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You may be eligible for a government subsidy if your household income is under:
The Affordable Care Act (ACA) offers subsidies based on your household income, family size, and Qualifying Life Events.

You may qualify if...
One of the life events below has happened to you in the past 60 days:
  • I got married or divorced
  • I had a baby
  • A member of my family died
  • I moved to another state
  • i lost my job
  • I started a new job
  • I lost my health insurance coverage
and
Your income is under:
  • $45,960 - Individuals
  • $62,040 - Family of 2
  • $78,120 - Family of 3
  • $94,200 - Family of 4

Covered California Enrollment 2020 -- Know its dates, eligibility, qualification and how it works

Covered California is the state’s health insurance exchanges, which the Affordable Care Act (ACA) created. The exchanges help connect people to individual health insurance

These plans provide discounted rates for people based on income. 

Californians should be aware of two significant health insurance changes in 2020:

  • All Californians need health insurance in 2020. The state implemented an individual mandate that requires that people have health insurance. If you don’t have coverage, you’ll get fined at tax time. 
  • The state is expanding subsidies to help middle-class people pay for their health care. Covered California estimates the expanded subsidies will lower health insurance costs for about 922,000 Californians. 

Now that we know what’s new for 2020, let’s dive into Covered California, the types of plans, who’s eligible, how to enroll and how to save via subsidies. 

 

What is Covered California? 

Covered California is the state’s individual marketplace. The Affordable Care Act (ACA) created individual marketplaces, which help people find individual health insurance. You may need individual health insurance if your employer doesn’t offer coverage or the plans are too expensive or limited. 

Covered California plans must offer 10 essential health benefits. That’s required in the ACA.

The 10 essential health benefits are:

  • Outpatient services
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity and newborn care
  • Mental health and substance abuse care
  • Prescription drugs
  • Rehab and habilitative services and devices
  • Labs
  • Preventive and wellness and chronic disease management
  • Pediatric services, including oral and vision care

 

Types of Covered California plans

Similar to other health insurance exchanges, Covered California classifies its plans based on costs. Each plan gets a metal classification that gives you an idea about premiums and out-of-pocket costs. 

Here are the differences: 

Type of plan% of health care costs that plan pays% of health care costs that member paysPremiumsOut-of-pocket costs
Bronze60%40%Lowest premiumsHighest out-of-pocket costs
Silver70%30%Lower than gold, higher than bronzeHigher than gold, less than bronze
Gold80%20%Lower than platinum, higher than silverHigher than platinum, less than silver
Platinum90%10%Highest premiumsLowest out-of-pocket costs

Beyond the metal plan, you can choose the type based on plan design. While the metal classification varies by costs, the plan design dives deeper into the care. Here are the types of health plans offered: 

  • Preferred provider organization (PPO) — PPOs offer large provider networks. They let you receive out-of-network care. You’ll have to pay more for that care, but it’s an option — unlike other types of plans. PPOs don’t require referrals to see specialists. PPOs usually have higher premiums than other plans for the flexibility of going out-of-network and not needing referrals. 
  • Health maintenance organization (HMO) — HMOs, which are the most common type of Covered California plan, offer restricted provider networks and you need to get referrals from your primary care provider to see specialists. You can’t usually get care outside of your network. If you see a provider outside of the network, you may have to pay the whole bill with no help from your plan. These plans are less expensive than PPOs. 
  • Exclusive provider organization (EPO) — EPOs are a PPO/HMO hybrid. EPOs don’t require you to choose a primary care provider. You don’t need referrals to see specialists. So, in those cases, it’s like a PPO. However, similar to an HMO, EPOs have restricted networks and won’t pay for care outside of your network. 
  • Healthcare service plan (HSP) — HSPs are similar to EPOs. HSPs require that you name a primary care physician and there’s no out-of-network care. In those ways, HSPs are like HMOs. However, you don’t need a referral to see specialists if you have an HSP, which is similar to a PPO.

