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 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:

Individual mandate is back for Californians

In 2020, California will have 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.

More people qualify for subsidies

Starting Jan. 1, 2020, Californians will get new financial help from the state of California
in addition to the financial help they may be eligible to receive from the federal
government to help them obtain health insurance. That means health coverage will be
more affordable for many people next year. With these changes, California will be the
first state in the nation to help middle-income consumers pay for health insurance.

Do you qualify for financial assistance?

The federal government may help you pay for your health coverage from Sharp Health Plan. Your modified gross income and family size will determine your financial eligibility.

Number of people in household	Qualifying annual family income levels
1	$74,940 or below
2	$101,460 or below
3	$127,980 or below
4	$154,500 or below
5	$181,020 or below
6	$207,540 or below

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, you can call Covered California at 1-800-300-1506.

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.

Take me there

More facts about Covered California

Coverage for adult children

Under 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.

Coverage levels

Most health insurance newly sold to individuals and small businesses must now be classified as one of four levels of coverage: Bronze, Silver, Gold or Platinum. In addition to those four levels of coverage, a minimum coverage plan is available to those who are younger than 30 or can provide certification that they are without affordable coverage or are experiencing hardship.

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. 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.

Enrolling in a plan

Open enrollment for health coverage begins October 15 and continues through January 15. However, Medi-Cal enrollment is year-round. Browse, compare and purchase health coverage with Covered California.

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.

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.