California Health Insurance

This guide will walk you through what you need to know for the 2021 Marketplace enrollment. Whether you are enrolling in an insurance plan through Healthcare.gov, a state exchange or a health insurance broker, these FAQs lay out general and California-specific information to help you understand your choices.

The official 2021 Annual Open Enrollment period is from November 1, 2020, through December 15, 2020. However, California starts its open enrollment period on October 15, 2020, and extends the end date until January 30, 2021.

How to Apply

Covered California is California’s official portal for buying a Health Insurance Marketplace plan. Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you will pay the same price for a plan regardless of where you buy it or whether you sign up via phone, online or by filling out paper forms.

When you sign up for coverage on Covered California, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this information handy:

• Social Security numbers for everyone in your household
• Your employer’s name and address
• Your most recent pay stub or recent records of your wages
• Information about other types of income you receive, such as alimony, unemployment benefits or a pension

Resolving Issues

The California Department of Managed Healthcare exists to help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers.

Residents can file complaints online using this form, or contact the office.

Email:
helpline@dmhc.ca.gov

Phone:
1-888-466-2219

Location:
California Department of Managed Health Care
980 Ninth St., Suite 500
Sacramento, CA 95814-2725

Frequently Asked Questions About the Affordable Care Act

Do I have to buy health insurance?

No. As of 2019 (for which you will have paid taxes in 2020) there is no requirement or penalty for not purchasing health insurance.

U.S. News generally recommends getting health insurance of some kind. Many premiums have changed since last year. So, even if your current plan is still available, research whether another plan might be a better value.

What is the penalty if I don’t have insurance?

Starting with the 2019 Marketplace, for which taxes are due in 2020, there is no longer a tax penalty for not having health insurance.

What are my options for buying a 2021 Marketplace health plan?

You’ll find health plans in as many as four coverage levels, commonly called metal tiers: platinum, gold, silver and bronze. Platinum plans charge high premiums but offer the best cost-sharing benefits, covering an average of 90 percent of health expenses incurred. On the other hand, bronze is the least expensive plan type but only covers an average of 60 percent of incurred health expenses.

Those younger than 30 may purchase a catastrophic plan without qualifying for an examption. Those over 30 may enroll in a catastrophic plan but only if you qualify for a hardship exemption. Read more about this at Healthcare.gov .

Am I eligible to buy insurance on the 2021 Marketplace?

You are eligible to buy coverage if you are a U.S. citizen, a U.S. national or an immigrant lawfully living in the U.S.

Those who are incarcerated or who are living in the U.S. illegally are not eligible to purchase coverage. You may purchase insurance through the exchanges if you are eligible for employer-sponsored coverage, though you likely wouldn’t be eligible for subsidies.

Do I qualify for a health insurance subsidy?

Your expected income and household size determine whether you can receive subsidies.

If you qualify for the premium tax credit, you can use it to reduce the cost of your monthly premium upfront, receive the amount when you file your taxes or opt for a mix of the two. When you enroll in a Marketplace insurance plan, you can choose what you’d prefer. The lower your income is, the larger your credit will be. Read the IRS’ Q&A on the premium tax credit to learn more.

Cost-sharing subsidies , which reduce what you pay for deductibles, copayments and coinsurance, are still available in 2021. Those who are eligible for cost-sharing subsidies must pick a Marketplace silver plan to use them. There are special cost-sharing rules for American Indians and Native Alaskans.

Even if you don’t qualify for a subsidy, you can still purchase a plan on Covered California.

I hardly ever get sick. Can I opt for a catastrophic plan to save money?

It depends on your age and your financial situation. Catastrophic plans, which have cheaper premiums but high deductibles, are only available to adults younger than 30 and those who qualify for a hardship or affordability exemption.

What is Minimum Essential Coverage and do all Marketplace plans offer these?

Minimum Essential Coverage (MEC) is a set of essential health benefits and qualifications offered by all Marketplace plans, and the minimum requirement to be considered healthcare coverage by the Affordable Care Act (ACA).

Insurance plans must provide 10 essential health services in order to meet the Affordable Care Act requirement for healthcare coverage—these include emergency services, prescription drugs, laboratory services and hospitalization. Coverage for pre-existing conditions are also required for all Marketplace plans. For a full list of these essential benefits, see the Marketplace information at Healthcare.gov .

Due to the end of the individual mandate fee in 2019, you may buy a health plan outside of the Marketplace that does not provide Minimum Essential Coverage without incurring a fee.

What are short-term plans and are they offered in the Marketplace?

Short-term plans are lower-cost health plans that tend to offer less coverage. These plans are intended for those who wish to save money on medical care, or are looking for temporary medical coverage before enrolling in a different health plan. Short-term plans are not offered in the Marketplace because they do not meet the Affordable Care Act’s standard of coverage and benefits. However, due to a 2017 Executive Order and changes in Department of Health and Human Services regulations, short-term health insurance policies have changed and are being offered in some states by private insurers. Currently, short-term plans have a maximum initial term of 364 days, with an option to renew for a total term of 36 months.

I had a stroke last year. Can I still get covered?

Under the Affordable Care Act, insurers are not allowed to deny coverage based on pre-existing medical conditions.

I’m unemployed. Where do I get coverage?

If you are unemployed, you might qualify for Medicaid or a subsidy to help cover the expense of a private health insurance plan. You could also apply for an exemption. Which programs or subsidies you are eligible for depend on your household size and income, not your employment status. If you are receiving unemployment compensation, you will need to report the expected amount when applying for coverage.

Do I have to be on the same plan as my spouse?

No. The Affordable Care Act does not require that spouses be on the same plan. However, if you are looking to qualify for tax credits to help you pay for your insurance, your total household income will be considered.

Last updated by Staff, U.S. News | October 12, 2018 Scroll back to top