Most Commonly Asked Questions About Covered California

Open enrollment in full swing, deadline to sign up is Jan. 31

Open enrollment in full swing, deadline to sign up is Jan. 31

Open enrollment for Covered California, the state health insurance exchange, is currently under way.

In response to questions about the future of health care exchanges under the incoming Trump administration, state officials are assuring the public that the program is still open for business. In fact, they are encouraging consumers to renew their policies or sign up if they haven’t enrolled previously. Open enrollment for Covered California began Nov. 1 and ends Jan. 31.


“The benefits for 2017 are there. They are in law and in contracts. The subsidies are there,” Covered California Executive Director Peter Lee recently told reporters.


Since taking effect in 2014, Covered California has helped to reduce the number of uninsured Californians.


If this is your first time looking for coverage through the state health insurance exchange, now is the time to learn more about your options. And if you have been enrolled already, now is the time to renew your health plan or make any changes, including switching to a lower-cost one.


While the deadline to apply or make changes is Jan. 31, you’ll need to act sooner – by Dec. 19 – if you want to make certain your coverage begins on Jan. 1, 2017.


“It’s important to learn more about your options, including physician network, prices, benefits and financial assistance available,” said Marc Reynolds, corporate senior vice president for payer relations at Scripps Health. “Take the time to carefully review all of the options presented through Covered California.”


To help guide you in this process, we’ve answered some of the most commonly asked Covered California questions.


Q: Who can enroll in Covered California?


A: Covered California was designed for state residents who are U.S. citizens or legal U.S. residents, and do not have access to health insurance through a private company, their workplace, a family member’s employer, or a government program such as Medicare or Medi-Cal. If you aren’t covered through one of these options, you can buy health insurance through Covered California.


Q: What health plans are available?


A: Throughout California, you have a choice of buying insurance from at least two but as many as six private insurance companies, depending on where you live. In San Diego County, consumers have at least five insurance companies to choose from during open enrollment. For example, Scripps Clinic and Scripps Coastal Medical Center doctors are in-network providers on the Health Net HMO CommunityCare, Blue Shield HMO Trio and Blue Shield PPO health insurance plans that Covered California offers. Not all providers are in all networks.


Health insurance plans are sold in four primary levels of coverage: Bronze, Silver, Gold and Platinum. While plans vary, in brief you have the option to pay more for your monthly premium and less when you use care, or pay less for your premium and more when you use care. In addition to these metal-tiered plans, a minimum coverage plan is available to people younger than 30.


Q: What if I can’t afford the health insurance premiums or other costs?


A: Sliding-scale financial assistance is available if you cannot afford to pay the full cost of your premiums. Depending on your income, you may qualify for government subsidies to help keep your out-of-pocket expenses down, including copayments, or tax credits to help reduce your monthly premiums if you cannot afford to pay for your full costs. About 90 percent of Covered California enrollees get help to pay for their premiums. In San Diego County, the figure is 87 percent.


Q: What will my Covered California health insurance cover?

A: The Affordable Care Act requires that all newly purchased insurance plans, including those on Covered California, cover essential health benefits such as doctor visits, hospitalization, emergency care, maternity care, pediatric care, preventive and wellness services and chronic disease management, rehabilitative services, mental health and prescriptions. Insurance companies cannot deny access or charge higher premiums if you have a pre-existing health condition or you become ill. Like all ACA plans, Covered California health plans also include pediatric oral and vision care services.

Q: Should I be concerned about rising premiums?

A: Premiums are rising in states with health insurance exchanges for various reasons, including in California. The increases in California have been generally lower than in other states due largely to greater participation by health insurance companies in Covered California, which makes the marketplace more competitive.


It is important to note that as premiums rise so do subsidies for those who need help buying health insurance.


Covered California officials strongly encourage consumers to shop around to find a plan that best suits them and their interest in a particular health care provider, the cost of premiums and the cost of out-of-pocket expenses related to care, such as deductibles.


Q: What happens if I don’t enroll by the deadline?


A: If you haven’t signed up by the deadline and do not qualify for special enrollment, you won’t be eligible to buy health insurance under Covered California until the next open enrollment period in late 2018.


You may also have to pay penalties and fees for not having insurance and those can add up fast. The penalty for tax year 2016 is $695 per adult, $347.50 per child under 18, or up to 2.5 percent of a household’s adjusted gross income, whichever is larger.


You may sign up after open enrollment only if you experience a qualifying life event, such as getting married, having a child, losing health coverage through an employer, or becoming a legal resident.


Q: Where can I get help enrolling in Covered California?


A: You may enroll for health coverage through Covered California online, by phone or in person with free assistance from a certified enroller. Covered California’s website provides links to certified counselors and insurance brokers trained in Covered California insurance plans as well as county offices where you can go for help. Visit the Covered California website: or call (800) 300-1506.