A: Yes, under the Affordable Care Act, health insurance companies cannot deny coverage or charge more based on pre-existing conditions.
Q: Are there any exclusions or limitations in the Cover California health insurance plans?
A: Yes, like all health insurance plans, Cover California health insurance plans have exclusions and limitations. These may include limits on certain treatments, procedures, or medications. You should review the plan details carefully before enrolling in a plan.
Q: Can I cancel my Cover California health insurance plan?
A: Yes, you can cancel your Cover California health insurance plan at any time. However, you may have to pay a penalty if you don’t have another health insurance plan to replace it.
Conclusion
Cover California is a convenient and affordable way for Californians to get health insurance. It offers a range of plans from different insurers, with financial assistance available for those who qualify. With the open enrollment period underway, now is the time to explore your options and enroll in a plan that fits your needs and budget.