FAQs

If you live in California and need assistance with finding out if you qualify for a subsidy on your health insurance, and/or looking to secure new health insurance coverage, please feel to contact me at 530-273-9500 or email me at jill.stone@healthinsurance4california.com

I have been a licensed Health Insurance Agent for 20 years, and am Certified by the State of California to assist all Californians with the Affordable Health Care Act (aka Obamacare).

PLEASE NOTE: Using an agent to assist you enroll does NOT cost you the consumer anything. However, by doing so, you have one person to contact for all of your health insurance question’s, and guidance through the process. ~Thank you~

FAQ’s

I received a Form 1095-A in the mail from Covered California. What is it, and what should I do with it?
The 1095-A is similar to other tax documents that consumers commonly receive, like the W-2 and 1099 forms, and you will need to save it for filing your federal income tax return. This form helps to determine whether you received too much or too little financial assistance in paying for your insurance premium. Read more about this form here.

What can I do if I forgot my password?
You can reset your password by clicking “Account Sign In” and then clicking the “Forgot Your Password?” link. Enter your user name. After you correctly answer your security questions, you will be able to enter a new password. If you do not remember the answers to your security questions, it is best to leave them unanswered and call the Service Center at (800) 300-1506. A Service Center representative can help reset your password.

When you create your password, be sure to follow these rules:

  • You cannot use words found in a dictionary or names.
  • Your new password cannot be one that you have used within the last 24 passwords.
  • Your password must have at least eight characters and have no more than 16 characters.
  • Your password must start with a letter and include:
    • At least one uppercase letter (A-Z).
    • At least one lowercase letter (a-z).
    • At least one number (0-9).
    • At least one special character (#, $, %, etc.).

What can I do if I forgot my user name?
You can reset your password by clicking “Account Login” and then clicking the “Forgot Your Username?” link.

I recently received a letter from Covered California. Where can I get more information?
Visit the Covered California Notices to Consumers page.

When will I get my bill?
Your health insurance company will send you a bill about two weeks after they receive your application or renewal. The payment due date will be printed on the bill. Please send your payment to your health insurance company before the deadline. If you pay your bill by mail, be sure you send it in time for the insurance company to receive your payment by the payment date printed on the bill. Your health insurance company also may accept payment through the phone or online, which would be faster than mailing your payment. Contact your health insurance company or visit the Paying Your Premium page for more information about payment options.

Will I get a new health insurance card?
If you renew and keep the same health insurance plan, you can keep your current card for 2015. If you change coverage, such as metal tiers or health insurance companies, your health insurance company will send you a new welcome packet and health insurance card approximately 10 days after receiving payment.

I applied for Medi-Cal but have not received any information from the county. What should I do?
If you have already applied, you do not need to apply again. Medi-Cal is processing your application as quickly as possible. Due to the large number of Medi-Cal applications received, processing is taking longer than expected, and proof of certain information is required in order to complete each application. If you need immediate assistance or have a specific question about your application, contact your county human services agency for in-person assistance with your application. You can also find more information within the Medi-Cal section of this website and on the California Department of Health Care Services’ website .

Health Insurance for Students
Most students, unless they qualify for an exemption, will have to purchase health insurance or they will be subject to a tax penalty.

A student may be eligible for an exemption, for example, if a student is not lawfully present in the United States or if they do not file taxes because they are below the tax filing threshold.

Student Health Plans and the Affordable Care Act
A “student health plan” refers to a special policy of health coverage that colleges and universities make available to their enrolled students. Typically, the student health plan is different from the employer-sponsored group coverage that colleges and universities offer their faculty and staff.

Student health plans count as health insurance coverage (e.g. “minimum essential coverage”) under the Affordable Care Act. Therefore, for the months consumers are enrolled in student health coverage, they will not have to pay a penalty.

If students have a “fully insured” student health plan, that plan does have to cover all 10 of the essential health benefits,” including ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care. Generally, fully insured plans must also offer contraceptives without cost-sharing (meaning no co-pays, etc.). A fully insured plan is one that your college or university purchases from a health insurance company.

However, if the student health plan is “self-insured,” it might not be required to cover essential health benefits. Consumers should check with their college to find out what type of student health plan it offers.

Covered California Coverage for Students
Students can opt out of their student health plans and purchase coverage through Covered California. Depending on income, students may receive tax credits to help pay for a private health plan through Covered California or receive low- or no-cost coverage through Medi-Cal.

If, however, students accept and enroll in the school’s health insurance plan, they will not be eligible for tax credits through Covered California while they are covered by their school’s plan. When students are considering whether to enroll in their school’s health insurance plan or a Covered California health plan, they should consider the location of clinics/doctors and the costs of accessing services.

Minimum Coverage Plans
If students are under 30, they may be able to buy an additional health insurance plan option called a minimum coverage plan. These minimum coverage plans usually have lower premiums and mostly protect consumers from worst-case scenarios. Catastrophic plans through Covered California cover three doctor visits or urgent care visits, including outpatient mental health/substance use visits, with no out-of-pocket costs, and free preventive benefits. All other services will be full price but at the negotiated in-network price, until an individual spends $6,350, after which all in-network services are covered at 100 percent.

Student Health Plans and Parent Health Plans
For a Covered California health plan, as long as students are a tax dependent of their parent(s) or under the age of 26, their eligibility for student health coverage does not make them ineligible to be covered on their parent’s family health plan.

