Buying Health Coverage on CoveredCA
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The Basics
Health coverage helps pay for medical costs. A health care plan has a set of services that the plan provider agrees to pay for if you need them, like when you see a doctor or go to the pharmacy.
One way to get health coverage is through government programs, like Medicare and Medi-Cal. Another way is through private insurance companies. The two main ways to get private health coverage are through your job, which is called employer-sponsored group health coverage, or by buying it on your own, called individual health coverage. You can buy an individual plan for yourself and for your entire family.
In the past, buying individual health coverage could be very difficult, especially for people with disabilities. Many people worried that they wouldn’t qualify for it and, even if they did qualify, they might not be able to afford the monthly payments (called premiums) or other fees, like copayments or deductibles.
However, this has changed. Now, private health coverage companies cannot reject your application because you have a health condition, and if you get your insurance through Covered California, there should be a private or public health plan you can afford.
This article is about getting health coverage through Covered California. It will help you understand:
- If an individual plan is right for you
- What services your plan will cover
- How to choose a plan
- How much you will have to pay for health care, and
- How to sign up.
If you need more help in understanding individual health plans after reading this article, we recommend you talk to trained experts. Here are some good resources:
- 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 has local help and 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.
Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. For news related to health coverage, visit Covered California.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
- The Basics
- Is it Right for You?
- What it Covers
- What You Pay
- How to Sign Up
- FAQs
- Pitfalls
- Next Steps
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Is it Right for You?
Almost everyone should be able to get health coverage. The question is, which plan is right for you and your family?
This page looks at options you may have, such as getting public health coverage, like Medi-Cal or Medicare, or getting health insurance through your job. If these options are available to you, they are better choices than getting an individual plan, because they cost less.
Then, we’ll look at why you might choose to get an individual plan. We’ll focus on getting a plan through Covered California, the easiest place for most people to shop for an individual plan and the only place where you can get help from the government to pay for your private insurance (if you qualify).
Other options that are probably better
The best way to figure out if buying an individual health plan is the right option for you is to sign up for Covered California and complete an application. Covered California will tell you what health coverage options are open to you. If you have any of the options below, don’t pay for private insurance through Covered California.
Public health coverage
There are several public health care programs that help people with disabilities, seniors, children, and anybody who has low income. If you or a family member qualifies for these programs, they are usually your best option and you will not be allowed to purchase a government-subsidized individual plan through Covered California.
Medi-Cal
Medi-Cal is a major government-funded health program that helps people with low income. You may qualify for Medi-Cal if you are in one of these situations:
- Your family’s income is at or below 138% of the Federal Poverty Level (FPL) ($20,783 for an individual; $43,056 for a family of four). There are no limits to how much money or other resources you have. This is the most common type of Medi-Cal. You can read more about this in DB101’s Medi-Cal article.
- You are a child 18 or younger and your family’s income is at or below 266% of FPL ($82,992 per year for a family of four).
- You are pregnant, and your family’s income is at or below 213% of FPL ($43,537 if you are single and pregnant with your first child, $66,456 per year for a family of four, including the baby).
-
You have a disability or are elderly:
- Medi-Cal for people with disabilities and seniors may offer additional services, but there are more eligibility requirements and different income rules. DB101's Medi-Cal article explains Medi-Cal for people with disabilities.
- Medi-Cal's Working Disabled Program lets people with disabilities who make more money than the income limits for other types of Medi-Cal get Medi-Cal coverage. Learn more about it in DB101’s Medi-Cal article.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Income-based Medi-Cal, adults (138% FPG) | |
Income-based Medi-Cal, children (266% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
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Since January 1, 2024, all immigrants in California can get Medi-Cal coverage, if they meet all other program requirements.
If you are an immigrant and aren't sure about what benefits you can get, contact an organization in your area that works with immigrants.
Medicare
Medicare is a health insurance program run by the federal government that covers seniors (65 years old or older) and people with disabilities. In order to get health coverage through Medicare, you must have worked for a certain number of years and met other eligibility rules, detailed in DB101’s Medicare article.
