Covered California Questions & Answers

Experts Answer the Most Common Covered California Questions Asked About The Affordable Care Act

What plans can I choose from? 

  1. Bronze Plans
  2. Silver Plans
  3. Gold Plans
  4. Platinum Plans
  5. Catastrophic Plans

Please note that this list provides only the plan types and does not include specific details or variations within each plan type.

Covered California plans

How do I get my 1095-A form?

If you enrolled in a health plan through a Covered California Enrollment Center, you have an alternative option to obtain your 1095 form. In addition to accessing it online through the Covered California website, you can visit the Enrollment Center where you enrolled and request a copy of your 1095 form in person.

1095-A form

What if I can’t afford health insurance?

If your income is below the threshold established by the Federal Government, you and your family may be eligible for insurance coverage through Medi-Cal. Additionally, individuals who do not meet the requirements for Medi-Cal may still be eligible for significant subsidies to help make their insurance more affordable.

What if my income is too high for Medi-Cal?

If your income exceeds the eligibility threshold for Medi-Cal, you have options such as:

  • Employer-sponsored health care plan
  • Private health insurance
  • A plan through the Covered California Exchange

What does the Affordable Care Act require of me?

The ACA initially included an individual mandate. However, as of 2019, the penalty for not having health insurance was reduced to $0, effectively eliminating the individual mandate. In response, California instituted an Individual Mandate, which went into effect on January 1, 2020. Therefore requiring residents to maintain qualifying health insurance coverage or be penalized. 

Can I insure my 23 year old daughter?

Yes, you can generally insure your 23-year-old daughter on your Covered California plan, provided she meets certain eligibility criteria. The eligibility rules for dependents on a Covered California plan are based on several factors, including age, marital status, and tax filing status. In general, if your daughter is 23 years old, married, and files income taxes jointly with her husband, she would not typically qualify as a dependent under your Covered California plan.

I no longer qualify for Medi-Cal. What do I need to do to get health insurance?

Please reach out to our enrollment center or visit our office, and we will assist you in enrolling for new health insurance. If you have been released from Medi-Cal within the last 60 days, you qualify for special enrollment and can enroll immediately. However, if it has been over 60 days since your release from Medi-Cal, you may need to wait until the next open enrollment period.

I live with my boyfriend. Can we get a plan together?

Yes, if you meet certain eligibility criteria. Covered California allows individuals to apply for coverage as a household, and you may be eligible to apply as a household if you meet the following requirements:

  1. You must be legally recognized as domestic partners or spouses.
  2. You must file taxes jointly.
  3. You must be able to demonstrate that you share a primary residence.

What if I underestimate my income for the year?

if you have underestimated your income for the year while recieving a subsidy, you may have to repay some or all of the subsidy you received if your income increases substantially. However, there is a cap on how much you have to repay, and it is essential to report changes in income to Covered California as soon as possible.

Read more about estimating income

When will my insurance begin?

  1. If you enroll during the Open Enrollment Period, which typically occurs between November and January each year, your coverage will generally begin on January 1st of the following year.
  2. Special Enrollment Period: your coverage can begin either on the first day of the month following your enrollment.

Read more about effective dates 

If I choose to go with a Covered California Plan, is there any financial assistance available?

Yes! Individuals with lower incomes often qualify for subsidized plans. To qualify for a subsidy, be prepared to provide your address, a tax return and the name of your employer. Examples of subsidized Covered California Plans include:

  • The Bronze Plan with payments as low as 1.00 per month.
  • The Silver Plan with payments as low as 48.00 per month.

Can I change my plan whenever I want?

No, Covered California has specific enrollment periods during which you can make changes to your health insurance plan. The main enrollment period is called the Open Enrollment Period, which typically takes place once a year, usually between November and January. During this period, you can switch plans, add or drop coverage, or enroll in a new plan.

How much income is too much for Covered California?

In general, individuals or families with income up to 400% of the federal poverty level may be eligible for premium assistance subsidies through Covered California. This means that if your income falls below or is equal to 400% of the FPL, you may qualify for subsidies. However, if your income exceeds this threshold, you still may be eligible for a tax credit if you have a Silver Plan.

Is Covered California based on gross or net income?

Covered California primarily uses modified adjusted gross income (MAGI) as the basis for determining eligibility for subsidies and premium assistance. MAGI is calculated using various income sources and specific adjustments. While gross income serves as the starting point, certain deductions and adjustments are made to arrive at the MAGI figure.

Does my plan cover dental & vision covereage?

Covered California plans can offer dental and vision coverage, but they are not automatically included in all health plans. Dental and vision coverage are considered optional benefits and can be added to your health plan for an additional premium.