People looking for a plan through Covered California usually have multiple choices. Covered California said more than 99% of Californians have at least two health insurance company options in 2020. Eighty-seven percent have at least three insurer choices. 

Covered California selected 11 insurers to provide plans in 2020:

  • Anthem Blue Cross of California
  • Blue Shield of California 
  • Chinese Community Health Plan 
  • Health Net
  • Kaiser Permanente
  • L.A. Care Health Plan
  • Molina Healthcare
  • Oscar Health Plan of California
  • Sharp Health Plan
  • Valley Health Plan
  • Western Health Advantage

In addition to health insurance, Covered California offers dental plans. These are separate from health insurance plans. Insurers with dental plans are: 

  • Access Dental Plan
  • Anthem Blue Cross
  • California Dental Network
  • Delta Dental of California
  • Dental Health Services
  • Liberty Dental Plan 
  • Premier Access

Covered California offers two dental plan designs: HMOs and PPOs. 

 

Individual mandate in California

California is bringing back the individual mandate in 2020. The ACA implemented the individual mandate on a federal level. Congress has since removed the individual mandate fine, but the Golden State has implemented it at the state level for 2020. There are a handful of states with their own individual mandate. 

You’ll get fined at tax time depending on your family size and income if you didn’t have health insurance coverage in the previous year. 

The fine amount depends on your family size and income. The highest penalty is $2,100 per family. 

 

Who’s eligible for Covered California? 

Calfornia residents, as well as undocumented people, can apply for Covered California plans. 

During the application process, Covered California will verify your identity, income, citizenship and immigration status. If Covered California can’t confirm any information, the state may deem you “conditionally eligible.” In that case, you’ll get coverage for 90 days while you provide additional documents to Covered California. 

 

Expanded subsidies in Covered California

People who sign up through Covered California may find subsidized plans based on their income. When you apply and enter your income information, Cover California will tell you whether you’re eligible for subsidies, how much help you get and the premiums you pay.

The vast majority of people with Covered California plans receive subsidies. The ACA allowed for subsidies up to 400% of the federal poverty level. 

Covered California estimated that 85% of eligible low-income Californians qualify for state subsidies on top of federal tax credits. 

California is expanding subsidies for middle-class Californians in 2020. The new subsidies help people between 400% and 600% of the federal poverty level. That includes individuals making up to $74,940 and a family of four earning $154,500. 

Here are the subsidy levels:

Household sizeEligible annual household income ranges
1Up to $74,940
2Up to $101,460
3Up to $127,980
4Up to $154,500
5Up to $181,020

Source: Covered California

 

People below 138% of the federal poverty level can apply for Medi-Cal, which is California’s Medicaid program. Medi-Cal plans are lower cost with the same or better benefits than other health plans. 

Covered California estimates that people who have signed up for 2020 are already seeing savings. The new state subsidies are reducing low-income people’s monthly premiums an average of $19 per month on top of previous subsidies. 

Middle-income Californians eligible for a subsidy are saving an average of $526 per month per household in 2020. 

 

How to enroll in Covered California

You can apply online, in person or by phone. 

It takes about 30 minutes to apply online. You’re able to save your application and finish later if needed. You’ll need the following documents to complete the enrollment: 

  • Social Security number
  • Immigration documents for non-citizens
  • Employer and income information
  • Federal tax information

If you’d rather enroll at one of the 630 Covered California storefronts, you can search for your local location

As part of the application process, Covered California’s site helps you narrow choices. For instance, it will ask you how often you use medical services. Depending on whether how much you use medical services, Covered California will provide options that might work for you.

 

Covered California open enrollment

Covered California has a longer open enrollment than any other state. Most states run from Nov. 1-Dec. 15. A handful of other states have longer open enrollment periods, but nothing like what’s offered by California. CoveredCalifornia

Covered California’s open enrollment runs from Oct. 15-Jan. 31. That gives you more than three months to sign up for a plan or make changes to your health insurance. 

If you sign up by Dec. 15, your coverage begins on Jan. 1. If you sign up after Dec. 15, your plan will start later. Remember, if you don’t have health insurance in 2020, you’ll be subject to a fine at tax time. 