If you get Medicare, you cannot get government help with paying for an individual health plan. You could still buy an individual plan through Covered California, but you would have to pay the entire premium yourself. Also, if you want more coverage than what Medicare offers, it is probably better for you to look into whether you might also qualify for Medi-Cal based on having a disability or being elderly, which would help pay your Medicare premiums and other Medicare expenses. Another option is to look at getting a Medicare supplement policy (sometimes called a Medigap policy) or signing up for a Medicare Advantage plan. These options are not available through Covered California.
If you or members of your family are eligible for a public program, that public program is probably your best option. If you think you might be eligible for a public program, see the other articles in DB101’s Health Care Coverage section.
Group coverage through your employer
To get private health insurance, a monthly payment called a premium must be paid every month. Many employers offer to pay part, or all, of this monthly premium as a job benefit for you as an employee, your children until they turn 26 years old, and your spouse.
If your employer offers you health coverage that would cost you, for your policy alone, less than 8.39% of your income and that coverage meets bronze-level standards, you won't qualify for government help via tax subsidies to reduce the premium on an individual plan. That means that if you decide to purchase an individual health plan, you will have to pay the full premium, which will probably be more than you would pay if you used the coverage provided by your employer. To learn more about employer-sponsored health coverage, read DB101’s article about it.
Note: Before 2023, the spouse or children of an employee would not qualify for subsidies on Covered California if the employer offered coverage that was affordable for the employee's policy alone, even if the cost to add the rest of the family wasn't affordable. This was called the "family glitch." This changed starting in 2023. Learn more about affordability rules for family members and how it affects eligibility for tax credits on Covered California.
If your family makes 138% of the Federal Poverty Level or less, you can choose to get Medi-Cal through Covered California even if your employer offers coverage.
Note: If you work and have been determined disabled according to Social Security rules, you may be able to get coverage through Medi-Cal's Working Disabled Program. Talk to a benefits planner to learn more about Medi-Cal's Working Disabled Program.
If your employer provides health coverage, you should not get an individual plan for yourself or your family. In most cases, the group coverage will be your best option.
However, if your income is at or below 138% FPL of the Federal Poverty Level or if you have a disability, it could be a better choice for you to get Medi-Cal for your entire family. In some cases it may even make sense to get employer-sponsored coverage for the adults in your family and get Medi-Cal for the children.
When an Individual Plan is Your Best Option
You should get an individual plan through Covered California if you cannot get health coverage from:
- Your job
- Your spouse’s job
- Your parent’s job
- Medi-Cal, or
- Medicare
If you cannot get health coverage from any of the above options, the government may help you pay your monthly premium through a tax credit. If your family’s income is at or below 250% of FPG, $37,650 for an individual ($78,000 for a family of four), the government will also help you get a plan that has lower copayments and other expenses. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
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.
Later, we’ll go into more detail about how much you have to pay.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Income-based Medi-Cal, adults (138% FPG) | |
Income-based Medi-Cal, children (266% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
|
Clarence and Samuel have two small children and live in a two-bedroom apartment. Clarence is 37 years old and makes $55,000 per year as a freelance writer, while Samuel is 42 years old and makes $45,000 per year running his own small bakery, so their combined income is $90,000 per year. Since both of them are self-employed, they cannot get employer-provided coverage and their combined income is 288% of the Federal Poverty Guidelines (FPG), meaning that they and their children don’t qualify for Medi-Cal.
They went to Covered California and found a plan that would cover their entire family. Since the federal government would help pay for their premium, this plan would cost them less than $700 a month. It wasn’t totally free, but it was a pretty good deal and they were satisfied.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
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What it Covers
Health insurance coverage is now much more standardized than it used to be. In the past, many plans did not cover important services, such as childbirth or mental health services. Now, all individual plans must cover a set of benefits which are called Essential Health Benefits (EHBs).
All individual health coverage options must cover your needs when it comes to these Essential Health Benefits. The biggest thing that will vary is how much you’ll have to pay, which we’ll look at later; and even then, there are limits to how much your insurance can charge you for your care.
Essential Health Benefits
These are the Essential Health Benefits that all plans must provide:
- Ambulatory patient services (care you get without being admitted to the hospital)
- Emergency services
- Hospitalization
- Maternity and newborn care (care before and after your baby is born)
-
Preventive and wellness services and chronic disease management, including:
- Immunization vaccines for many diseases
- Screening for different conditions
- Counseling for some health issues
- Women’s preventive care
- Children’s preventive care
- Prescription drugs
- Laboratory services
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
- Pediatric services for children, including oral and vision care
Non-Essential Health Benefits
There are some types of health care that plans are not required to provide. Here are some examples of services that may not be covered:
- Fertility treatments
- Cosmetic surgery (unless medically necessary)
- Dental care for adults
- Vision care for adults
- Alternative medicine such as acupuncture
There may be individual plans you can get that cover these items. However, no plan is required to provide them and the plans that do offer them will be more expensive.
Differences Between Plans
Plans you can get through Covered California all offer the same Essential Health Benefits. The real differences between plans are whether they offer non-essential benefits, which doctors you are allowed to visit, how much your monthly premium is, and how much you have to pay each time you visit the doctor or need another medical service.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
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What You Pay
Here we are going to look at the types of expenses you have to pay if you get an individual plan for yourself or your family through Covered California. Then, we’ll look at what factors can make those expenses higher or lower.
Expenses
When it comes to individual plans you will need to pay a monthly premium, plus additional fees each time you get a service.
The Monthly Premium
The monthly premium is a set amount of money you have to pay each month to be part of a plan, regardless of whether you use any health care that month.
Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
Stephen is single and pays about $400 per month for his individual coverage plan.
Additional Fees When You Get Care
Each time you get care, you may need to pay additional fees. Which of these fees you have to pay and how much you have to pay depend on your plan; some plans only have copayments, while others have copayments, coinsurance, and deductibles.
Copayments are a set amount you have to pay for a medical visit or service. The exact amount of the copayment varies depending on the service you get: medications, visits to specialists, lab tests, x-rays, emergency room visits, and other services can all have different copayment amounts.
Under Stephen’s plan, he has to pay $40 each time he visits a specialist, $20 for each prescription drug, and $30 for each lab test.
Coinsurance is a set percentage of the cost of a visit or service that you must pay.
Under Stephen’s plan, he has to pay 20% of the cost of any surgery. So, if his surgery costs $5,000, he has to pay $1,000 and his insurance covers the rest.
A deductible is a set amount of money that you pay out of your own pocket each year before the insurance company will begin to pay for certain services, including hospital care, emergency room visits, and brand-name prescription drugs. Once you have paid the deductible, you do not have to pay it again until the next calendar year.
If you are under 30, you can sign up for a catastrophic plan with a high deductible. You will have to pay the deductible before this type of plan will pay for most Essential Health Benefits, though you will be able to see your primary care provider up to 3 times and get preventive care without paying the deductible.
Tip: If you have to pay a deductible before your health plan will pay for your medications, shop around to see where you can get them cheaper. Some stores may have generic medications much cheaper than your usual pharmacy – as low as $5 or less for some medications.
Under Stephen’s plan, there is a $2,000 annual deductible before his plan will pay for hospital care. If he needs to stay in the hospital for several days to recover from his surgery, he will pay the first $2,000 of his stay. After he has paid that amount, he also has to pay 20% of the rest of the cost. If he goes back to the hospital later in the year, he will not have to pay the deductible again.
Maximum Out-of-Pocket Expenses
Each plan has a maximum amount you have to pay each year in fees for medical services (copayments, coinsurance, and deductible). This cap for your out-of-pocket expenses does not include the money you spend on your monthly premiums. The exact amount of your out-of-pocket maximum will depend on your plan and can range from $2,000 up to $9,450 for an individual or $18,900 for a family.
Stephen gets a plan through Covered California that:
- Has a $500 per month premium
- Requires $40 copayments for visits to his doctor and $20 copayments for generic medications
- Requires 20% coinsurance for hospital care and outpatient surgery.
- Has a $2,000 deductible.
- Has a $5,000 out-of-pocket maximum.
When Stephen has an automobile accident and goes to the emergency room, he has to pay his full $2,000 deductible, because he hadn’t yet paid it this year. The accident also forces him to have major surgery that costs $15,000. He’s already paid his annual deductible, so now he just has to pay his 20% coinsurance, which means he pays $3,000 for the operation and his insurance plan covers the rest. Between the $2,000 he paid for the emergency visit and the $3,000 he paid for the operation, he has spent his entire out-of-pocket maximum for the year.
