Jeffrey Wade
California offers its residents a variety of health insurance options, including Covered California, the official health insurance marketplace of California, which offers financial help for those who need it. The state also provides free counseling and information on Medicare, as well as assistance with Medicare through California's Health Insurance Counseling and Advocacy Program (HICAP). For those with limited income, the Medi-Cal Program provides free or low-cost comprehensive health coverage. Additionally, California requires all insurance policies to provide coverage for mental health and substance use disorder services, with equal coverage for mental and physical health issues. Individual and family health insurance plans are also available from providers like Anthem, which include coverage for doctor visits, hospital care, and mental health benefits.
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What You'll Learn
How to get financial help with insurance
California residents who are also US citizens or lawful immigrants may be able to get financial help with health insurance via Covered California. The amount of financial help you can get is determined by a sliding scale that depends on your age and geographic region. For example, someone in Southern California may pay a lower premium than someone in Northern California.
To qualify for financial help, you must give Covered California permission to check your income annually. You can also add or remove household members, change your address, and make corrections to your personal information. You can do this by calling 800-300-1506 or by TTY 800-889-4500.
If your income exceeds the limit for financial help, you may still be able to get affordable health care through Covered California. You can also qualify for free or low-cost health insurance through Medi-Cal, which uses the same application as Covered California. Children under 19 can get Medi-Cal even if their parents don't qualify, and children under 19 get free vision and dental care with a Covered California health plan.
If you are already insured but are struggling to pay your medical bills, you can try to make a personal case and plead for financial relief. You can also look for charities, churches, or advocacy groups that may give grants based on need. You can also ask the healthcare billing office for a payment plan.
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What insurance covers
In California, health insurance covers essential health benefits, including preventive care, which helps you stay healthy and catch potential health problems early. Most policies are required to cover certain preventive health benefits with no out-of-pocket expenses, meaning no co-pay or co-insurance, even if you have not met your deductible.
All insurance policies in California must provide coverage for mental health and substance use disorder services, with equal coverage for mental and physical health issues. Insurers cannot charge more for mental health treatment and cannot limit the number of visits or put greater restrictions on mental health treatment than on other medical benefits. This includes covering Applied Behavioral Therapy for Autism Spectrum Disorder.
For those with limited incomes, the Medi-Cal program provides comprehensive health coverage for individuals and families for free or at a low cost. This includes health, dental, and vision care. Children under 19 get free vision care with a Covered California health plan. Medicare Savings Programs can also help pay for premiums, deductibles, and co-insurance fees.
California's health insurance marketplace, Covered California, is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It offers a range of health plans with varying monthly payments and deductibles, including Bronze plans with low monthly payments and higher deductibles for those who only need coverage for medical emergencies.
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Mental health coverage
If your household income is within the 0%-400% Federal Poverty Level (FPL) range and you do not receive full health care coverage through an employer, you may be eligible for financial assistance to reduce your premium. California's health insurance plans are divided into tiers: Bronze, Silver, Gold, and Platinum. These plans cover the 10 Essential Health Benefits, including mental health and substance use disorder services.
Mental health insurance coverage can vary depending on your insurance company, state, and healthcare provider. Generally, you can receive coverage for a wide range of services, including counseling, inpatient treatment, and substance use treatment. For example, you might use these services to talk to a therapist, see a psychiatrist for medication, or be admitted to a rehabilitation facility.
In California, a law was signed in 2021 that requires you to be offered a return appointment within 10 business days when you see a mental health or substance abuse health professional. This law also applies if you are referred by your healthcare provider. Additionally, under Medi-Cal rules, you may be eligible for Specialty Mental Health Services if you meet the access and medical necessity criteria. These services include rehabilitative mental health services, medication support, and crisis intervention.
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Medi-Cal
Some people who apply for Covered California may qualify for Medi-Cal. Covered California is a free service from the state of California that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It is the only place where Californians can get financial help when buying health insurance from well-known companies.
If an individual is notified that they no longer qualify for Medi-Cal, they can call the service center within 60 days to see what their options are with Covered California. They may be eligible for a new plan through Covered California.
All insurance policies sold in California are required to provide coverage for mental health and substance use disorder services. Insurers must provide equal coverage for mental and physical health issues. For example, insurers cannot charge more for a visit to a mental health provider than they would for a similar physical health provider. Insurers cannot limit the number of visits or put other restrictions on mental health treatment that are greater than those for other medical benefits.
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Medicare
Original Medicare forms the foundation of your Medicare coverage and has two parts: Part A (health insurance) and Part B (medical insurance). Part B has a monthly premium. In general, prescriptions are not covered by Original Medicare. To benefit from coverage, you must enrol in Medicare, and the Initial Enrollment Period (IEP) lasts seven months. The IEP begins three months before the month you turn 65 and ends three months after the month you turn 65. During the IEP, you can make more choices about your Medicare coverage, such as bundling your plans with a Medicare Advantage (Part C) plan.
If you are already enrolled in Covered California, California's health insurance marketplace, and become eligible for Medicare, you must take immediate action to avoid financial penalties and gaps in health coverage. People who are eligible for Medicare, even if they do not enrol, are generally not eligible to receive financial help to lower the cost of a Covered California health plan. Therefore, it is important to understand how Medicare fits in with your current coverage and to take note of important dates and deadlines.
There are times outside of the IEP when you can still sign up for Medicare, but you might have to pay a late-enrollment penalty. The GEP allows you to enrol if you missed the IEP, and the SEP is an eight-month period for enrolling in Medicare Part B if you are leaving group, employer, or union coverage.
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Frequently asked questions
Medi-Cal is California's Medicaid health care program. It provides comprehensive health coverage for children and adults with limited income and resources. Depending on your income, you can get free or low-cost health care through Medi-Cal.
You can apply for Medi-Cal anytime throughout the year online or through Covered California.
Most health insurance in California covers a wide range of basic services, also known as Essential Health Benefits. These include preventive care, doctor visits, hospital care, and mental health benefits. All insurance policies in California are required to provide coverage for mental health and substance use disorder services.
Knowing the basics of how health insurance works can help you choose the best plan for yourself or your family. You can shop for individual medical health insurance on the ACA Marketplace at Anthem. Covered California is a free service that connects Californians with brand-name health insurance and is the only place where you can get financial help when buying health insurance.
