Deadlines for Open Enrollment in the Exchanges
In California, open enrollment in Covered California is available now until 1/31/21. In many other states using the federal exchanges, open enrollment ends on December 15, 2020. So if you are uninsured in California, apply now. https://www.coveredca.com/get-started/ or https://www.coveredca.com/apply/?gclid=EAIaIQobChMI_7y5g7Cw7QIVEhLnCh1aQwl-EAAYAiAAEgLGa_D_BwE Many are experiencing loss of health coverage for the first time due to the Covid recession and are not familiar with Covered California.
If you are uninsured in other states using the federal exchanges, the web site is: https://www.healthcare.gov/ You have less than two weeks remaining in Open Enrollment.
If your income as an individual is between 138% of the federal poverty level and 600% of FPL, you are potentially eligible for help paying your premiums through Covered California. About 1.5 million Californians are enrolled in Covered California. If your income is less than 138% of FPL, you are likely eligible for MediCal; you pay no premiums. https://www.dhcs.ca.gov/services/medi-cal/Pages/DoYouQualifyForMedi-Cal.aspx Over 13 million Californians are enrolled in MediCal. There are no open enrollment deadlines to qualify for MediCal.
In most other states, premium assistance is only available to 400% of FPL. Twelve states, primarily in the South, have still not implemented the Medicaid expansion, which under the Affordable Care Act has a 90/10 federal matching rate. https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
If your income is between 138% of FPL and 250% of FPL, you are potentially eligible for cost sharing reductions; this means lower or no deductibles and lower copays or coinsurance. https://hbex.coveredca.com/data-research/library/CoveredCA_CSRs_and_the_Individual_Market-7-21-17.pdf To get these cost sharing reductions if you do qualify for them, you must choose the silver plans in Covered California.
In Covered California, you will have a choice of plans and a choice of cost sharing. You can choose bronze (pays 60% of expected medical costs), silver (pays 70% of expected medical costs, gold (pays 80% of medical costs) or platinum (pays 90% of expected medical costs. The trade-offs are less cost sharing means higher premiums unless you qualify for the cost sharing reductions.
The choice of plans depends on your county of residence. https://www.coveredca.com/get-started/ Most subscribers in Covered California enroll in Kaiser, Blue Shield or Health Net, but plan popularity varies widely by county. In some small rural counties, there are only two plan choices available: typically Blue Shield and Blue Cross. In other populous counties, there may be as many as six plan choices. Some like, LA Care or Valley Health, are public plans. Some like Kaiser and Blue Shield are non-profit plans. Some like Health Net and Blue Cross are for profit. Some like Sharp and Chinese Community Health Plan are regional plans. Their prices (premiums) vary quite widely, so make sure you comparison shop. Their participating doctors and hospital networks vary as well. Some like Kaiser or Molina are HMO plans; others like Blue Cross are PPO plans.
Many of the uninsured are unaware of MediCal or Covered California. Many are unaware that they can have reduced premiums and/or reduced cost sharing (copays and deductibles) options based on their incomes. A bit less than 90% of people enrolled in Covered California get financial help paying their premiums or reducing their copays and deductibles.
As of now, 93% of Californians have health coverage; we have made remarkable progress under the ACA. Of California’s remaining 3 million uninsured, about 1 million are eligible for Covered California and about 300,000 are eligible for MediCal. https://www.kpbs.org/news/2017/nov/21/californias-uninsured-rates-drops-record-low/ and https://healthcare.assembly.ca.gov/sites/healthcare.assembly.ca.gov/files/Report%20Final%203_13_18.pdf
If you are undocumented, you are ineligible for Covered California, but you may be eligible for limited benefits (emergencies, prenatal care and deliveries) under MediCal or depending on your age (less than 26) you could be eligible for full scope MediCal. About 60% of California’s remaining uninsured are undocumented workers.
If you are eligible for but do not enroll in any form of coverage, in California you may have to pay a tax penalty; there are exceptions. https://www.coveredca.com/learning-center/tax-penalty-details-and-exemptions/penalty/ The tax penalty does not apply in most other states; however since the federal tax penalties were repealed, a handful of states have now instituted tax penalties . https://www.cnbc.com/2020/01/16/these-people-might-face-a-surprise-health-insurance-tax-this-year.html
The last two years, the average premium increases in Covered California plans have been less than 1%. https://www.coveredca.com/newsroom/news-releases/2020/08/04/californias-efforts-to-build-on-the-affordable-care-act-lead-to-a-record-low-rate-change-for-the-second-consecutive-year/
Prepared by: Lucien Wulsin
Dated: 12/2/20