Stephen has to stay in the hospital for 3 days as he recovers from his operation, and he also needs to take a number of medications to help the recovery and prevent infection. Usually he would have to pay 20% coinsurance for the hospital stay and a $20 copayment for each medication; but because he already spent his out-of-pocket maximum this year, he doesn’t have to pay anything – his insurance plan will cover it all. In fact, other than his $500 monthly premium, Stephen will not have to pay anything for any of his health care for the rest of the year.
What Affects How Much You Pay
The amount you pay for these expenses if you get an individual plan through Covered California depends on five main factors:
- The level of health plan you choose
- The type of plan you get
- Your family’s income
- Where you live, and
- Your age.
Note: Health plans used to charge people more based on their gender or whether they had pre-existing conditions. That is no longer allowed. People can only be charged more based on the factors listed here.
Health Plan Levels
There are 4 different levels of plan available to most people:
- Platinum plans have the highest monthly premiums and the lowest fees when you get medical care.
- Gold plans have slightly lower premiums and slightly higher fees when you get medical care.
- Silver plans have lower premiums. The fees for medical services depend on your family’s income; if you make less than 250% of the Federal Poverty Guidelines (FPG), the fees may be as low as a gold or platinum plan.
- Bronze plans have the lowest monthly premiums and the highest fees when you get medical care.
You may see these plans listed with percentage ratings (60%, 70%, 73%, 80%, 87%, or 90%). The higher the percentage rating, the lower the fees you have to pay when you get medical care. Note: These percentage ratings do not reflect what percentage of your family's expenses your plan will pay for. They are based on averages for thousands of families and how much your plan actually ends up paying for your family could be much higher or much lower than what the percentage rating says, depending on the services your family needs.
Health Plan Types
There are three main types of private health plan available through Covered California:
-
Health Maintenance Organizations (HMOs) have a specific network of health care providers, including doctors, hospitals, labs, and pharmacies. You choose a primary care provider (PCP) from their network. When you have a medical problem that isn’t an emergency, you may need to see your PCP first. If your PCP thinks you need to see a specialist, your PCP will write you a referral to see another doctor in the network. You can only get services outside your network in an emergency.
- The Bottom Line: HMOs have lower costs and less paperwork than PPOs, but you have fewer choices of health providers.
-
Preferred Provider Organizations (PPOs) also have a network of doctors, but you can usually see any doctor in the network, including specialists, without a referral from a primary care provider (PCP). You can also see a doctor outside of the PPO network, but you will have to pay a higher portion of the bill.
- The Bottom Line: PPOs offer more physician choice and don’t require much paperwork if you stay in their network. They usually have a deductible and your premium and total out-of-pocket costs may be higher than in an HMO.
-
Exclusive Provider Organizations (EPOs) are similar to HMOs. They have a specific network of health care providers, including doctors, hospitals, labs, and pharmacies, and you are not allowed to get services outside that network unless there is an emergency. However, their network of providers is usually smaller than an HMO’s. Unlike an HMO, you do not need to have a primary care provider (PCP).
- The Bottom Line: EPOs usually have limited physician choice like an HMO, but do not require a PCP referral in order to get specialist care. EPOs have the lowest premiums.
Some health plans on Covered California let you create Health Savings Accounts (HSAs) to set money aside to help you pay for certain approved medical expenses. For example, you could use the money in this account to pay for expenses like doctor’s visits or prescriptions that aren’t paid for by your insurance before you meet your deductible.
You decide how much money to put into the account, up to a certain limit. The big advantage of these is that they let you save the money tax-free. The higher the rate of taxes you pay on your earnings, the more they help you. If you don’t have a high tax rate, they probably aren’t going to help you much. Some of these plans have a trade-off that they have higher deductibles or copayments, so they could actually make health care more expensive for some people.
Your Family’s Income
Families that make less money and don’t have employers who provide affordable coverage may get government help paying for their health care:
- The government may help pay for your premium through tax credits. That means you would pay less each month. You might get this help no matter what metal your plan is. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
- If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you 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 does not help you with these expenses.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Income-based Medi-Cal, adults (138% FPG) | |
Income-based Medi-Cal, children (266% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
|
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:
- 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 state or federal help to pay for individual coverage, Covered California tells you and lists insurance options for you.
