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You Qualify for Affordable Health Coverage

Special Circumstances

Choosing the right health insurance plan depends on each individual’s unique life circumstances. To find out more about coverage options, consumers can browse the categories in this section. All individuals have unique experiences that help determine their health coverage options — whether a veteran, an immigrant, or a parent, each will be able to explore the health coverage available to make an informed decision.

Special Enrollment

Open enrollment for 2015 coverage ended Feb. 15. Once open enrollment has ended, consumers can enroll in a Covered California health insurance plan only if they have experienced a qualifying life event. Consumers can enroll in Medi-Cal at any time.

Common Types of Qualifying Life Events for Special Enrollment

  • Getting married or entering into a domestic partnership.
  • Having a child or adopting a child, receiving a child into foster care, or placing a child in adoption or in a foster home.
  • Change in place of residency, which allows a consumer to gain access to new Covered California health insurance plans. This includes moving to California from another state. This also applies to individuals who are released from jail or prison.
  • Losing health coverage. For example, consumers are no longer eligible for Medi-Cal, or they lose health coverage through their job.
  • Income changes so much that a consumer becomes newly eligible or ineligible for help paying for their insurance. For example, if a consumer is already getting help paying for their insurance premium, and their income goes down, they may be able to get extra help.
  • Becoming citizens, national or lawfully present individuals. This event applies only to people who were not previously citizens, nationals or lawfully present.
  • The consumer’s enrollment was wrong, due to the misconduct or misrepresentation of their health insurance company, Covered California or a non-Covered California entity (such as a Certified Enrollment Counselor).
  • Being a member of a federally recognized American Indian or Alaska Native tribe. A consumer in this category may enroll in health insurance or change health insurance plan once a month even if the open enrollment period is over.
  • Covered California can also determine, on a case-by-case basis, that the consumer experienced an exceptional circumstance, which could allow for a special enrollment period.

These are just some of the more common qualifying life events. Consumers can click here to read more about special enrollment and qualifying life events.

Consumers have 60 days from the date on which the qualifying life event happens to enroll in a Covered California health insurance plan or change their existing Covered California plan. For example, if a consumer has a child on June 1, they have until July 31 to notify Covered California, complete an application for their new child, choose a health plan and pay for it. If they do not get health coverage for their child, they may have to pay a tax penalty.

Although Open Enrollment has now ended you may still have options. Contact Us Today for more informtion.

Getting Covered

Even those who are healthy today benefit from having health insurance. It's impossible to predict whether someone will get sick or have an accident, and with the average cost of a three-day hospital stay priced at $30,000, it doesn't make sense to take the gamble of going without health insurance — particularly if it can be found at an affordable price.

Covered California makes it simple and more affordable for millions of Californians to get quality health insurance, including Medi-Cal, that can't be canceled or denied because of a pre-existing medical condition or if someone gets sick. Covered California offers a range of plans so a consumer can choose the one that best meets their health needs and financial situation, and can be attained easily online, in person or by phone.

If a consumer has health insurance through their job already, coverage will only get better as a result of the Patient Protection and Affordable Care Act, the federal health care law that created health insurance exchanges such as Covered California. And, should someone decide to leave his/her job tomorrow, the Affordable Care Act provides a sense of security and protection when it comes to health coverage.

All newly purchased insurance plans— even those sold outside of Covered California — must cover essential health benefits such as doctor visits, hospitalization, emergency care, maternity care, pediatric care for children, and prescriptions. This legislation also provides sliding-scale financial help, so almost all Americans can get quality health coverage at a fair price.

Purchasing health insurance through Covered California has many advantages. Covered California is the only place where an individual can learn about and use federal financial assistance that can help reduce health care costs. Consumers can also learn if they are eligible for low-cost or no-cost Medi-Cal. This also includes the ability to make true "apples to apples" comparisons of health insurance plans.

Covered California serves Californians by helping to:

  • Improve access to quality coverage. More Californians than ever before have easy access to a wide range of private health insurance plans. Millions of Californians who do not have health insurance can benefit from lower-cost coverage. Covered California helps these individuals learn about the health coverage options that best meet their needs. It also helps millions more who are not eligible for financial support, but can still benefit by using the insurance protections that have taken effect under the new health care law.
  • Make health coverage affordable. Covered California can help consumers find out if they are eligible for sliding-scale financial assistance that could help reduce health care costs. If income is very limited, consumers may be eligible for free coverage through Medi-Cal. Covered California also helps reduce health care costs for all Californians by reducing the number of uninsured and the burden of uncompensated care that was previously borne by all of those who had insurance.
  • Improve the health of all Californians. With health insurance, individuals don't have to wait for small health problems to become big ones. Access to preventive care and a network of health professionals who are trained to keep are available to help consumers stay healthy. Covered California also works to promote prevention and wellness programs that help all Californians.

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