There are many things in life that must be completed by certain deadlines. Registering a vehicle, filing taxes, and of course choosing a health care plan. Unlike waiting at the DMV or filing taxes, enrolling in health care doesn’t have to be a challenging or time-consuming process. However, when the time is right to apply for Covered California, it is important that you examine available health plans during the open enrollment period..

What is open enrollment? 

Under the Affordable Care Act (ACA) many eligible individuals are able to choose the health insurance plans that will best meet their needs. In order to receive health insurance for the upcoming year, it is important that you compare, contrast, and select a plan during the Covered California and Marketplace open enrollment periods. If you live in California and don’t sign up for health insurance during the Covered California open enrollment period, then you will not be eligible for health insurance until the next open enrollment period or unless you experience a qualifying life event.

What is Covered California Open Enrollment?

Covered California Open Enrollment is the annual period when California residents can enroll in or change their health insurance plans through the state’s official marketplace, Covered California. Established under the Affordable Care Act (ACA), also known as Obamacare, Covered California offers a platform for individuals, families, and small businesses to compare and purchase ACA-compliant health insurance plans. This marketplace not only facilitates access to a range of health insurance options but also provides financial assistance for eligible Californians to help reduce premium costs. To learn more about Covered California and its relation to Obamacare, you can visit the Covered California website and the section specifically about Obamacare in California.

When is the Covered California Open Enrollment period?

The Covered California Open Enrollment period for the 2024 plan year typically starts in the fall of the previous year and extends into January of the plan year. For the 2024 coverage year, the open enrollment is expected to begin on November 1, 2023, and will likely run until January 31, 2024. These dates are important as they offer the primary opportunity for California residents to enroll in a new health plan or make changes to their existing coverage through the Covered California marketplace. It’s essential to enroll or make changes within this timeframe to ensure coverage for the 2024 year, as missing this period may result in having to wait until the next open enrollment, unless one qualifies for a Special Enrollment Period due to life events such as marriage, birth of a child, or loss of other coverage.

Eligibility and enrollment

Understanding eligibility and enrollment for health insurance is a crucial step in securing the right coverage for your needs. Whether you’re enrolling through a government marketplace, an employer, or directly with an insurance provider, knowing the criteria and enrollment periods can significantly impact your access to healthcare. Below, we delve into the key aspects of eligibility and the process of enrolling in health insurance plans.

Who is eligible to enroll in Covered California?

Eligibility for enrolling in health insurance plans through Covered California is primarily based on residency, income, and citizenship status. To be eligible, individuals must:

1. Reside in California: You must be a resident of California and plan to live there for the duration of the coverage.
2. Citizenship or Legal Residency: Eligible individuals must be U.S. citizens, U.S. nationals, or have a legal presence in the United States. This includes lawful permanent residents (green card holders), asylum seekers, and holders of certain types of visas.
3. Not Incarcerated: Individuals who are currently incarcerated are not eligible to enroll in Covered California plans.
4. Income Requirements: While there is no income limit for purchasing insurance through Covered California, the amount of financial assistance (like premium subsidies) you can receive is based on your income level. This assistance is available to individuals and families with incomes between 138% and 400% of the federal poverty level.
5. Not Covered by Other Health Insurance: You are generally not eligible if you have access to affordable health insurance through an employer or government program like Medicare. However, there are exceptions, especially if the employer-based insurance is not considered affordable under ACA guidelines.

Covered California is designed to make healthcare accessible to a wide range of Californians, especially those who do not have access to employer-sponsored insurance or do not qualify for Medicaid (Medi-Cal in California). It’s important to provide accurate information about income and residency status during the application process to determine eligibility and the level of financial aid that can be provided.

What is the enrollment process for Covered California?

Enrolling in a health insurance plan through Covered California during open enrollment is a straightforward process. Here’s a basic overview of how to enroll:

1. Review Available Plans: Start by reviewing the various health insurance plans available on the Covered California website. Consider factors like coverage, premiums, deductibles, and out-of-network costs.
2. Check for Financial Assistance: Determine if you qualify for financial assistance, such as premium subsidies, based on your income. The Covered California website offers tools to estimate your eligibility for subsidies.
3. Create an Account: If you’re a new user, create an account on the Covered California website. For returning users, log in to your existing account.
4. Fill Out the Application: Complete the online application form, providing accurate information about your income, household size, and other relevant details.
5. Choose a Plan: After completing the application, you’ll be presented with plan options. Compare these plans and select the one that best fits your healthcare needs and budget.
6. Enroll and Pay the Premium: Once you’ve chosen a plan, proceed to enroll and set up your first premium payment. Your coverage will start on the effective date, typically January 1st if you enroll during open enrollment.

