What’s new with Covered California

Know your coverage options on California’s health care market exchange.

Covered California makes it simple and more affordable for millions of Californians to get quality health insurance that can’t be canceled or denied because of a pre-existing medical condition. It offers a range of plans so consumers can choose the one that best meets their health needs and financial situation.

Covered California is the only place to get premium assistance to help you buy health insurance in California. This means you may qualify for financial assistance on a health plan through the marketplace exchange. Our Sharp Health Plan individual plans are available through Covered California. Here is some helpful information to help you find the right plan for you and your family.

Here’s a guide to some of the changes:

What is the Inflation Reduction Act?

The Inflation Reduction Act expands subsidies (premium assistance), helps lower premium costs and makes health care coverage more affordable.

Find out if you can receive financial help

There are two ways to qualify for assistance: through federal tax credits and/or CA state subsidy.

  • If you are enrolled in benefits with Sharp Health Plan through Covered California: Covered California will notify you and update your premium assistance.
  • If you are enrolled in benefits directly with Sharp Health Plan: Please contact our IFP Sales Team to find out if you qualify.

Individual mandate is back for Californians

California now has a statewide coverage mandate, resulting in a tax penalty for those who do not have health insurance. The penalty is based on 2.5% of household income or a minimum of $695 per adult, whichever is greater.

Financial assistance

Financial assistance reduces the cost of monthly premiums. If you qualify for financial assistance, Covered California provides the assistance directly to Sharp Health Plan, and you are only responsible for the premium Covered California gives you. To find out more, contact our Individual and Family Plans sales team at 1-858-499-8211 or ifpsales@sharp.com.

The amount of financial assistance you receive depends on your estimated household income and taxable household size. Individuals and families making up to 600% of the federal poverty level can qualify for financial assistance.

Cost-sharing reductions

Cost-sharing reductions are a form of financial assistance that lowers out-of-pocket costs including lower deductibles, coinsurance and copays. Individuals and families who purchase a plan from Sharp Health Plan through the Covered California marketplace — and who have a household income at or below 400% of the federal poverty level — may qualify for cost-sharing reductions.

Visit Covered California to see if you qualify and to apply for reduced-cost plans.

More facts about Covered California

Coverage for adult children

Under the Affordable Care Act, you can cover your adult children under your insurance policy until the age of 26, unless there is a qualifying reason to require further coverage.

If your adult child is turning 26, they may stay on your plan until the end of the benefit year (December 31). If your child does not enroll into a new health plan or provide proof of disability, Covered California™ will enroll them into their own health plan for the upcoming year.

If your adult child is disabled and over 26 years old, they may remain on your plan with proof of disability. A disabled adult child refers to a child who is both: (A) Incapable of self-sustaining employment by reason of a physically or mentally disabling injury, illness, or condition, and (B) Chiefly dependent upon the primary subscriber for support and maintenance. For your disabled adult child to remain on your plan, you will need to complete and return a Totally Disabled Dependent Form to Sharp Health Plan. Please contact Customer Care for more information.

Your child can enroll in their own plan by applying on Covered California's website.

Please contact Covered California at 1-800-300-1506, Monday – Friday, 8 am to 6 pm, to remove your dependent(s) from your health plan. You may also visit Covered California's website to find a certified enrollment counselor or agent in your area.

If you have questions, please contact Customer Care at 1-800-359-2002 or email customer.service@sharp.com. We are available to assist you Monday – Friday, 8 am to 6 pm.

Coverage levels

Most health insurance policies sold to individuals and small businesses are classified as one of four tiers of coverage: Bronze, Silver, Gold or Platinum. A minimum essential coverage plan is available to those who are under 30 or are granted a hardship exemption through the federal government. Visit healthcare.gov for more information on hardship exemptions.

Dental benefits

All Covered California health insurance plans offer embedded pediatric dental coverage. This means that dental insurance for children is included in the price of all health plans purchased in the exchange. In addition, Covered California now offers supplemental dental coverage for adults, through optional family dental plans.

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

Difference between Covered California and Medi-Cal

Covered California is the state marketplace for health insurance where individuals and families can shop for plans and receive financial assistance, if eligible.

Medi-Cal is a program that offers free or low-cost health insurance to individuals with low income, and accepts applications year-round. To learn more about Medi-Cal and how to apply, you can find additional information here.

Enrolling in a plan

Open enrollment for health coverage begins November 1 and continues through January 31. However, Medi-Cal enrollment is year-round. Browse, compare and purchase health coverage with Covered California.

Outside of open enrollment, you may 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.

Essential health benefits

All health insurance plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits. These benefits fit into 10 categories, and include services like prescription drugs, mental health care, and emergency services. View all benefits.

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. Some covered preventive care services include:

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

Vision coverage

Covered California offers consumers a pathway to quality vision care. Vision care benefits for children are included in all health plans purchased through the exchange. Vision care for adults is not offered in Covered California health plans, but Covered California works with certain vision insurance companies to offer vision coverage directly to consumers.

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.