Paul Sanchez
There are several ways to apply for medical insurance in California. The state of California set up Covered California to help people and families find affordable health insurance. You can apply for Covered California online, in person, or by phone. You can also apply for Medi-Cal, California's Medicaid health care program, which pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal and Covered California use the same application, so once you apply, you will find out which program you qualify for. Some people who apply for Covered California may also qualify for Medi-Cal.
| Characteristics | Values |
|---|---|
| Application Methods | Online, In-person, Phone |
| Application Time | About an hour |
| Application Website | CoveredCA.com |
| Phone Number | (800) 300-1506 |
| Application Documents | Not specified, but it is recommended to have necessary documents on hand |
| Enrollment Period | Open or Special Enrollment Period |
| Open Enrollment Period | November 1 of the preceding calendar year through January 31 of the benefit year |
| Special Enrollment Period | Applicable if there is a life change such as marriage, divorce, a new child, or loss of a job |
| Eligibility | Income up to 138% of the Federal Poverty Level (FPL) for adults, and up to 266% FPL for children |
| Cost | $0 monthly premiums |
| Health Benefits | Same as Covered California |
| Health Plan Options | Varies depending on the county of residence |
| Health Plan Directory | Medi-Cal Managed Care: Health Plan Directory |
| Health Plan Providers | 23 Medi-Cal managed care plans |
| Additional Benefits | Dental, Pharmacy, Behavioral, and Voluntary |
| Grievance Support | Toll-free number: 1-888-466-2219, TDD line: 1-877-688-9891 |
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What You'll Learn
Medi-Cal and Covered California application
To apply for medical insurance in California, you can apply for health insurance through Covered California or Medi-Cal. These programs have the same application, and you will be informed of the program you qualify for once you apply. Some households even qualify for both.
The application process is simple and can be done online, in person, or by phone. Applying online takes about an hour, and you can proceed at your own pace by saving your application and returning to it later. Before starting your application, ensure you have all the necessary documents on hand to ensure a seamless enrollment process. There are also hundreds of enrollment centers and thousands of certified enrollers across the state who can provide free assistance with the application process.
To qualify for Medi-Cal, you must meet certain income requirements. As of July 1, 2022, all monthly premiums were reduced to $0, and individuals in Medi-Cal will receive the same health benefits as Covered California but at a lower or no cost. For those with higher incomes enrolled in Share of Cost Medi-Cal, certain healthcare costs must be incurred before Medi-Cal pays for medically necessary goods and services. The health plan options available to you will vary depending on the county you live in.
Special enrollment periods are available for certain qualifying life events, such as moving within California and gaining access to a new Covered California health insurance plan, the birth or adoption of a child, becoming a citizen or permanent legal resident, or losing coverage after leaving active duty or the California National Guard.
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Eligibility criteria for Medi-Cal
Medi-Cal is California's Medicaid health care program. It offers free or low-cost health services to eligible individuals. Eligibility for Medi-Cal is based on several factors, including income, age, disability status, and citizenship. Here are the detailed criteria for qualifying for Medi-Cal:
Income Requirements:
- Medi-Cal is designed for individuals with limited income and resources. The income threshold to qualify for Medi-Cal is up to 138% of the Federal Poverty Level (FPL) for adults and up to 266% FPL for children.
- If your income is slightly above these thresholds, you may still qualify for discounted health insurance plans through Covered California.
Citizenship and Residency:
To be eligible for Medi-Cal, individuals must be residents of California. They must also be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents.
Age and Disability:
- Individuals who are 65 years or older, blind, or have a disability may qualify for Medi-Cal. The definition of disability follows the Social Security Administration's criteria.
- Additionally, children with certain disabilities who are not otherwise eligible may still qualify for Medi-Cal coverage.
Pregnancy and Parenting Status:
- Pregnant women and parents may be eligible for Medi-Cal. The program provides coverage for pregnancy and postpartum care.
- Additionally, the County Children's Health Initiative Program (CCHIP) offers comprehensive health, dental, and vision insurance for children up to age 18 who don't qualify for other publicly funded insurance programs.
Supplemental Security Income (SSI):
- Individuals who qualify for SSI automatically qualify for full Medi-Cal coverage. To be eligible for SSI, your countable monthly income must not exceed certain thresholds ($954.72 for an individual or $1,598.14 for a couple).
- If you are aged 65 or older, blind, or disabled but don't qualify for SSI, you may still be eligible for Medi-Cal through the Aged & Disabled Federal Poverty Level (A&D FPL) program. This program has different asset and income requirements.
It's important to note that these criteria are not exhaustive, and there may be additional factors considered during the application process. If you are unsure about your eligibility, you can contact the Medi-Cal service center or seek guidance from a certified enrollment counselor.
