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Most Commonly Asked Questions About Covered California

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

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

Open enrollment for Covered California, the state health insurance exchange, is currently under way. Covered California Open Enrollment 2020 runs through Jan. 31. Consumers who choose to go without coverage could face a penalty when they file their state taxes for 2020 in the spring of 2021.


Officials recently announced new state subsidies and a renewed push to increase access to affordable care for more people in California. Consumers who qualify through Covered California can get financial assistance on a sliding scale to reduce premium costs.


“Whether you never thought you could get financial help, or if you have checked before, you need to check again because there is new money available that may dramatically reduce the cost of your coverage,” Covered California Executive Director Peter Lee recently said.


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 Covered California, now is the time to learn more about your options. If you’ve 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. 15 — if you want to make certain your coverage begins on Jan. 1, 2020.


It’s important to learn more about your options, including physician network, prices, benefits and financial assistance available. 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 US 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.


Insurance companies cannot deny access or charge higher premiums if you have a pre-existing health condition or you become ill.

Q. When can I sign up for health insurance?

A: Covered California Open Enrollment 2020 began Oct. 15 and runs through Jan. 31, 2020.


Individuals with qualifying events can enroll at any time of the year. Qualifying events include loss of insurance coverage, a move to or within California, recent marriage or domestic partnership, recently had a baby or adopted a child.

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, Scripps accepts many health plans available directly through health insurance brokers and Covered California. 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. Plans vary. You have the option to pay more for your monthly premium and pay less when you use care, or pay less for your monthly premium and pay 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 and household size, you may qualify for government subsidies to help keep your out-of-pocket expenses down, including copayments, or qualify for tax credits to help reduce your monthly premiums if you cannot afford to pay for your full costs.


California has expanded subsidies for households with income between 400 and 600 percent of the federal poverty level, or up to $74,940 for an individual and up to $154,500 for a family of four. This is expected to help many middle-income families, including small-business owners and the self-employed, who previously did not qualify for financial help because their incomes exceeded federal limits.


Californians with very limited incomes may be eligible for Medi-Cal.

Q: What will my Covered California health insurance cover?

A: The federal Affordable Care Act requires that all newly purchased insurance plans, including those on Covered California, cover what is known as essential health benefits: doctor visits, hospitalization, emergency care, maternity care, pediatric care (including dental and visual coverage), preventive and wellness services and chronic disease management, rehabilitative services, mental health and prescriptions.


Dental and vision coverage for adults are offered separately.

Q: Should I be concerned about rising premiums?

A: Premium increases in California have been generally lower than in other states due largely to greater participation by health insurance companies in Covered California, which has made the marketplace more competitive. Eleven insurance companies currently participate in the marketplace. Premium increases were projected to be under 1 percent for 2020, the lowest increase since the program started, and much lower than the five-year average increase of 7.9 percent.


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 2020.


You may also have to pay penalties and fees for not having insurance and those can add up fast. California earlier this year enacted legislation to restore the individual mandate penalty for the upcoming 2020 coverage year. People who choose to go without coverage they can afford in 2020 will be subject to paying the penalty when they file their state taxes in the spring of 2021. The state mandate is being administered by the California Franchise Tax Board.


The state penalty will match what the federal penalty was before Congress eliminated it in December 2017 and which became effective in 2019. It amounts to 2.5 percent of household income or $695 per adult, whichever is greater, with a family maximum of $2,100.

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: www.coveredca.com or call (800) 300-1506.