- 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.
- In January or February, Covered California 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.
Where You Live
Different providers offer different plans in different parts of the state and the prices of these plans vary.
Your Age
The older you are, the higher your monthly premium. However, older people can only be charged a premium that is at most 3 times as high as a young person would be charged.
Things to Think About
When you use Covered California to get health coverage, you can control two of the things that affect how much you pay for your coverage: you choose the level of plan you want (platinum, gold, silver, or bronze) and what type of plan you want (HMO, PPO, or EPO).
Here are some questions to think about as you compare plans:
- Do you qualify for government help paying for your health coverage?
- How high a premium can you afford to pay each month?
- How often do you visit the doctor or need other medical services? Try and add up the copayments you would need to pay for those appointments each month. Can you afford those?
- Do you like your current doctors? Which types of health coverage do they accept? Are you willing to switch doctors to save money?
- Are you okay with having a primary care physician who refers you to specialists when you need them? Or do you prefer being able to set up appointments with specialists on your own?
- Are you comfortable with having a deductible for hospital care, outpatient surgery, and emergency room services?
Each family has a different situation, and the right answers for you will depend on your specific needs. For example, if you know you will have to go to the doctor a lot, you may want to make sure that you don’t have high copayments. Or, if you hardly ever go to the doctor, you may prefer to have a lower premium.
Try out CoveredCA's Shop and Compare Tool to see how much you might have to pay each month for a silver level plan.
Sonia, Anthony, and their two little children are getting health coverage through Covered California. Sonia makes $66,000 per year (a little more than 200% of the Federal Poverty Line for a family of four) at her job, but her employer doesn’t offer health coverage for its employees, so her family has to pay for an individual plan. Anthony is a stay-at-home dad.
Sonia is a little nervous since her family doesn’t make a lot of money, but she knows that there is supposed to be an affordable option for every family, so she decides to check out Covered California. Covered California asks her for some basic info, including where they live, how much income the family has, and the age of each family member.
Once she’s answered these questions, Covered California displays a set of options for herself and her family, and she finds that her family qualifies for a government-subsidized silver-level plan, with a premium she can afford, low copayments, and no deductible.
If you can no longer afford your plan
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 2024, then you can’t leave that plan until 2025.
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 via tax credits (meaning that you have to pay less).
If you are a member of an American Indian tribe recognized by the federal government and you earn less than 300% of the Federal Poverty Level ($45,180 per year for an individual, $93,600 for a family of four), you will not pay any copayments or deductible for the health insurance plan you get through Covered California.
American Indians can also change health plans up to once a month.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
Try It
How to Sign Up
Covered California is the best way for you to get an individual health plan. In the past you had to call up each individual insurance company or go through an insurance broker if you wanted to buy your own health insurance, but Covered California provides a one-stop shop where you can compare plans and figure out which one is right for you. Also, remember that it is the only place where you can get government help to pay for your individual plan.
When you first look at Covered California , just try to get a sense of what your options are so that you can make an informed decision when you are ready. As you use Covered California, there may be times when you will be confused or even think there is a mistake. There are people who can help answer your questions. Get help by calling Covered California at 1-800-300-1506 or 1-888-889-4500 (TTY) or get local help. You can also use the Online Chat feature if you want to copy-and-paste a record of what was said. It is important to make sure that you get the best and most affordable plan for your situation.
Open enrollment
Anybody who wants to sign up for an individual plan can do so now, until open enrollment ends.
Usually, you can only sign up for an insurance plan through Covered California during a certain time called open enrollment. To sign up for an individual plan that will cover you during 2025, you must sign up between November 1, 2024 and January 31, 2025.
If you do not sign up during that time, you will usually not be allowed to sign up for an individual plan through Covered California until another year has passed. That means you might not be able to get coverage for an entire year.
