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Covered California Q&A

Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


October 2016 Archives


Question: I am leaving my current job in a few weeks to relocate to southern california to help my family out and my health coverage will discontinue as of December 2016. I will be doing a 13 week temp job and then am unsure of my employment thereafter. I am wondering if I can sign up for Covered California now so that i will have coverage through my temp job and thereafter?

Answer: Starting on November 1st, you can apply for Covered California coverage to be effective January 1, 2017. You will need a California address. Your initial premium assistance will be based on the monthly income from your temp job. When your income changes again during the year, you can update your Covered California account at that time.


Question: I qualified for Silver 94 for 2016. My income and household size will stay the same for 2017, but CC only give me the option for Silver 87. Why is that?

Answer: Households with income 139% to 150% of the Federal Poverty Level (FPL) are eligible for enhanced Silver 94 Plans. Your income was in that range in 2016, but apparently it is now between 151% and 200% FPl making you eligible for enhanced Silver 87 plans. Have a look at the income section of your Covered California account. You will probably find that your income has been increased. Covered California can and does change income figures when they receive data from the IRS that does not match your income estimate.


Marital Separation Eligibility?

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Question: I just separated from my husband, living on my own. I make $25,000/year income myself. We filed taxes together last year. Will I have a problem enrolling in a plan for 2017? I don't have an individual income tax return to show. I am wondering how that works.

Answer: You can be eligible for Covered California coverage for 2017 as a 1-person household, if you get divorced and file a single taxpayer return for the 2017 tax year. Married filing separately will not work.


Question: I recently got married, my husband has been receiving Covered California benefits and I have been on MediCal. I just signed a contract with a school district today that offers health coverage for both of us. I plan to sign up for benefits for myself, but is my husband required to accept my employer health coverage as well? Will we be penalized during tax season for the 3/4 of a year that we were receiving assistance before getting benefits?

Answer: While your husband is not required to accept your employer-based health coverage, he will no longer be eligible for premium assistance through Covered California. He will not be penalized for receiving subsidized coverage in 2016. However, if you are filing a joint tax return for 2016, your combined income may result in a subsidy "overpayment" for him which you will have to repay as part of your 2016 federal income tax.


Question: How do I get a new password for my CoveredCA account?

Answer: You can reset your password by clicking “Account Sign In” and then clicking the “Forgot Your Password?” link. Enter your user name. After you correctly answer your security questions, you will be able to enter a new password. If you do not remember the answers to your security questions, it is best to leave them unanswered and call the Covered California Service Center at (800) 300-1506. A Service Center representative can help reset your password.


Cancel VA for Covered California?

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Question: I been on VA coverage for years. It sucks, but the price is right, especially the prescription drug prices. With my income, I could buy an enhanced silver plan for under $100/mo. Can I switch?

Answer: Yes. You can cancel your VA coverage and enroll in Covered California coverage. The first thing to consider is the cost tradeoffs. Va coverage has $0 monthly premium and almost $0 out-of-pocket costs except for prescription drugs which by law a considerably lower than commercially available plans.

Your fair share premium, lets say $90 for a Covered Ca policy would be due monthly, but on top of that you will have out-of-pocket expenses when you use your benefits. An enhanced Silver Plan on Covered California will cover 70% to 94% of your medical expenses depending on your income. Let’s say you have a $10,000 medical expense, at best with 94% coverage, you would be on the hook for $600, at worst with 70% coverage, you would have to pay $3,000

If you choose to cancel your VA coverage and enroll in a plan through Covered California, you can reapply for enrollment in VA health care at any time, but you should keep in mind that returning to the VA for health care enrollment will be based on eligibility factors at the time of their application, which may result in a denial of enrollment.


Question: Some of our family are undocumented. Can they apply for Covered California health care?

Answer: Immigrants who are not “lawfully present” are not eligible to purchase a health plan through Covered California; however, they may be eligible for coverage through Medi-Cal.

