Covered California Basics
Our goal with your Health Exchange Page
We know that insurance can be frustrating, and complicated. Our goal is to help by offering some advice and to give you an idea of what to expect. We also provide you access to a Licensed Agency that you can reach out to.
In addition to providing this information at no cost to you, we can help manage your Exchange plans.
For Direct Help, Click Here
The Health Care Reform Act
Know as PPACA or the ACA, which stands for the Patient Protection Affordable Care Act was written to strengthen your protections, simplify your plans and provide coverage to all legally present persons.
Here are a few resources if you would like to have a copy of the law:
The Affordable Care Act, through the Congress Library
Reconcillation Act, from the U.S. House of Representatives
But sometimes when things become simple, other areas become complicated. The exchanges are just that, they make comparing plans and finding coverage options easy, but that is where the easy stops. Enrolling, and keeping your coverage can become pretty complicated.
The hard part of enrolling through the Exchanges such as Covered California are the following:
- Understanding what is counted in your household income.
- Projecting income and preparing for being way off in your estimated income.
- Getting help as married and filing separately, knowing what is required
- Having your account frozen.
- How to cancell your coverage
- Reaching Covered California when you need help, or understanding if you should be reaching your insurance carrier.
Understanding what is counted for Income:
How to count your income for Health Credits on the Exchange
Who is counted in your Household Income?
Can Employer related insurance disqualify me or my family from receiving Tax Credit Help?
Projecting your Income for Tax Credits and Subsidies:
Getting this right is important, and you must remember that ultimately you will need to pay back any premium assistance you received that you did not qualify for.
Estimating your Income, from the IRS
How to estimate your expected Income for Exchange Health Plans
Married and I want to receive Tax Credits:
First, you must be filing Married Filing Jointly, any other way will disqualify you for help, unless you are separated... There may be some wiggle room for separated persons. You will need to count each others income, and if one is offered coverage at work, you will need to know if it is considered affordable by that employees wages to their premium only. If it is affordable, we are sorry, but you most likely will not qualify for financial help.
I got blindsided by MediCal, what do I do?
If you were expecting the plan you chose and ended up in the MediCal system, you will first need to check your income. If your income is out of the MediCal range, you will need to call your Social Worker. If you can not reach them, you may want to talk with a broker that has experience in getting these resolved by working with and through Covered California or the Exchange in your state. But until it is resolved, you will be on a Medicaid type of coverage.
Here are some links for Medicaid and MediCal:
What is Medicaid called in my State?
Is my Income within Medicaid or MediCal limits?
My Exchange, or Covered California Account got Frozen...
You are going to need to first figure out why your account is frozen. It could be something simple like a wrong social security number, or you may have clicked a yes that should have been a no on your enrollment link. Or it could be more complicated, Medicaid, the DOD, IRS and Homeland Security have authority over the Exchanges. If something is not matching their systems you are going to need to address it right away. Sometimes the Exchange can help, but these may be better handled by working with a Broker or Agent, as they have internal access that can help speed things up for you.
Here is a little additional information about General Health Insurance and your Plan Benefits.
What about cancelling my plan?
Cancelling coverage is straight forward, for "On Exchange" plans, you can only cancel plans on a future date, you can not cancel retroactively.
Do I have Dental and Vision in my Health Plan?
If you are under 18 years old, yes you have Dental and Vision coverage with your Health Plan. Otherwise, no you do not, as you are an adult... Sorry.
Updating Household Info:
This is important to do on a timely manner, you will need to update anything that impacts your ability to recieve tax credits, like moving, or receiving MediCare or Group Health Insurance.
Should I have help or should I run this on my own?
This one is totally up to you, if you prefer to not have help and you know how to navigate between Carriers and the Exchanges, you might want to manage this one on your own. But, if you want help, or wouldn't mind an extra set of hands, a certified enrollment councilor can at least get you started. Or a Certified Agency can set you up, help you choose a plan, manage documentation for you, and help with Carrier and Exchange disruptions or questions.
Sometimes people that tried to set up their own coverage ended up running into big problems. At the end of the day they ended up delegating access to their account with us, and we were able to fix things quickly. So you may have that as an option too.
Should I be calling the Exchange or my Insurance Carrier?
Normally you call the Insurance Carrier, but their are times you would need to call the Health Exchange.
How do I allow a Insurance Agent, a family member or a friend access to my Covered California Account?
This is normally very straight forward, if you have an active Covered Ca Account, and you want an Insurance Agency or Brokerage to help with the Management and aid in correspondence, you can delegate access to the agency. To delegate access, login to your account and search for Local Help, and search for a specific (ex. Jessica L Dreiling Agent) and select delegate access to my account. Just call and let us know you did this, so we can begin helping with whatever is going on.
If you want to allow a family member or a friend access to your account as well as the ability to call Covered CA just fill out "this form" and send it to Covered Ca. If you want this form to be handled promptly, just email it to us and we can get it to the proper channel, but please include your email and phone number, because we will need to update you on the progress.
While you are here, go ahead and check out your rates, and see what plans may be a good fit for you at our Quote My Exchange Plans Link. If you want help, let us know.
Further Resources for Exchange Based Plans: