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Covered California Overview

Filed in Health Program News by on December 31, 2013

What Is Covered California?

Covered California Logo

To facilitate the process of providing health insurance coverage to all Americans, the federal Patient Protection and Affordable Care Act (PPACA) required each state to create a special health insurance marketplace known as an Exchange. Covered California is the California Health Insurance Exchange, the state’s primary individual health insurance marketplace since October 2013. Covered California offers consumers new online tools to compare affordable health insurance plans. Covered California also enables low-income individuals and families to qualify for free health insurance through Medi-Cal (the California Medical Assistance Program) and moderate-income families to qualify for insurance premium subsidies to make private health insurance coverage more affordable.

Covered California enrollment opened on October 1, 2013. Coverage began January 1, 2014 in order to meet the March 31, 2014 deadline for Californians to obtain insurance or face IRS penalties for the 2014 tax year. Individuals who did not enroll during the initial open-enrollment period must wait until October 1, 2014 to purchase coverage. From 2014 forward, most Californians will be required to have health insurance as a result of the Patient Protection and Affordable Care Act, also known as “health-care reform,” “Obamacare” or the “Affordable Care Act (ACA).”

Certified Enrollment Entities

Individuals and families can enroll through a Covered California Certified Entity. Certified Enrollment Counselors must be affiliated with an enrollment entity in order to be compensated. Uncompensated Enrollment Counselors include hospitals, providers and licensed agents. Enrollment entities are eligible for training and registration to provide in-person enrollment counseling to help consumers apply for Covered California programs.

Two types of Covered California representatives will facilitate consumers through the enrollment process:

  • Certified Enrollment Counselors
  • Navigators

Nile Sisters Development Initiative is a Covered California Certified Enrollment Counselor. Our health advocate staff provides Covered California application assistance, including translation in Arabic, Burmese, Spanish and Swahili.

Applying for Coverage

A consumer may initiate contact to Covered California via any one of the following options: online, phone, a licensed agent or in-person assister. Although some applicants will complete an online application, most consumers, eventually, will speak to a Covered California Call Center Representative (CCR). The CCR will conduct a quick qualification interview to establish family size and income level. If the consumer’s income bracket qualifies him for free public health care through Medi-Cal, the CCR will transfer the consumer to a county-based network call center.

Verifying Income

Income information can be complex, and this part of the Covered California application process is critical. The California Health Insurance Exchange incorporates electronic verification directly from the IRS. The income data from the consumer’s last federal income tax return is available to the online applicant or the CCR. The CCR can use this IRS data to help determine the consumer’s estimated income for the year, but the consumer can override the income tax data if a significant change in income has occurred during the current year.

Qualifying for Insurance Premium Subsidies

Consumers who are eligible for advanced tax credits to help pay insurance premiums may be receiving or may be able to receive affordable employer-sponsored group health insurance. Those who do not receive employer-sponsored group health insurance coverage will be eligible to receive advance payments of the premium subsidy.

Selecting a Benefit Plan

After application submission, the consumer will receive a congratulatory confirmation, a list of programs for which the consumer qualifies and an explanation of the steps to take next. This completes the application process. Applicants then may enroll in a Covered California health insurance plan and immediately apply their tax credit.

Covered California simplifies the health insurance shopping process by offering side-by-side comparisons of standardized plan benefits. And health insurance coverage is assured because the law requires insurers to accept all applicants, regardless of pre-existing health conditions, extending insurance access to many formerly uninsured Americans.

Download a printable overview of the Covered California enrollment process.»

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