Individuals who are not lawfully present may apply for coverage through Covered California for their lawfully present family members (such as a dependent child), who may be eligible for coverage through a Covered California plan or through Medi-Cal.

Additionally, Covered California encourages any U.S. citizen or person who is lawfully present to apply for health care coverage through Covered California even if they have family members in their household who are undocumented or not lawfully present. Families with mixed immigration status can still apply for health coverage through Covered California.


How to Renew Medi-Cal?

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Question: My son is on Medi-Cal. What do I have to do to make sure he is renewed for 2017?

Answer: Medi-Cal coverage is renewed throughout the year on the anniversary of the person’s enrollment in Medi-Cal. This means that a Medi-Cal renewal may not coincide with a Covered California open enrollment. Your son will receive a Medi-Cal renewal form from his local county human services agency. Complete this form and mail or fax it, along with any needed information the county requests, to your local county human services agency. You can also renew by visiting your county human services agency in person or by calling the phone number on the renewal notice.


Question: I got a renewal notice from Covered California last week. It seemed to say that I don’t have to do anything and I will be renewed. Is that correct? What if I want to change plans?

Answer: Yes. If you take no action to actively renew or change plans, you will automatically be renewed, 30 days after the date on your renewal notice, into the same plan you had in 2016. During open enrollment, you have two options to renew your health plan through Covered California: (1) If you want to keep your same health plan and coverage, Covered California will automatically check your information with federal government data sources and renew your coverage with the same health plan. You will be automatically renewed in the same health plan, if it is still available, with the appropriate tax credits, as long as you have filed your taxes the previous year. (2) To make changes to your coverage or switch health plans, either log on to your Covered California online account or contact your Certified Insurance Agent or call Covered California at (800) 300-1506 to make the change. If you decide to shop for a new plan, be sure to log into your account prior to using the tool, so your selection can be saved. If you add a plan to your shopping cart before you are signed in, your selection will not be saved.


Question: Can you give me a quick outline of the benefit changes in Covered California plans in 2017?

Answer: In 2017, Covered California health plans have improved benefit designs by reducing the number of services that are subject to a deductible. People in Silver, Gold and Platinum plans will pay a flat copay for emergency room visits without having to satisfy a deductible. Urgent care costs in every plan will be same as the primary care visit. People in Silver 70 plans will save as much as $55 on an urgent care visit and $10 on a primary care visit. Even people in the most affordable Bronze plans can now see their doctor or a specialist three times before the visits are subject to the deductible.


Question: I will be eligible for Medicare starting in January. Can I stay in Covered California and keep gettin my subsidy instead or as a supplement to Medicare?

Answer: If you are eligible for Medicare, you cannot purchase a Covered California health plan and get premium assistance. However, if your income is low you may still be eligible for Medi-Cal. The Covered California application automatically checks to see if consumers qualify for Medi-Cal. If you qualify for both Medicare and Medi-Cal, Medi-Cal will help pay for Medicare premiums and cost-sharing requirements. Medi-Cal may cover additional benefits, such as dental services, nursing home care, and personal care services. Medi-Cal may also provide extra financial assistance to help with the cost of Medicare Part D prescription drug coverage.


Question: I received notification from Anthem Bluecross that an 36% increase is coming for 2017 1/1/17, I don't understand why such an increase, could you possible know why?

Answer: There are two primary reasons. (1) Since 2014, the federal government has reimbursed health insurers who enroll higher-cost consumers in their plans through a reinsurance program. In 2017, those reimbursement payments will end. (2) Insurers now have a better understanding of the risk pool. In previous years many insurers set premiums too low to cover their actual costs. Even so, 2017 premium increases in California are lower than in most other states.


Question: I'm applying for myself and my husband. I currently have a job and indicated income for myself on the application, however my husband is temporarily unemployed. Even though I didn't claim any income under his name, after I submitted my application I was asked to submit proof of income for him.From the look of it, my application won't be considered "complete" until all documents have been submitted, so I'm really not sure what to do.