Special Enrollment
There are certain situations when you can sign up for an individual plan through Covered California even though it is not the usual open enrollment period:
- Your household income is at or below 150% of FPG
- If you lose other health coverage you had
- If your health provider is not meeting its obligations
- If your income changes and you gain or lose eligibility for government help paying for your coverage
- If you become a legal resident of the United States
- If you move
- If there was a mistake in your enrollment
- In other life-changing circumstances, such as having a child or getting married
Note: American Indians do not have these restrictions on enrollment.
Visit Covered California
The best way for you to get an idea of what you could get through Covered California is for you to browse its website or call the Covered California call center at 1-800-300-1506 or 1-888-889-4500 (TTY).
You don’t have to sign up for a plan immediately, unless the open enrollment period is about to end. What you should do is research the options listed and get good advice about other alternatives.
Before you start looking into an individual plan, make sure you talk with your employer to see if your family is covered by an employer-sponsored plan. If you are, you will not be eligible to get government help paying for an individual plan.
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Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
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Frequently Asked Questions
Why should I get an individual health plan?
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?
- 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?
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?
“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?
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?
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:
- 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.
- 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.
- 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?
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:
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The government may help pay for your premium through tax credits. That means you would pay less each month. You might get this help no matter what metal your plan is.
- If you make 250% of the Federal Poverty Guidelines (FPG) or less and get a silver plan, the government also pays to reduce your copayments, co-insurance, deductible, and out-of-pocket maximum. That means you 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 does not help you with these expenses.
Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
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: You may 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.
Your family size: | |
Income limits for your family: | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
$15,060 | |
$5,380 | |
Income-based Medi-Cal, adults (138% FPG) | |
Income-based Medi-Cal, children (266% FPG) | |
Subsidized private plans, reduced fees (250% FPG) | |
Subsidized private plans (no income limit) | -- |
If your family's income is at or below the limit for a program, you may qualify if you meet other program rules.
Notes:
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When can I sign up?
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?
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 2024, then you can’t leave that plan until 2025.
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?
Yes, immigrants can get health coverage through Covered California. They may qualify for individual coverage with government help paying for their premiums or for Medi-Cal, depending on their situation.
Note: Medi-Cal was opened to all immigrants on January 1, 2024.
My job offers health insurance, but I don’t like the option they offer. Can I purchase an individual plan instead?
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.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
Try It
Common Pitfalls
Not getting health coverage because you think it will be too expensive
In the past, some people found it impossible to find health coverage that was affordable and met their needs. Now, there should be an option for almost everybody, even if you have a disability. The exact health coverage that will be right for you will depend on things like your family’s income, whether you have access to employer-sponsored coverage, your age, where you live, and whether you have a disability.
If you have the option of employer-sponsored coverage or public health programs like Medicare or Medi-Cal, they are probably your best bet.
If you don’t, you will probably end up getting an individual plan through Covered California and the government may help you pay for that plan. Note: There is no income limit for getting subsidies that help pay individual coverage premiums. (Before 2021, the limit was 400% of FPG for federal subsidies and 600% of FPG for state subsidies.) To get subsidies, you still must meet other eligibility rules and the premium amount you pay depends on your income and your plan.
Note: If you do not have coverage, you may have to pay a tax penalty on your California taxes.
Believing you have to get the same health coverage for every member of your family
There may be situations where it makes more sense for different members of your family to get health coverage in different ways. Do not feel that just because one member of your family gets a certain plan, the entire family needs to get that plan.
For example, let’s say you work for a company that only offers health coverage for you and your children, but not your spouse. You could take the coverage for yourself and your spouse could get coverage on Covered California. Since your employer doesn’t offer coverage for your spouse, your spouse might even qualify to get government help paying for an individual plan through tax subsidies. If your income is low enough, your children could sign up for Medi-Cal, even if you and your spouse don’t qualify for it.
As you can see, in some situations it can make sense for a single family to get totally different types of coverage for different family members.
Getting an individual plan without using Covered California
Covered California is the best option for getting an individual plan. You are still allowed to get insurance through an insurance broker, but there are four big reasons it is better to use Covered California:
- It’s the only place where you can get federal or state help paying for your premiums and other health expenses.
- It will automatically figure out if you or your family is eligible for a public health coverage program like Medi-Cal. If you are, you can sign up for that program instead of an individual plan.