After open enrollment, you can only add coverage or make changes if there’s a qualifying event. For instance, if you have a child, get married or divorced, your spouse dies, you lose coverage or you move. If you go through one of these life events, it will kick off a special enrollment period when you can sign up or make changes to your health insurance. Otherwise, you can only make changes during open enrollment. 

An exception is Medi-Cal. Medi-Cal doesn’t have an open enrollment period. You can sign for Medi-Cal at any time if you’re eligible. 

Also, remember, that Covered California doesn’t affect plans in the employer-sponsored market. Employers have their own open enrollment. It’s up to the business to decide on an open enrollment period.

 

How much does Covered California cost? 

Covered California separates the state into 19 pricing regions. The regions vary on pricing and health insurance options. Covered California also offers subsidized ACA marketplace plans, which lowers your premiums. 

Average premiums will increase by less than 1% in 2020 compared to 2019. That’s the lowest rate increase in six years. 

Covered California believes the small increase is connected to the new state individual mandate. Here’s why — insurers base rates on risk. The mandate will expand the risk pool and likely bring in healthy people who didn’t have health insurance. Hence, insurers expect this influx of new members will help pay for the health care for members who need more services. 

However, the rate increases/decreases vary by region. For instance, in 2020, one area will see average premiums that are nearly 7% lower than 2019, while another will see an almost 7% rate increase on average. 

Make sure to shop around before deciding on a plan. The average savings for comparing policies is 9%, according to Covered California. 

Here are the average rate increases by region. These don’t take into account subsidies that can help you decrease costs. Covered California also included the average savings you could receive by shopping around for a policy.  

RegionCounties in regionAverage rate changeHow much you can save by shopping around
1Alpine, Amador, Butte, Calaveras, Coluse, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba-1.7%-8.4%
2Marin, Napa, Solano, Sonoma1.1%-3.6%
3Sacramento, Placer, El Dorado, Yolo1.8%-2.2%
4San Francisco6.6%-3.7%
5Contra Costa0.6%-5.5%
6Alameda1.9%-3.5%
7Santa Clara2%-14.1%
8San Mateo2%-4.8%
9Monterey, San Benito, Santa Cruz1%-6.1%
10San Joaquin, Stanislaus, Merced, Mariposa, Tulare-5.7%-9.3%
11Fresno, Kings, Madera3.4%1.7%
12San Luis Obispo, Santa Barbara, Ventura4.6%-2.3%
13Mono, Inyo, Imperial-6.9%-9.7%
14Kern-0.5%-5.1%
15Los Angeles (northeast) 2.6%-9.8%
16Los Angeles (southwest)0.1%-12.4%
17San Bernardino, Riverside0.1%-10.4%
18Orange1%-16.5%
19San Diego0.2%-11.4%
State average0.8%-9%

Source: Covered California

 

Individual plans outside of Covered California

Most individual health insurance in the Golden State is through Covered California. However, you can also buy an individual plan that’s not part of the insurance exchange. 

More than 1 million Californians with individual insurance buy it outside of the exchanges. 

One downside is that people who get individual insurance outside of Covered California aren’t eligible for subsidies. However, if your household income is beyond 600% of the federal poverty level, you may want to check out individual insurance beyond Covered California to see if other plans might work for you. 

Ready to get a quote?

Find Affordable Health Insurance Now!

Please enter valid Zip Code.
Please enter valid date.
You may be eligible for a government subsidy if your household income is under:
The Affordable Care Act (ACA) offers subsidies based on your household income, family size, and Qualifying Life Events.

You may qualify if...
One of the life events below has happened to you in the past 60 days:
  • I got married or divorced
  • I had a baby
  • A member of my family died
  • I moved to another state
  • i lost my job
  • I started a new job
  • I lost my health insurance coverage
and
Your income is under:
  • $45,960 - Individuals
  • $62,040 - Family of 2
  • $78,120 - Family of 3
  • $94,200 - Family of 4
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