Series for Covered CA: Part 1 – Introduction

OBAMACARE is normally used to mean Covered California (Covered CA) but they not the same thing. Obamacare is the law, the formal name of which is Patient Protection and Affordable Care Act (PPACA) signed into law to reform the health care industry by President Barack Obama on March 23, 2010  and upheld by the Supreme Court on June 28, 2012. Covered CA is a California marketplace to implement the law. Other states may have their own implementations or use the federal implementation. Think of Covered CA like a grocery store where you can shop subsidized health insurance plans from companies like Anthem, Blue Shield, Health Net, Kaiser, LA Care, Molina, etc.

The mission of the Covered CA is to increase the number of Californians with health insurance, improve the quality of health care for all Californians, reduce health care coverage costs and make sure California’s diverse population has fair and equal access to quality health care. Covered CA plans meet the ten essential health benefits stipulated in PPACA, including emergency care, hospitalization, prescription drugs, maternity, and newborn care, with no annual or lifetime dollar limits, and with capped out-of-pocket payments. You can get a Covered CA plan without subsidy if subsidy is unimportant to you or you do not want to be hassled by the income related documents and verification. Most people though want to get subsidy based on their income. When they submit their application, their application will either stay within Covered CA in which case they can select a subsidized plan, or their application will be transferred to free or low-cost Medi-Cal for adults whose household income falls below 138% of the federal poverty level (FPL) and for minors below 19 years old whose household income falls below 266% of the FPL. As long as you are a Californian with legal status, not jailed and you applied during open enrollment period or special enrollment period with valid qualifying event, then you are guaranteed coverage through Covered CA, without an uprated premium even if you are unhealthy.

California driver’s license, California ID, and student ID are common proofs of being a Californian.

Several proofs of legal presence are acceptable. If you are US born, you don’t even have to show proof unless Covered CA asks for it later. If you are a US citizen but not US born, the best proof is the Certificate of Naturalization or the Certificate of Citizenship. US passport is also very well accepted. If you are not a US citizen, but you have eligible immigration status, then you can apply with Covered CA too. Common examples of documents proving legal presence are Permanent Resident card (Green card), temporary I-551 stamp on passport, I-94 or I-94A, Employment Authorization card (Work permit), and I-20 of non-immigrant students. For those who are petitioned, have not received the Green card yet but had already received their I-797, the Notice of Action document, can also apply. Complete list of documents for eligibility can be found here:

When you are applying, even the information of those who do not want health insurance need to be known to Covered CA. For example, the husband may already be in Medicare. Or the husband has insurance from the company. So the wife thinks that only her info is needed. Or perhaps the children already have existing Medi-Cal so they need not to apply anymore. In these situations, the info of the husband or the children still need to be presented too. Why? Because Covered CA needs to verify plan eligibility, income and subsidy based on the info of all the household members.

Even if a person is not eligible, perhaps because he has no legal presence, his info like name, birth date etc must still be presented. For example, a family of four (4) with undocumented parents who want to apply for their children can simply say the parents do not want health insurance but their info is still needed. People do not need to worry about Covered CA sharing their immigration or other info to institutions irrelevant to securing health insurance because Covered CA will not share it.

The best rule of thumb is to include the info of all the taxpayers and dependents in a tax return in one Covered CA application.

Renewal for Jan 1, 2017 effective date  is now ongoing for existing members. New applicants can enroll between Nov 1, 2016 and Jan 31, 2017. If you need help renewing or enrolling, please call 855-955-1800 or visit an official Covered CA storefront near you.

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For more information, please contact Joseph Doratan at 855-955-1800 or [email protected].

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