Why should I get an individual health plan?

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By getting health coverage, you know that your health needs will be covered and that you do not have to worry about what would happen if you had an accident.

For most people, you (and your family) should get an individual health plan through Covered California if you cannot get public health coverage or affordable health coverage through an employer.

Speak to your employer’s Human Resources department (or your spouse’s or parent’s Human Resources department) to learn if you can get coverage through an employer. Covered California can help you figure out if you are eligible for public health coverage. If you have been determined disabled according to Social Security's rules, you may be able to get other types of Medi-Cal. Talk to a Benefits Planner to learn more about them.

This is really confusing. Where can I get help?

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  • Covered California has a lot of great information introducing your options. You can also call Covered California at 1-800-300-1506 or 1-888-889-4500 (TTY).
  • Covered California also lists organizations that can give you local help in finding the right plan for you. You can use the Online Chat feature if you want to copy-and-paste a record of what was said.
  • If you have a disability, talk to a Benefits Planner to learn if you have additional options.

I have a disability. Will I really be able to get insurance that covers my medical problems?

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Yes. Plans cannot deny people coverage anymore. That means that when you apply for insurance, they cannot reject your application and they cannot say that they won’t cover medical needs related to your disability. They also cannot charge you more because you have a disability.

Additionally, all plans must cover the Essential Health Benefits (EHBs), which means that they offer much more comprehensive coverage than many health plans did in the past, including chronic disease management, rehabilitative and habilitative services and devices, and mental health and substance abuse coverage, just to name a few.

What’s the difference between Covered California, the Health Exchange, and the Health Insurance Marketplace?

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“Health insurance marketplace” is a national term used for the websites in each state that let individuals and small businesses sign up for health coverage. However, that's not what California’s marketplace is actually called. Covered California is the name of California’s health insurance marketplace.

“Health exchanges” is a term that was used before Covered California was established.

I’ve been getting by without health insurance because it was too expensive. Why should I get it now?

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There are new programs that make health coverage more affordable if you have low income. If health coverage is too expensive for you, the government may help you pay for it via tax credits. If you still cannot afford a private health coverage plan, you may be able to get a public health coverage plan like Medi-Cal. Check Covered California to see if you can get one of these options.

Note: It is very important to have health coverage, but starting in 2019 there is no tax penalty if you don't have coverage.

How does the government help pay for individual coverage?

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Depending on your situation, you may qualify to have the government help pay for your individual health plan via tax credits. Here's how it works:
  1. When you sign up at Covered California, you give details about your family's situation. Covered California reviews that information instantly. If your family qualifies for government help to pay for individual coverage, Covered California tells you and lists insurance options for you.
  2. Your insurance options list the full cost of the monthly premium, how much of that premium the government will pay each month, and how much you will pay each month. The way the government helps pay the premium is by giving you a tax credit every month, so you don't have to think about it during the year. All you have to do is make sure you keep paying your part of the premium.
  3. In January or February, the government will send you a form listing how much your total health care tax credits were for the previous year. You will need this form at tax time, because it is possible the government paid more or less than it should have for your health coverage. If so, this will be sorted out when you file your taxes.

Do I have to get a silver level plan on Covered California in order for the government to help me pay for my insurance?

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No, but depending on your income, you may get more help from the government if you get a silver level plan. Here’s how it works:
  • If your family makes 400% of the Federal Poverty Level (FPL) or less, the government helps pay for your premium via tax credits. That means you pay less each month. You can get this help no matter what metal your plan is.
  • If you make 250% of FPL or less and get a silver plan, the government also pays to reduce your copayments, coinsurance, deductible, and out-of-pocket maximum. That means you’ll pay less each time you need medical services. If you get this help, your silver plan might actually be as good or better than many platinum or gold plans. If you do not get a silver plan, the government will not help you with these expenses.

When Covered California looks at your income, they will count most types of earned and unearned income you have. However, some income is not counted, including Supplemental Security Income (SSI) benefits and some contributions to retirement accounts. Learn more about what types of income affect whether you get help paying for individual coverage.

The bottom line: If your family makes less than 400% of FPL, you’ll get help paying the premium, regardless of whether you get a platinum, gold, silver, or bronze plan, but if you make less than 250% of FPL, you will only get help with your copayments and other expenses if you get a silver plan.

Health Coverage Income Limits for Your Family

When can I sign up?

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Covered California is the best place for you to get individual health coverage. Through Covered California you can apply for individual coverage or for public health coverage, such as Medi-Cal. Covered California will calculate your eligibility for all of these programs and, if you choose individual health coverage, will tell you how much your premium will cost you and how much the government will help with tax credits.

Covered California lets you compare health plans side-by-side and figure out which is best for you based on their costs and the benefits they offer.

What happens if I sign up for an individual plan and then my income changes and I can no longer afford it?

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Usually, when you sign up for a plan through Covered California, you need to stay on the plan for the entire calendar year. So, if you are signed up for 2019, then you can’t leave that plan until 2020.

However, there are certain situations when you may be able to change plans mid-year:

  • If your income changes and you gain or lose eligibility for government help paying for your coverage
  • If your health provider is not meeting its obligations
  • If you move
  • In other life-changing circumstances, such as having a child or getting married

The first one is the key. If your income goes down and you can’t afford your plan anymore, you need to report your change in income to Covered California. You may qualify to get Medi-Cal or to have the government increase how much it pays for your current insurance (meaning that you have to pay less).

Note: American Indians do not have these restrictions and can change up to once a month.

I’m an immigrant. Am I allowed to get health coverage through Covered California? Will the government help me pay my monthly premium?

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Most immigrants can get health coverage through Covered California. However, the rules are not identical to the rules for United States citizens. Here are the basic rules:
  • Legal residents for 5 or more years or who meet specific noncitizen requirements have the exact same benefits as citizens. They can pay for individual plans through Covered California, qualify to get government help paying for their premiums and other fees (if their income is low enough), and get public coverage through Medi-Cal and other programs.
  • Some non-citizens who have legal immigration satatus in the United States do not qualify for full Medi-Cal coverage. However, if their income is at or below 400% of the Federal Poverty Level (FPL), they can qualify for government help paying for individual coverage.
  • Immigrants who are undocumented cannot get individual plans through Covered California, cannot get government help paying for their coverage, and cannot get public coverage through Medi-Cal. They can purchase coverage through an insurance agent or directly from an insurer and they may qualify for other public programs or for emergency or pregnancy-related Medi-Cal coverage. Visit your local county social services agency to learn what programs may exist for undocumented immigrants.
    • Note: Undocumented immigrants do not have to pay a penalty if they do not have health coverage.

If your immigration status changes and you become eligible for a public program or if you become eligible to use Covered California, you can sign up immediately – you do not need to wait until open enrollment begins.

If you are not sure whether your immigration status qualifies, contact an organization in your area that works with immigrants.

My job offers health insurance, but I don’t like the option they offer. Can I purchase an individual plan instead?

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Yes, but it is probably a bad idea. If your employer offers coverage that is affordable, you and your family will not get any help paying for an individual plan, so it will be much more expensive than the employer-provided plan.