Covered California
Open Enrollment takes place each year during the fall. If you do not have a "qualifying life event" you must wait until open enrollment to enroll in a Covered California Plan. However, Medi-Cal enrollment is open year round.
Special Enrollment is always open for people who have a qualifying life event, to enroll in a Covered CA plan or make changes to their current plan. Coverage begins after completing the application process. For information on qualifying life events: www.coveredca.com/individuals-and-families/getting-covered/special-enrollment/. Medi-Cal: Remember that Medi-Cal is open all year and may be retroactive for medical services used in the prior three months. Remind clients to respond to any re-determination letter they have received from Medi-Cal to maintain their Medi-Cal status. Pediatric Dental coverage is included in Covered CA plans, ask your health insurance provider for more information. Pregnant Women: There are several public and subsidized insurance options for pregnant women, regardless of immigration status. Read more here: www.coveredca.com/individuals-and-families/getting-covered/pregnant-women. Note: The Covered California website, Medi-Cal and Covered California use the same application. After the client enters information, they find out whether they qualify for Medi-Cal or Covered California. Anyone can determine their eligibility in advance at: https://apply.coveredca.com/lw-shopandcompare/. |
Need Help?
Download the Family Resource Center Directory and contact the appropriate Family Resource Center for help from an advocate or other staff member.
Family Resource Centers can help with non-medical needs too, such as food, clothing, and shelter. |
Enrollment Assistance
The Access Support Network, Community Health Centers of the Central Coast, and CAPSLO are certified enrollment counselors and can help with Covered CA applications, free of charge. Find these and other non-profit enrollment assisters at: https://apply.coveredca.com/hix/entity/locateassister/searchentities
The Public Health Nurse Navigator Program also helps with Covered CA applications, free of charge: www.slocounty.ca.gov/Departments/Health-Agency/Public-Health/All-Public-Health-Services/Health-Care-Access-Health-Care-Navigation.aspx.
To locate a Covered CA-certified insurance agent in your town, click here. Certified Insurance Agents may have specialized knowledge about which providers and medications are covered by each plan that would be helpful for people with more complex medical situations. This service is also free of charge.
The Public Health Nurse Navigator Program also helps with Covered CA applications, free of charge: www.slocounty.ca.gov/Departments/Health-Agency/Public-Health/All-Public-Health-Services/Health-Care-Access-Health-Care-Navigation.aspx.
To locate a Covered CA-certified insurance agent in your town, click here. Certified Insurance Agents may have specialized knowledge about which providers and medications are covered by each plan that would be helpful for people with more complex medical situations. This service is also free of charge.
Income Levels
Access to sliding scale health insurance is available through Covered CA for adults with income levels between 138% and 400% of the Federal Poverty Level (FPL) and children with income levels between 266% and 400% of the FPL (adults and children with incomes below these amounts are eligible for Medi-Cal coverage). The sliding scale cost is covered by advance premium tax credits. Eligibility for tax credits is determined using last year's FPL. Use the Covered CA website to determine eligibility: https://apply.coveredca.com/lw-shopandcompare/.
Both individuals and families can purchase sliding-scale insurance through Covered CA. For example, if a child is covered by Medi-Cal, the parents can purchase insurance through Covered CA. Or if an adult has insurance through their employer, insurance for their child can be purchased through Covered CA if the employer does not offer dependent coverage.
Families with incomes above 400% of the FPL can also purchase policies through Covered CA or through an independent broker but will not receive subsidies.
Both individuals and families can purchase sliding-scale insurance through Covered CA. For example, if a child is covered by Medi-Cal, the parents can purchase insurance through Covered CA. Or if an adult has insurance through their employer, insurance for their child can be purchased through Covered CA if the employer does not offer dependent coverage.
Families with incomes above 400% of the FPL can also purchase policies through Covered CA or through an independent broker but will not receive subsidies.