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Covered CA Basics
Covered California is a health insurance marketplace in California set up under the Affordable Care Act (ACA) also known as Obamacare. Covered California offers affordable coverage through multiple carriers at different levels of coverage.
For low income individuals and families, Covered California offers a government subsidy to help assist for a portion of the monthly premium. The subsidy varies based on income range.
Many options are available when it comes to choosing a plan. It is important to understand your options before making a decision. To help you with this, let's briefly discuss the these four areas:
Levels of Coverage - There are four levels of coverage offered under the Affordable Care Act aka Obama Care. The four levels are bronze, silver, gold, and platinum. There is also a catastrophic plan which also known as minimum coverage. These latter plan is only available to individuals under 30 years old or over 30 and can certify that they do not have affordable coverage or facing a financial hardship.
It is probably a good idea to discuss the silver level of coverage. Why? The silver level of coverage actually has levels within itself. There are actually four levels of silver coverage:
Each level comes with its own max-out-of-pocket, deductible, co-payments and co-insurance. The difference from one level to the next is significant. However, we will not discuss these in depth at this time. What is important to know about these four levels is that you cannot choose any particular level, rather, you qualify for one of the four based on your family make-up and income.
Essential Health Benefits - Every health insurance plan offered through Covered CA must provide what is know as essential health benefits. These benefits are broken down into 10 service categories which include:
Preventive and wellness
Mental health and substance use
Rehabilitative and Habilitative
Dental Coverage - All Covered CA health insurance plans offer embedded pediatric dental coverage. This means that dental insurance for children 18 and under is included with the plan at no extra cost. As of 2016, Covered CA offers supplemental dental coverage for adults at an additional cost which is billed separately from the health plan.
Vision Coverage - As with the dental coverage, all Covered CA plans come with pediatric vision care benefits embedded. As of July, 2017 Covered CA does not offer vision coverage.
Special Enrollment Periods
If you did not enroll into a health insurance plan during open enrollment, you may still be able to enroll through a special enrollment period. A special enrollment period is created when certain things or events happen in our life. Let's discuss the most common life events which trigger a special enrollment period.
Loosing your current health coverage - This applies to those people who were insured either through their employer or through the state's Medi-cal/medic-aid program and for one reason or another, lost the coverage.
Moving - If you move to California from another state, or you moved to a new area within California where your current insurance is not available, you may qualify for a special enrollment period.
Marriage - If you get married or enter into a domestic partnership, you may enroll through a special enrollment period.
Aging Out - If you are on your parents' insurance plan as a dependent, upon your 26 birthday you will loose your eligibility to continue on their plan. This will create a special enrollment period for you and you may enroll.
Child - If you/your spouse give birth to a newborn, a special enrollment period is created and you, your spouse and the newborn are eligible to enroll. Adopting a child or receiving a child into foster care, as well as placing a child in adoption or in a foster home also creates a special enrollment period.
Legal Status - becoming a legal resident, becoming a citizen or a national will allow you to enroll outside of open enrollment through a special enrollment period.
Income - If your income changes drastically to the point that you no longer qualify for federal subsidies or if the income change made you eligible for subsidies you can enroll through a special enrollment period.
Tribe - If you are a member of a federally recognized American Indian or Alaska Native tribe, the open enrollment guidelines don't really apply to you. You may enroll into n insurance plan at any time and may switch your insurance plan once a month.
Exceptional Circumstance - Covered CA may, on a case-by-case basis and at its full discretion, determine that an individual experienced an exceptional circumstance and allow him/her to enroll under a special enrollment period.
You have 60 days from the date on which the qualifying life event occurred to enroll into a Covered CA plan or change your current Covered CA plan. For example: if your Medi-Cal was termed on May 31st. you have until July 30th to enroll in a new plan.