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 federal premium assistance to help you buy health insurance in California. That means you may qualify for a discount on a health plan through the marketplace exchange. Here's some helpful information to help you find the right plan for you and your family.

 

Here's a guide to some of the changes:

2018/19 open enrollment dates

Open enrollment runs from October 15, 2018 to January 15, 2019.


No more tax penalties

The individual mandate, the requirement for all to have health coverage under the Affordable Care Act, is no longer in effect. There is no tax penalty. But don't worry, this won't effect your ability to receive financial assistance.


 

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 $48,560 or below
2 $65,840 or below
3 $83,120 or below
4 $100,400 or below
5 $117,680 or below
 6 $134,960 or below 

Tax credits

Tax credits reduce the cost of monthly premiums. If you qualify for Monthly Premium Assistance, you can have your tax credit sent straight to Sharp Health Plan to reduce the amount you pay in premium during the year. You can also pay the full premium during the year and get a tax credit when you file your federal income tax form. It’s your choice.

The amount of tax credit you receive depends on your estimated household income and household size. Individual and families with lower incomes will get the most financial support. This includes individuals and families making up to 400 percent of the federal poverty level.

Cost-sharing reductions

Individuals and families who purchase a plan from Sharp through the Covered California Marketplace—and who have a household income at or below 250 percent of the federal poverty level – might qualify for cost-sharing reductions. If you qualify you can save on out-of-pocket costs with lower deductibles, coinsurance, and copays. 

 

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 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.