Orlando Harmon
If you've lost your Medi-Cal insurance, you can apply for a health insurance plan outside of open enrollment. California's Health Insurance Marketplace, Covered California, offers four different health plan levels: platinum, gold, silver, or bronze. These plans vary in premium cost and benefit levels, but all provide the minimum essential coverage required by the Affordable Care Act. You can apply for health insurance through Covered California if you've experienced a major life change, such as losing your health insurance, within the last 60 days.
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What You'll Learn
Apply for a health insurance plan outside open enrollment
In California, you can apply for a health insurance plan outside of open enrollment if you have experienced certain major life changes within the last 60 days. These include losing your Medi-Cal insurance, losing your health insurance through your job, exhausting your COBRA insurance, and turning 19 and becoming ineligible for a child-only plan. You can also apply outside of open enrollment if you move to California from out of state or move within California and gain access to a new Covered California health insurance plan.
If you have experienced one of these life changes, you can use the special enrollment period to enroll in a new health insurance plan. You can also use this period to make changes to your current plan, such as adding or removing dependents.
It's important to note that most health plans sold outside of open enrollment don't count as qualifying health coverage. This means that if you buy a plan outside of the Marketplace, you won't be able to get premium tax credits or other savings based on your income.
To apply for a health insurance plan outside of open enrollment in California, you can visit the Covered California website or contact their customer service center for more information. You can also use this method to find out if you qualify for Medi-Cal, which offers no-cost or low-cost coverage based on your income.
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Check if you qualify for Covered California
To check if you qualify for Covered California, you must meet the following eligibility criteria:
Residency
Firstly, you must be a California resident. Covered California is the state's health insurance marketplace, so you must live in California to qualify for its plans.
Immigration Status
You must be a lawfully present immigrant to qualify for Covered California. However, individuals who are not lawfully present can still apply to see if they are eligible for a health plan through Covered California or Medi-Cal. While immigrants who aren't lawfully present don't qualify for Covered California, they may be eligible for coverage through Medi-Cal.
Income
Covered California has specific income parameters. To qualify for a government health insurance plan, your household income must be between 0% and 400% of the Federal Poverty Level (FPL). The FPL is issued annually by the Department of Health and Human Services (HHS). California's low-income cutoffs are below $47,520 a year. Families of four earning below the median household income in California ($97,200 per year) qualify for government assistance.
Existing Coverage
You cannot be enrolled in Medicare or have employer-sponsored health care to qualify for Covered California. If you have lost your health insurance through your job, you may be eligible for a special enrollment period outside of the usual open enrollment.
Age
Children under 19 get free vision care with a Covered California health plan. If you are turning 19, you may no longer be eligible for a child-only plan and will need to apply for a new plan. Similarly, if you are turning 26, you may no longer be eligible for a parent's health plan and will need to apply for your own coverage.
Life Changes
You can apply for a health insurance plan outside of open enrollment if you have experienced a major life change, such as moving to California from out of state or within California, gaining access to a new Covered California health insurance plan.
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Learn about health insurance options for small businesses
If you are a small business owner, you can choose from several types of healthcare plans for your business. Small business health insurance, also known as group health insurance, provides small business owners with access to coverage for their employees. It is a critical factor in helping small businesses retain and recruit employees and maintain productivity and satisfaction.
There are five main types of healthcare plans for small businesses:
- HMO (Health Maintenance Organization): HMOs are designed to keep costs low and predictable by only using doctors and hospitals within the HMO network. They typically have low premiums, deductibles, and fixed copays for doctor visits. Primary care physicians (PCPs) are the primary point of contact for all medical care, including specialty referrals.
- PPO (Preferred Provider Organization): PPO networks allow employees to choose where to go for care without a referral from a PCP or the need to use providers in the plan's provider network. However, these plans usually have higher monthly premiums and out-of-pocket costs like copays, coinsurance, and deductibles.
- EPO (Exclusive Provider Organization): EPOs offer a local network of doctors and hospitals to choose from. EPO plans typically have lower monthly premiums but come with higher deductibles when healthcare services are needed.
- POS (Point of Service): A POS plan requires a referral from a PCP before seeing a specialist. This plan covers out-of-network doctors but at a higher out-of-pocket cost than in-network doctors.
- HDHP (High Deductible Health Plan): An HDHP has low premiums but higher immediate out-of-pocket costs. Employers often pair HDHPs with a Health Savings Account (HSA) to offset costs such as deductibles.
In addition to these plans, small businesses can also explore Health Reimbursement Arrangements (HRAs) and group health plans to contribute to their employees' healthcare costs.
When considering health insurance options, small business owners can use resources like HealthCare.gov and UnitedHealthcare to learn more about specific plans, eligibility requirements, and costs.
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Apply for Medi-Cal at your Local County Services Office
If you're looking to apply for Medi-Cal, you can do so at your local County Services Office. This is California's health insurance programme, providing low or no-cost health coverage.
Each county has a different set of health plans available, but all counties provide the same high-quality care. You can find out which health plans are available in your county by checking the online directory of health plans available through Medi-Cal managed care.
To apply for Medi-Cal, you'll need to provide information about your income, as this will determine your eligibility. You can also apply for Covered California at the same time, which offers Bronze plans with financial assistance. If you have recently experienced a major life change, such as losing your job-based insurance or turning 26 and aging out of your parent's plan, you can apply outside of open enrollment.
You can also apply for Medi-Cal online or by completing an application through the mail. If you have any questions about the application process or need help with enrollment, you can contact the DHCS (Department of Health Care Services), which oversees the Medi-Cal programme. They can provide you with the necessary forms and information to complete your application.
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Learn about the different levels of health plans
Health insurance plans are divided into different levels, or categories, that indicate how costs are shared between the insurer and the insured. These categories are often referred to as "metal levels". The four main categories are Bronze, Silver, Gold, and Platinum, with Catastrophic plans being a fifth category for specific individuals.
Bronze plans offer the least coverage, with the insured responsible for paying, on average, 40% of their medical costs. These plans are an affordable way to protect oneself from high medical bills and are a good alternative to having no insurance. They also offer free preventive care and other essential health benefits.
Silver plans are the most popular category, with 54% of the population choosing this option for 2023. They feature higher monthly premiums than Bronze plans, but you will pay less out-of-pocket when you need to see a doctor. Silver plans are also the only option for those who qualify for cost-sharing reductions due to their household size and income.
Gold and Platinum plans have higher premiums as they pay more of your medical expenses. Platinum plans offer the most coverage, with the lowest deductibles and coinsurance amounts.
Catastrophic plans are available to people under 30, some people with limited incomes, and certain people over 30 who meet specific criteria. These plans have very high deductibles (in 2024, $9,450) and must also cover the first three primary care visits and preventive care for free.
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Frequently asked questions
You can apply for a health insurance plan through Covered California, California's Health Insurance Marketplace. There are four different health plan levels: platinum, gold, silver, and bronze.
You can apply for health insurance through Covered California by applying at your Local County Services Office, online at CoveredCA.com, or over the phone.
To qualify for Covered California, you must have experienced a major life change, such as losing your health insurance, moving within California, or turning 26 years old and losing your parent's health insurance coverage.
Covered California offers health and dental options for small businesses with 1 to 100 employees. Children under 19 also get free vision care with a Covered California health plan.
