Frequently Asked Questions about Covered California



As an agent, I get asked a LOT of questions about Covered California. In today’s post, I decided to compile a list of the more frequent questions I get asked. I figure since I get asked these same questions often, a few of my web site visitors must be wondering about the same things.

What's Covered California?

Covered California is California’s marketplace for ACA-Compliant plans. While most other states use Healthcare.gov, a California resident would use Covered California. Instead of being operated and funded by the federal government, Covered California is operated locally and operating costs are self-contained by “PMPM” rates they receive from the insurance carriers when they enroll you.

In short, it’s a healthcare market place. And, if you want premium assistance in California, the way you must enroll into an Individual Health Plan.

Which Covered California Plan is Best?

That’s a remarkably difficult question to answer. The way that question actually needs to be phrased is “Which Covered California plan is best for you?”
Insurance isn’t a once-size-fits-all type of product. This is true of all types of insurance, but it’s especially true in regards to health insurance. If you’re a very health person, buying the most expensive health plan for the great benefits is likely to be a colossal waste of money for you. Conversely, if you use a lot of health care services, you’re going to waste a lot of money paying deductibles with a cheaper plan that could have been mitigated by simply paying the higher premiums.

That’s why I always suggest using an agent. Just because Covered California has a website where you can Do-It-Yourself, it’s usually not a good idea unless you have a solid background in how health insurance works. If you’d like a free consultation on selecting the best plan for you, request a quote.

WHO DOES COVERED CALIFORNIA COVER?

The short answer is just about everyone. The difference is who qualifies for premium assistance. If you don’t qualify for a tax credit, you’re better off leaving Covered California on the sideline. If you need quotes for non-Covered California Plans, I can help you out with that.

WHO QUALIFIES FOR COVERED CALIFORNIA / WHO IS ELIGIBLE FOR COVERED CALIFORNIA?

Any California Resident can buy their individual health plan through Covered California. But, just like with the last question, if you don’t qualify for premium assistance, don’t bother. It’s likely to be more trouble than it’s worth.

Whether you qualify for Premium Assistance depends on your Adjusted Gross Income for the year your covered as well as your Household size. I can help you determine whether you’d qualify for Premium Assistance in about 5 minutes in most cases.

WHICH DOCTORS WHO ACCEPT COVERED CALIFORNIA?

It doesn’t actually work that way, contrary to popular belief. Doctors don’t contract with Covered California, they contract with the insurance carriers. If you need help finding a doctor that accepts your plan or you’d like help finding a plan that your current doctor accepts, I can help with that.

WHAT DOES COVERED CALIFORNIA COVER?

Covered California isn’t a health plan, it’s a market place. You need to look at the benefit plans of the plan you want to buy to determine what is covered. There are 10 essential health benefits that all health plans cover, but 9 out of 10 of them are covered at varying degrees. Fully understanding a health plan can be difficult and it can sometimes be even harder to determine what your health and financial needs are for a health plan. That’s why agents like me are here to help you.

WHAT IS COVERED CALIFORNIA PREMIUM ASSISTANCE? / WHAT IS COVERED CALIFORNIA TAX CREDIT? / WHAT IS APTC?

Premium Assistance is the heart of Covered California’s mission. It applies a monthly tax credit in the form of a deduction to your monthly premium, making insurance much for affordable for a lot of individuals and families with tight incomes. It follows the rules set forth by the Affordable Care Act (ACA or “Obamacare”) to determine financial need. The Covered California Tax Credit (or Advanced Premium Tax Credit / APTC) in short, reduces your tax premiums by giving you a tax credit divied up each month that you qualify.

WHAT DOES COVERED CALIFORNIA COST?

It’s going to vary wildly per person. I have some clients that literally pay $1 per month for their health plan while others are stuck with a bill around $1,500 per month. It great depends on your income, your household size, the plan you’re selecting and the number of people on the health plan.

WHAT IS COVERED CALIFORNIA ENHANCED SILVER PLAN?

If your income falls into a certain range, you qualify for an “Enhanced Silver Plan.” These plans are Silver-tiered plans that have special subsidies to lower your deductibles, copays and coinsurance. Donald Trump has signed an executive order that ended the funding for these plans, so there is now a 13% surcharge on these plans. So these plans are a little more expensive for 2018. If you get premium assistance, it might still be worth it, if not then you’ll get cheaper rates for the same plans off exchange.

WHAT IS COVERED CALIFORNIA DEADLINE?

For a effective date of January 1st, 2018, your application needs to be completed submitted by December 15th, 2017. There is some time after that for a February 1st effective date.

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