Health care reform and you

Learn about the Affordable Care Act and how it impacts you.


The Affordable Care Act (ACA) brings major changes to the healthcare landscape. You now have a new way to shop for health insurance, and may be eligible for government-sponsored financial assistance to help pay for it.

Most U.S. citizens and legal residents are now required by law to have coverage. If you go without health coverage for three consecutive months or longer, you may be charged a penalty by the government. If your income is below a certain level or you have certain religious beliefs, you may be excluded from the share responsibility requirement. You can find information about the individual shared responsibility payment at Covered California.

Here’s a quick guide to some of the most important changes so far. 

  • Most U.S. citizens and legal residents are now required by law to have coverage
  • Young adults can stay on their parent’s health insurance until age 26
  • Adults who were denied coverage because of a pre-existing condition can now get coverage
  • Preventive screenings and services are covered at no cost to you when you use a doctor within your network

Enrolling in a plan

Open enrollment for 2017 coverage begins Nov. 1, 2016, and continues through Jan. 31, 2017. However, Medi-Cal enrollment is year-round. During open enrollment, you can purchase health coverage here, directly from Sharp Health Plan, or through Covered California , a state health insurance marketplace where you can learn about financial assistance and buy subsidized plans.

Outside of open enrollment, you might still be able to enroll in a plan if you’ve had a qualifying event. Qualifying events are certain life changes like getting married, having a baby or moving. 

Visit Covered California or browse and compare Individual and family plans now.

Penalties for being without insurance

If you’re not covered by an employer, or enrolled in a Medicare or Medi-Cal plan, then you’ll need to enroll in a plan to avoid a penalty. If you don’t have health insurance in 2016, you will be fined $325 or 2% of your annual income, whichever is greater. This fine is set to increase in 2016 to $696 or 2.5% of your income.

Learn more 


Essential health benefits made accessible for everyone 

When you enroll in health insurance, healthcare reform limits how much you pay out of pocket for essential health benefits each year, and has eliminated the annual and lifetime limits on the amount a health plan pays out for essential benefits on your behalf. What’s more, there are services that all plans are required to cover such as birth control or breastfeeding support.

Some plans may offer additional coverage, but are not required to by law. Additional benefits for adults include benefits like dental and vision coverage.

View benefits

A few of these services include:

  • Emergency services and hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use services
  • Prescription drugs
  • Preventive and wellness
  • Pediatric oral and vision care

Health care reform means automatic dental and vision care coverage for all children under 19 on your family plan

Vision care for children 

We’re proud to partner with Vision Service Plan (VSP) to provide pediatric policies as supplemental riders to individual, family and group plans. Our youngest members under 19 years old have access to the highest-quality eye care services.

Dental care for children

We partner with top-rated providers to ensure our youngest members have access to high-quality oral care services. Access Dental is our provider for individual, family and small employer group plans, while Premier Access is our provider for both small and large employer groups.

There are no deductibles or copays for many preventive care services, including: 

  • Oral examinations
  • Topical fluoride treatments
  • X-rays
  • Cleanings
  • Dental sealant treatments

You can’t be denied health insurance for your existing conditions

You can’t be denied coverage or charged more for any health or medical condition that you had before your coverage started. This includes pregnancy. If you get pregnant and then enroll in a marketplace plan, care for pregnancy and childbirth is covered when your new plan begins.

Learn more about coverage for pre-existing conditions 


Your right to preventive care

The Affordable Care Act requires that your preventive services, like your well-woman exam, mammography, and screenings for cancer, are covered with no out-of-pocket costs to you. 

See the full list of covered care

Some covered preventive care services include: 

  • Well-woman exams
  • Tobacco use screenings
  • Immunization vaccines
  • HIV screenings
  • Diet counseling
  • Depression screenings


How long can I insure my children under my policy?

Under the Health Care Reform, you can cover your adult children under your insurance policy up to 26 years of age, unless there’s a qualifying reason to require further coverage.

Covered California is California’s health insurance exchange, or local marketplace, where you can find affordable health insurance for you and your family. See if you qualify for financial assistance, browse and shop plans and apply directly on the Covered California website. 

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