Covered California
Open enrollment is from Nov. 1 through Jan. 31.
Open enrollment is from Nov. 1 through Jan. 31.
Covered California is a free service that connects Californians with brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place where you can get financial help when you buy health insurance from well-known companies. That means when you apply, you may qualify for a discount on a health plan through Covered California, or get health insurance through the state’s Medi-Cal program. Either way, you’ll have great health coverage.
CoveredCA.com is sponsored by Covered California and the Department of Health Care Services, which work together to help Californians get the coverage and care that are right for them.
Most Immigrants Qualify for Health Coverage
Under the Affordable Care Act, most immigrants qualify for health coverage, including the following groups:
Lawful permanent residents (green card holders).
Lawful temporary residents.
Persons fleeing persecution, including refugees and asylees.
Other humanitarian immigrants, including those granted temporary protected status.
Non-immigrant status holders (including worker visas and student visas).
Everyone Can Apply
As of Jan. 1, 2024, adults in California ages 26 through 49 will be allowed to qualify for Medi-Cal, regardless of their immigration status. All other Medi-Cal eligibility rules, including income limits, will still apply. Find out more on the Department of Health Care Services website.
A recent federal rule change will allow Deferred Action for Childhood Arrivals (DACA) recipients who meet all other eligibility requirements to enroll in a health plan through Covered California starting Nov. 1, 2024. Eligible DACA recipients can receive financial help if they qualify.
Both lawfully present and not lawfully present individuals can apply through Covered California to see if they are eligible for a health plan through Covered California or Medi-Cal. There is no “waiting period” or “five-year bar.”
To apply for health insurance, call (800) 300-1506 or apply with a certified enroller or your county. Get information on applying for Medi-Cal.
People under age 26 can stay on a parent’s health plan.
People under 30 have special options for health insurance. They can buy a minimum coverage health plan (also known as a catastrophic plan). These plans are inexpensive and protect you from staggering medical bills in case of an emergency. Preventive care is free under these plans. They have high deductibles, which you’ll have to meet before emergency medical care is covered 100 percent by your plan.
If someone claims you as a dependent, you can buy a plan through Covered California, but it won’t come with financial help, no matter what your income.
Students should explore the option of enrolling in a student health plan.
Medi-Cal was expanded to accept more people in 2014. Use the Shop and Compare Tool to find out if you’re eligible for free or low-cost health insurance.
Pregnancy and childbirth services are covered under all plans available through Covered California and Medi-Cal.
Having a baby means you qualify for special enrollment – in other words, you can enroll through Covered California even if it’s outside the normal open-enrollment period. Your plan would be effective the day your baby is born.
Becoming pregnant doesn’t qualify you to apply during special enrollment, but California offers other programs that can help you.
Do you already have a plan through Covered California? Once your baby is born, you can add your child to your current plan, or you can switch to a new plan.
Most students, unless they qualify for an exemption, will have to purchase health insurance or they will be subject to a tax penalty.
A student may be eligible for an exemption, for example, if a student is not lawfully present in the United States or if they do not file taxes because they are below the tax filing threshold.
A “student health plan” refers to a special policy of health coverage that colleges and universities make available to their enrolled students. Typically, the student health plan is different from the employer-sponsored group coverage that colleges and universities offer their faculty and staff.
Student health plans count as health insurance coverage (e.g. “minimum essential coverage”) under the Affordable Care Act. Therefore, for the months consumers are enrolled in student health coverage, they will not have to pay a penalty.
If students have a “fully insured” student health plan, that plan does have to cover all 10 of the essential health benefits,” including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and services for children, including dental and vision care. Generally, fully insured plans must also offer contraceptives without cost-sharing (meaning no co-pays, etc.). A fully insured plan is one that your college or university purchases from a health insurance company.
However, if the student health plan is “self-insured,” it might not be required to cover essential health benefits. Consumers should check with their college to find out what type of student health plan it offers.
Students can opt out of their student health plans and purchase coverage through Covered California. Depending on income, students may receive tax credits to help pay for a private health plan through Covered California or receive low- or no-cost coverage through Medi-Cal.
If, however, students accept and enroll in the school’s health insurance plan, they will not be eligible for tax credits through Covered California while they are covered by their school’s plan. When students are considering whether to enroll in their school’s health insurance plan or a Covered California health plan, they should consider the location of clinics/doctors and the costs of accessing services.
If students are under 30, they may be able to buy an additional health insurance plan option called a minimum coverage plan. These minimum coverage plans usually have lower premiums and mostly protect consumers from worst-case scenarios. Catastrophic plans through Covered California cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until an individual spends $8,150, after which all in-network services are covered at 100 percent.
For a Covered California health plan, as long as students are a tax dependent of their parent(s) or under the age of 26, their eligibility for student health coverage does not make them ineligible to be covered on their parent’s family health plan.
When making this decision, students should consider their parent’s insurance coverage network. If students attend a school that is far away from their parent’s home, their parent’s health insurance may not cover medical services provided to them while they are away at school. Students should speak with their parent’s health insurance plan for more information. If the student is going to school outside the state of California, only emergency services may be covered by a Covered California health insurance plan. Non-emergency services received outside the state of California will not be covered.
If students are claimed as a dependent on their parent’s taxes and choose to opt out of their student health coverage, their parent’s Covered California family plan would still be eligible for tax credits. Additionally, if students choose to stay or accept their student health plan, their parents would still be eligible for tax credits through Covered California, if otherwise eligible. However, parents must correctly state on their application that although their child (the student) is a tax dependent, they are not seeking health coverage through their (the parents’) Covered California health plan.
However, a student considering opting out of their student health plan to take part in a family plan through Covered California should consider the coverage network. If the school they attend is far away from the parent’s home, the parent’s health insurance may not cover medical services while the student is away at school. Students considering this option should speak with their parents’ health insurance plan for more information.
If students are tax dependents, they can be covered under their parents’ Covered California health plan, no matter where they live. However, Covered California does not offer any health plan products that have a network of doctors, hospitals or other health care providers outside of California at this time. Therefore, if the school the student attends is out-of-state, the parent’s health insurance will not cover most medical services while the student is away at school. The exception being that all emergency services must be covered at the in-network price, even if the service was received out of state. Students considering this option should speak with their parent’s health insurance plans for more information.
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