- Covered California has customer services representatives available over the phone at 1-800-300-1506 or 1-888-889-4500 (TTY).
- It’s totally free to use the marketplace to shop for insurance plans – there are no commissions and no hidden fees.
Waiting too long to sign up
Anybody who wants to sign up for an individual plan can do so now, until open enrollment ends.
Usually, you can only sign up for an insurance plan through Covered California during a certain time called open enrollment. To sign up for an individual plan that will cover you during 2025, you must sign up between November 1, 2024 and January 31, 2025.
If you do not sign up during that time, you will usually not be allowed to sign up for an individual plan through Covered California until another year has passed.
There are certain situations when you can sign up for an individual plan through Covered California even though it is not the usual open enrollment period:
- Your household income is at or below 150% of FPG
- If you lose other health coverage you had
- If your health provider is not meeting its obligations
- If your income changes and you gain or lose eligibility for government help paying for your coverage
- If you become a legal resident of the United States
- If you move
- If there was a mistake in your enrollment
- In other life-changing circumstances, such as having a child or getting married
Note: American Indians do not have these restrictions on enrollment.
Getting an individual plan without carefully considering employer-provided coverage or public coverage
If your employer offers you health coverage that would cost you, for your policy alone, less than 8.39% of your family’s income and that coverage meets bronze-level standards, neither you nor your family will qualify for government help to reduce the premium on an individual plan purchased through Covered California.
That means that if you decide to purchase an individual health plan, you will have to pay the full price, which will likely be more than you would have paid had you used the coverage provided by your employer. If your employer, your parent’s employer, or your spouse’s employer offers you health insurance, in most cases it will be less expensive than if you were to buy an individual plan.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.
Buying Health Coverage on CoveredCA
Try It
Next Steps
Learn More about Covered California
- 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) or use the Online Chat feature.
- To get an idea of what coverage options you have and how much your premium could be, check out CoveredCA's Shop and Compare Tool.
- There are organizations that can give you local help for finding the right plan for you.
- If you have a disability, talk to a benefits planner to learn if you have additional options.
- Read the California Department of Insurance's information about health care reform.
- Call the California Department of Managed Health Care at 1-888-466-2219 (TTY: 1-877-688-9891) if you have questions about a health plan.
Getting Help with Your Benefits
If you get Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or Childhood Disability Benefits (CDB), and you're looking for a job, a trained Benefits Planner can help you avoid problems with your job plan. If you need help or have questions about your situation, you can call the Ticket to Work Help Line at 1-866-968-7842 or 1-866-833-2967 (TTY), Monday through Friday.
View DB101's full list of experts who can help you understand different benefits.
Community-Based Organizations
Various community-based organizations guide people through state, federal, public, and private health and income programs. Some organizations may work with specific populations while others work with people with any type of disability. Here are a few examples
Goodwill Industries services range from personal evaluation and office skills training to career counseling, childcare, and transportation. Some Goodwill Industries centers also do benefits planning for people who get SSI, SSDI, and Medicare. Find locations at www.Goodwill.org, or by calling (voice) 1-800-466-3945.
The California Foundation for Independent Living Centers lists centers serving people with all disabilities. Many of these centers do benefits planning for people who get SSI, SSDI, and Medicare. If they don't offer benefits planning themselves, Independent Living Centers can refer you to local benefits planners. Find the list of independent living centers at www.CFILC.org, or by calling (voice) 1-916-325-1690 or (TTY) 1-916-325-1695.
The California Department of Public Health's Office of AIDS lists 1,300 organizations offering HIV/AIDS services throughout California. Some of these organizations provide case management, benefits planning, and benefits counseling services that can include help with public and private benefits programs. You can search the list online, or call (voice) 1-800-367-AIDS (2437) or (TTY) 1-888-225-AIDS (2437).
Disability Rights California provides representation for consumers of public programs who are disabled. Website publications include topics on health care, benefit programs, and In-Home Supportive Services.
Learn more
Employer-Sponsored Health Coverage
Your job, your parent's job, or your spouse's job may offer private health coverage as a benefit.
Medi-Cal
Medi-Cal covers people with and without disabilities who have low income.
Medicare
Medicare is public health coverage for people with disabilities and seniors.