Answer: Generally you have 90 days to submit the proof of income. My guess is that the eligibility screen is locked up due to the reason code chosen during the Special Enrollment Period, not due to the need to show proof of income. I strongly recommend that you find a Certified Insurance Agent to help you with the application. It doesn't cost you anything and will save you considerable grief.


Question: I lost my job in Nov 2015. I projected our 2016 income to be $33,000 which includes my husband's annual social security of $13,000. My unemployment ran out in July in which I collected a total of $10,800 making our gross 2016 income of $24,000. I have yet to get another job and have not had an interview. With tax exemptions our adjusted gross income will be below 138% of FPL. We have Silver PPO. How will this affect the ACA subsidies I've received to date and premiums I paid?

Answer: In 2017, you will be eligible for Medi-Cal. You will not have to pay back any of the advanced premium tax credits you received in 2016.


Question: I currently have insurance through Covered California (signed up Dec 2015). I have KP Silver 94 HMO plan. I'm trying to predict if I'm going to be dropped into MediCal based on my tax return for year 2015 which I'm close to completing and will be turning in soon, prior to extension deadline of Oct 17. It looks like my AGI will be around $17,480. Will I still qualify for Covered California...especially in consideration of any new changes to income qualifications during the upcoming enrollment period this fall 2016?... ...or will I be dropped into Medical?

Answer: In 2017, the annual income cut-off for Medi-Cal eligibility for a one-person household is $16,394.40, a two-person household is $22,170.60, a three-person household is $27,820.80, and a four-person household is $33,534.00.


Question: Is Covered California an insurance company? If so why dies it sell other insurance company products?

Answer: No. Covered California is a health insurance exchange governed by the State of California. Covered California has the power to regulate the insurance companies who participate in the state exchange. It provides a platform for Californians to get brand-name health insurance under the Affordable Care Act. Covered California is the only place Californians can qualify for financial subsidies from the federal government to help them pay their monthly premiums.


Question: What if I don’t have health insurance?

Answer: You may have to pay a tax penalty if you are deemed able to afford health insurance. The “shared responsibility payment” is a new tax penalty that Americans have to pay if they can afford health insurance but choose not to buy it. It’s called a shared responsibility payment because everyone in the United States is now required to be part of our health insurance system - buying health coverage for themselves and their families rather than relying on others to pay for their care. Those who don’t buy health insurance in 2017 may be subject to the penalty, which is $700 per adult and $350 per child, to a maximum of $2,085. or 2.5 percent of their income, whichever is greater.


Question: My friend has Anthem Blue Cross through Medi-Cal. How does that work?

Answer: Medi-Cal offers 22 managed care health plans, some of which are also offered by Covered California. Your choices depend on the county in which you live. Most counties offer commercial plans, including Anthem Blue Cross, Kaiser, Health Net, and Molina, as well as local not for profit health plans like L.A. Care. In some counties, one public plan is available and all Medi-Cal members are enrolled in that plan. An example is Cal Optima health plan in Orange County. Every county’s Medi-Cal plans provide the same high quality care to Californians at low or no cost, no matter where you live. The directory of Medi-Cal health plans will give you more information about your specific county.


Is Medi-Cal Any Good?

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Question: What is the difference between Covered California and Medi-Cal?

Medi-Cal is good health coverage. A recent survey of Medi-Cal members by the California Healthcare Foundation found that 90% of the members who answered rated Medi-Cal as a good or very good program. Medi-Cal emphasizes prevention-oriented health care that promotes health and well-being and works to ensure that members receive the right care at the right time. Your health care will be free or at a lower cost to you and your family. You can apply online at CoveredCA.com. A single application will let you know if you qualify for Covered California or Medi-Cal coverage. You can also apply in person at your local county human services agency or over the phone by calling (800) 300-1506. If you are determined eligible, Medi-Cal will mail you a packet of available health plans to choose from.

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