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Medi-Cal Eligibility and Covered California – Frequently Asked Questions
Covered California is the new marketplace that makes it possible for individuals and families to get free or low- cost health insurance through Medi-Cal, or to get help paying for private health insurance.
Our goal is to make it simple and affordable for Californians to get health insurance. Covered California is a partnership of the California Health Benefit Exchange and the California Department of Health Care Services.
Covered California can help you choose a private insurance plan that meets your health needs and budget. We offer some of the state’s best known health plans, and some regional or local plans too.
We can explain the costs and benefits of health insurance plans clearly, so you can compare the different choices available to you. You will know exactly what you’re getting and how much you have to pay before you choose your plan.
If you are a federally recognized American Indian or an Alaska Native, you may be eligible for:
- Free or low-cost insurance
- Premium assistance
- Reduced out-of-pocket expenses
- Special monthly enrollment periods
You can also get services from Indian Health Services’ funded tribal health programs or Indian health programs.
Be sure to complete Attachment A and send it to it with your proof of Native American or Alaska Native heritage document. You may use the following documents to provide proof of your Native American Indian or Native Alaskan heritage:
- Tribal enrollment card or
- Certificate of degree of Indian blood (CDIB) from the Bureau of Indian Affairs
Any Californian can get health insurance through Covered California if he or she is a state resident and cannot get affordable health insurance through a job.
Applicants may qualify for a free or low-cost health plan, or for financial help that can lower the cost of premiums and co-pays. The amount of financial help is based on household size and family income. Applicants qualify if their income meets the income limits.
Covered California will begin enrollment on Oct. 1, 2013, for coverage that will take effect Jan. 1, 2014. The open-enrollment period for coverage during 2014 will run from Oct. 1, 2013, to March 31, 2014. If you are eligible for Medi-Cal, the open enrollment period does not matter.
If your income changes during the year or at your annual renewal, you may qualify for other health insurance and premium assistance through Covered California.
You can apply for health insurance through Covered California in the following ways:
- Online: Visit www.CoveredCA.com. We provide information about each health insurance plan, explained in clear and simple terms.
- By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
- By fax: Fax your application to 1-888-329-3700.
- By mail: Mail the Covered California application to:
P.O. Box 989725
West Sacramento, CA 95798-9725
- In person: We have trained Certified Enrollment Counselors or Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free! For a list of places near where you live or work, visit www.CoveredCA.com or call
1-800-300-1506 (TTY: 1-888-889-4500).
You will receive a letter within 45 days to tell you which program you and your family members qualify for. If you don’t hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).
You will have a wide variety of health plans to choose from. Health insurance companies cannot refuse to cover you because you have been sick before or could not get coverage.
Covered California offers four groups of private health insurance plans: platinum, gold, silver, and bronze, plus a minimum coverage plan.
Each group offers a different level of coverage, from high to low. Health insurance plans that cover more of your medical expenses will usually have a higher premium but allow you to pay less when you receive medical care.
Platinum plans have the highest premium, but they pay 90% of your health care expenses. Gold plans pay pay 80% and silver plans pay 70% of your health care expenses. Bronze plans have the lowest premium but pay just 60% of covered health expenses.
If you qualify for Medi-Cal, the coverage and costs are different and may be free for you.
Yes, you can get health insurance regardless of any current or past health conditions. Starting in 2014, most health insurance plans can’t refuse to cover you or charge you more just because you have a pre-existing health condition.
You cannot be denied based on a pre-existing condition. Eligibility is based on income, not health status.
Covered California health plans start providing services on January 1, 2014.
If you enroll in a Covered California plan before Dec. 15, 2013, you can be eligible to have coverage that starts on Jan. 1, 2014. You will also need to pay your share of the premium before January. During the last three months of the initial Covered California open-enrollment period (from Jan. 1, 2014, through March 31, 2014), an individual who submits a completed application, receives an eligibility determination and makes a plan selection by the 15th of each month will receive a coverage-effective date of the first day of the following month, as long as the person’s full premium payment is received. For example, someone who has enrolled in a Covered California health insurance plan by Jan. 15, 2014, will have coverage beginning Feb. 1, 2014 if they pay their share of premium.
Currently, there are two open enrollment periods happening during the same period of time, which may be causing some confusion among California residents.
The Covered California exchange will permit individuals to enroll in health plan coverage or Medi-Cal during the initial enrollment period from October 1, 2013, to March 31, 2014, and thereafter during an open enrollment period that will begin on October 15 and last through December 7 annually. People who want to enroll in a health plan or find out if they are newly eligible for Medi-Cal, can call Covered California at 1-800-300-1506 or visit www.CoveredCA.com for information.
Medicare Open Enrollment
Medicare’s open enrollment period is October 15 through December 7 for all people with Medicare. Medicare clients can change their Medicare health plan and prescription drug coverage, which will take effect January 1, 2014. People with Medicare can call 1-800-MEDICARE or visit www.medicare.gov for plan information. If the person is satisfied with their current plan, they do not need to do anything.
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