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Applying online, in person, or by phone
Applying for medical insurance in California can be done online, in person, or by phone. Here's a step-by-step guide on how to apply through these different methods:
Applying Online:
- Visit the CoveredCA.com website.
- Start your application by creating an account and providing the necessary personal information.
- Have all the required documents ready before starting your application for a seamless process.
- The application process usually takes about an hour to complete.
- You can save your progress and come back to it later if needed.
- Once you submit your application, you will find out if you qualify for health insurance through Covered California or Medi-Cal.
Applying in Person:
- Locate your local county human services agency.
- Gather all the necessary documents and visit the agency during their business hours.
- You can get help with your application and enrol in a suitable plan.
Applying by Phone:
- Call Covered California at (800) 300-1506.
- Have the necessary documents on hand before the call to make the process smoother.
- A certified enroller will guide you through the application process over the phone.
Remember, Covered California and Medi-Cal use the same application. This means that by applying, you will be considered for both programs, and you will be informed of the one for which you qualify. Medi-Cal is California's Medicaid healthcare program, providing medical services for children and adults with limited income and resources.
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Open and special enrollment periods
Open enrollment for Covered California health insurance in California is from November 1 through January 31. Individuals can apply online or get free, confidential help by phone. The application takes about an hour to complete, and individuals will find out whether they qualify for Medi-Cal or Covered California.
Outside of open enrollment, individuals can still sign up for health insurance with a qualified life event. A qualified life event is a circumstance that has occurred within the last 60 days, such as losing one's job and the health benefits that come with it, moving, getting married, or having a baby. A life event is not required for those who are federally recognized American Indians, Native Alaskans, and those who qualify for Medi-Cal. They can enroll year-round.
Some common life events that qualify for special enrollment include:
- Losing Medi-Cal coverage (90-day special-enrollment period)
- Losing employer-sponsored coverage
- Exhausting COBRA coverage
- Turning 19 years old and no longer being eligible for a child-only plan
- Turning 26 years old and no longer being eligible for a parent's plan
- Moving to California from out of state
- Gaining access to at least one new Covered California health insurance plan after moving within California
- A child being born, adopted, or received into foster care
- Experiencing a natural or human-caused disaster, such as wildfires, that has been declared a state of emergency in California
- Losing coverage after leaving active duty, reserve duty, or the California National Guard
- Becoming a citizen, national, or permanent legal resident
- Becoming newly eligible or ineligible for tax credits or cost-sharing reductions while already enrolled in a Covered California plan
- Losing a dependent or dependent status due to divorce, legal separation, dissolution of domestic partnership, or death while already enrolled in a Covered California plan
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Cigna Healthcare plans
Cigna Healthcare offers a range of health insurance plans for individuals and families in California. These include HMO and Network plans, Point-of-Service plans, and other options such as Cigna Health Access, OAP, PPO, Indemnity, HRA, HSA, and Voluntary plans.
Cigna's plans provide access to a broad network of healthcare professionals and facilities throughout California. They offer virtual urgent care from as little as $0.01 and $0 preventive care visits, as well as $0-$3 for preferred prescription drugs on most plans. Cigna also provides access to health coaches and specialty pharmacists to help manage specific conditions.
If you are already enrolled in a Cigna Healthcare plan, you can learn more about your mental health and optometry service options by calling the number on your ID card. You can also find out which doctors are in-network and how to obtain services. To find a doctor, you can use the "Find a Doctor" button on the Cigna website, which will direct you to the Provider Directory. This directory will show you the participating physicians, hospitals, and pharmacies in your specified area.
To apply for a Cigna Healthcare plan, you can visit the Cigna website or contact a Cigna Healthcare sales representative to learn more about the availability, costs, and coverage details. Open Enrollment for 2026 starts on November 1, 2025. During the Special Enrollment Period, which typically runs from January 16 to the end of January, you may be able to shop for a plan if you've had a qualifying life event, such as marriage, a new child, or a recent move.
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Frequently asked questions
You can apply for medical insurance in California online on CoveredCA.com, in person at your local county's human services agency, or by calling Covered California at (800) 300-1506. Applying online takes about an hour, and you can save your application and come back to it later.
Eligibility for medical insurance in California is based on several factors, including income and residency status. Individuals with an income of up to 138% of the Federal Poverty Level (FPL) for adults and up to 266% FPL for children may qualify for Medi-Cal, California's Medicaid program.
The cost of medical insurance in California varies depending on the plan and the individual's income. Individuals with higher incomes enrolled in Share of Cost Medi-Cal must incur certain healthcare costs before Medi-Cal pays for medically necessary goods and services. However, as of July 1, 2022, all monthly premiums for Medi-Cal were reduced to $0.
Yes, there are special enrollment periods for certain life events, such as marriage, divorce, the birth or adoption of a child, losing or gaining a dependent, or a change in residency status. During these periods, individuals can enroll in medical insurance outside of the open enrollment period.