Additionally, if you experience certain life events outside of the open enrollment period, you may qualify for a Special Enrollment Period. These life events include losing health coverage, moving, getting married, having a baby, or adopting a child. During a Special Enrollment Period, you can enroll in or change your health plan. It’s important to apply within 60 days of the qualifying life event to ensure you get the coverage you need.

The special enrollment period is specifically designed to help people enroll in health insurance plans outside of the open enrollment period. In order to qualify for special enrollment and subsequently apply for Covered California health insurance plans, individuals must experience certain types of life events, including:

• Losing employer provided health insurance
• Moving to a new state or coverage area—health insurance plans that are acquired from the Marketplace or Covered California are not always transferable from one state to another
• Becoming a widow or widower
• Getting a divorce or becoming married
• Aging off of a parent’s health insurance plan
• Having a baby

It is important to note that you won’t have a qualifying life event, either through eHealth or Covered California, if you lost your health insurance because you failed to pay your monthly premiums or willingly decided to cancel your plan.  In those cases, you must wait until open enrollment or until you have another event that is a qualifying life event. Whether you need to purchase an individual health insurance plan or want to explore the family plans offered on Covered California, one thing is certain — you should mark your calendars with the Covered California open enrollment dates. Failing to select a health insurance plan during the open enrollment period could lead to a lapse in your health care coverage. Fortunately, with Covered California and private health insurance marketplaces you can review and purchase a health insurance plan that is right for you and your family’s needs.

Benefits and coverage options

When exploring health insurance through Covered California, it’s important to understand the benefits and coverage options available. Here’s an overview:

1. Essential Health Benefits: All plans offered through Covered California provide essential health benefits. These include outpatient care, emergency services, hospitalization, pregnancy and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services, and pediatric services, including oral and vision care.
2. Levels of Coverage – Metallic Tiers: Plans are categorized into four metallic tiers – Bronze, Silver, Gold, and Platinum – each representing a different level of cost-sharing. Bronze plans have the lowest monthly premiums but higher out-of-pocket costs, ideal for those who need minimal healthcare services. Silver plans offer a moderate balance between monthly premiums and out-of-pocket costs. Gold plans have higher monthly premiums but lower out-of-pocket costs, suitable for those who require frequent medical care. Platinum plans, while having the highest premiums, offer the most comprehensive coverage with the lowest out-of-pocket costs.
3. Network Types: Different plans have different network types, like HMOs, PPOs, and EPOs, which determine the healthcare providers you can see and how you can access specialists.
4. Cost-Sharing Reductions: For individuals and families with lower incomes, Silver plans can provide additional cost-sharing reductions, making healthcare more affordable by reducing out-of-pocket expenses like deductibles and co-pays.
5. Pediatric Dental and Vision Coverage: Pediatric services, including dental and vision care, are covered in all health plans for children up to the age of 19.
6. Preventive Services: All Covered California plans offer preventive services at no additional cost. These services include screenings, vaccinations, and wellness visits.
7. Prescription Drug Coverage: Prescription drugs are covered under all plans, with varying levels of cost-sharing.

By understanding these benefits and coverage options, you can better assess which plan will most effectively meet your healthcare needs and financial situation. It’s important to consider not only the monthly premiums but also the out-of-pocket costs, network restrictions, and specific benefits offered by each plan.

How to choose a health insurance plan

Choosing the right health insurance plan is a crucial decision that impacts both your health and finances. Here are some tips to help you select the best plan for your needs:

1. Assess Your Health Needs: Consider your current health status and medical needs. Do you have any chronic conditions? Do you require regular prescriptions or frequent doctor visits? Understanding your healthcare needs can guide you in choosing a plan with the right level of coverage.
2. Understand Plan Types: Familiarize yourself with different plan types, like HMOs, PPOs, and EPOs. HMOs usually have lower premiums but require you to choose a primary care physician and get referrals for specialists, while PPOs and EPOs offer more flexibility in choosing providers but often at a higher cost.
3. Compare Premiums and Out-of-Pocket Costs: Look beyond just the monthly premium. Consider deductibles, co-pays, co-insurance, and out-of-pocket maximums. A plan with a lower premium might cost more in the long run if it has high deductibles and co-pays.
4. Check the Provider Network: Ensure that the plan’s network includes your preferred doctors and hospitals. If you have a preferred healthcare provider, check if they are covered by the plan.
5. Review Drug Formulary: If you take prescription medications, review the plan’s formulary to see if your medications are covered and understand the costs involved.
6. Consider Additional Benefits: Some plans offer extra benefits like dental, vision, or wellness programs. If these are important to you, factor them into your decision.
7. Utilize Plan Comparison Tools: Use online comparison tools, often available on health insurance marketplaces, to compare the benefits and costs of different plans side by side.
8. Think About Future Needs: Consider any planned life changes, like starting a family, that might affect your health insurance needs in the near future.
9. Seek Expert Advice: If you’re unsure, consult with a health insurance broker or a financial advisor. They can provide guidance based on your specific situation.
10. Read Reviews and Experience: Check reviews or ask for recommendations from friends or family about their experiences with different health plans and insurance companies.

By carefully considering these factors, you can make an informed choice that balances cost with coverage, ensuring you have access to necessary healthcare services while also managing your financial risk.

Frequently asked questions about Covered California Open Enrollment

Does the Covered California open enrollment still apply if you shop somewhere else?

If you are a California resident, the extended open enrollment period for California typically still applies when you shop on eHealth.com. This means you can still benefit from the easy-to-use application process provided by eHealth, while also having a longer open enrollment period as a Californian. Also keep in mind that you can still generally apply for government premiums through Covered California, or by working with eHealth. To get government subsidies for insurance premiums, you must go through a subsidy application process either on a government-run website or through a partner authorized by the government, such as eHealth.  eHealth partners with the federal-run marketplace to make government subsidies available to qualifying customers on eHealth’s website in most states.

How is the Covered California open enrollment period different than the federal exchange?

Covered California, in general, is different from the federal exchange, because it is a state-based health insurance marketplace. It is meant specifically for people who need health insurance in California. The federal exchange runs the government-run health insurance marketplace in most other states. The enrollment period for the federal exchange, also known as the Marketplace, may have a different open enrollment period than certain state-run exchanges like California.  For example, California’s open enrollment period lasted until January 31, 2018 for 2018 coverage, while the federal exchange’s open enrollment period ended earlier on December 15, 2017 for 2018 coverage.

During open enrollment, you will be able to choose a health care plan for the upcoming year. The federal exchange is for the majority of states that, unlike California, have chosen to not run their own state exchanges. It is important to note that the Covered California open enrollment is scheduled to use a different deadline for the 2019 coverage year as well. Applications for Covered California health insurance plans are scheduled to be accepted from November 1 to January 31st. After this time period ends, Covered California’s open enrollment for the year will close until the fall. Covered California’s marketplace and open enrollment only applies to people who are California residents and wish to have health insurance coverage in California. Whether it is through a federal exchange, state exchange, or somewhere like eHealth, unless you have a qualifying life event, you will only be able to sign up for health insurance during periods of open enrollment.

Can I update my existing Covered California plan during Open Enrollment?

Yes, you can update your existing Covered California plan during Open Enrollment. This period provides an opportunity for you to review your current health insurance plan and make any necessary changes. Here’s how you can do it:

1. Log into Your Account: Access your account on the Covered California website. If you don’t have online access, you can also contact Covered California by phone.
2. Review Your Current Plan: Take some time to evaluate your current plan’s coverage, costs, and any changes to your healthcare needs since you last enrolled. This can include changes in income, family size, or health requirements.
3. Explore Other Plan Options: During Open Enrollment, you have the option to compare your current plan with other available plans. This is important, as there might be new options or changes to existing plans that could better suit your needs or offer more affordable coverage.
4. Update Information: Update any personal information that may have changed over the year, such as income, address, or family size, as these changes can affect your plan options and eligibility for subsidies.
5. Make Changes to Your Plan: If you decide that a different plan is more suitable, you can select a new plan during this period. The changes you make will take effect at the beginning of the new coverage year.
6. Confirm and Enroll: Once you have selected a new plan or updated your existing one, confirm your choice and complete the enrollment process. Ensure to review all the details before finalizing.

It’s important to make any changes or updates during the Open Enrollment period, as outside of this period, you can only make changes to your plan if you qualify for a Special Enrollment Period due to certain life events like moving, getting married, or losing other health coverage.