When making this decision, students should consider their parent’s insurance coverage network. If students attend a school that is far away from their parent’s home, their parent’s health insurance may not cover medical services provided to them while they are away at school. Students should speak with their parent’s health insurance plan for more information.

If students are claimed as a dependent on their parent’s taxes and choose to opt out of their student health coverage, their parent’s Covered California family plan would still be eligible for tax credits. Additionally, if students choose to stay or accept their student health plan, their parents would still be eligible for tax credits through Covered California, if otherwise eligible. However, parents must correctly state on their application that although their child (the student) is a tax dependent, they are not seeking health coverage through their (the parents’) Covered California health plan.

However, a student considering opting out of their student health plan to take part in a family plan through Covered California should consider the coverage network. If the school they attend is far away from the parent’s home, the parent’s health insurance may not cover medical services while the student is away at school. Students considering this option should speak with their parents’ health insurance plan for more information.

If students are tax dependents, they can be covered under their parents’ Covered California health plan, no matter where they live. However, Covered California does not offer any health plan products that have a network of doctors, hospitals or other health care providers outside of California at this time. Therefore, if the school the student attends is out-of-state, the parent’s health insurance will not cover most medical services while the student is away at school. The exception being that all emergency services must be covered at the in-network price, even if the service was received out of state. Students considering this option should speak with their parent’s health insurance plans for more information.

Health Options for Pregnant Women
Pregnancy is an important time for women to get the medical care they need. In California, there are several options for uninsured pregnant women to get health coverage. These options include Medi-Cal (both full-scope Medi-Cal and pregnancy-related Medi-Cal coverage), the Medi-Cal Access Program (MAP, formerly known as the Access for Infants and Mothers [AIM] program), and Covered California.

Medi-Cal and MAP enroll new members throughout the year, whereas Covered California has an open-enrollment period. Eligibility for Medi-Cal and MAP depend on income. To learn more about Medi-Cal, visit the Medi-Cal section of this website. Read below for more information about Covered California.

Coverage Through Covered California
All Covered California health insurance plans include prenatal care and labor and delivery services, including postpartum care and breastfeeding support, supplies and counseling. Consumers should consider the different Covered California plans, including copayments, deductibles and coinsurance before making a decision on which plan to pursue. Tax credits are available to lawfully present applicants who are not eligible for other minimum essential coverage through a government program (such as full-scope Medi-Cal) or through an employer and who have household incomes that are 100 percent through 400 percent of the federal poverty level (FPL). Cost-sharing subsidies are also available to applicants with household incomes that are 100 percent through 250 percent of the FPL. Unlike Medi-Cal and MAP, Covered California considers a pregnant woman to be a household size of one. See the table below, which contains income ranges used to determine subsidy eligibility during the 2015 coverage year.

Family Size

Monthly Income
(100% – 400% FPL)

1 (pregnant applicant, unmarried, no dependents)

$973 – $3,890

2

$1,311 – $5,243

3

$1,649 – $6,597

4

$1,988 – $7,950

5

$2,326 – $9,303

Once a baby is delivered, the parents should notify Covered California to enroll their newborn in health coverage. The mother and baby may be eligible for Medi-Cal or a different amount of tax credits at that time. Either way, the baby’s coverage takes effect on the date of birth. To apply for Covered California, click the “Apply” button at the top of the page or call (800) 300-1506.

Open enrollment for Covered California health insurance plans happens once a year. For 2015 coverage, open enrollment ended Feb. 15, 2015. Outside of that time frame, individuals must experience a “qualifying life event” to be able to enroll in a Covered California health insurance plan through special enrollment. Pregnancy is not considered a qualifying life event for special enrollment, but there are other significant life changes, such as changing jobs or getting married, that may qualify someone for special enrollment in Covered California. Click here for more information about special enrollment.

Individuals on Medicare
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

If consumers are enrolled in Medicare, they do not need to do anything with Covered California or anything else related to the new health care law because they are already covered. No matter how consumers get Medicare, whether through Original Medicare or a Medicare Advantage Plan, they will still have the same benefits and security they have now. Consumers will receive new benefits, such as more preventive services and increased savings on brand-name drugs.

Covered California and Medicare Supplemental Plans
Covered California does not sell Medicare Advantage plans (such as Medicare HMOs and PPOs), Medicare Part D prescription drug plans, or Medigap policies. These plans will be available as they were before.

Consumers can enroll in a Medicare Advantage plan or a Medicare Part D plan on the Medicare website or by signing up directly with the company that offers the plan. To learn more about the different coverage options under Medicare, including the Medicare Advantage plans, Part D drug plans, and Medigap supplemental policies available in a particular area, and how to enroll, consumers can visit Medicare Plan Finder or call (800) Medicare.

Covered California, Medicare, and Tax Credits
Generally, someone who is eligible for Medicare — even if they do not enroll in it — cannot receive tax credits to help them pay for a Covered California health plan. Additionally, if a consumer chooses to enroll in a Covered California health plan instead of Medicare and then enroll in Medicare later, they may have to pay a late enrollment penalty.

Medicare Part A has a premium: However, if someone qualifies for Medicare but has to pay a premium for Part A and does not enroll in Medicare Part A, they may be eligible for a Covered California health plan. Depending on a consumer’s income, they may be eligible for premium assistance and cost-sharing subsidies for the Covered California health plan. However, if consumers choose to enroll in a Covered California health plan instead of Medicare and then enroll in Medicare later, their premium for Part A, and possibly Part B, could increase by 10% due to paying a late enrollment penalty.

Covered California, Medicare, and Medi-Cal
If consumers are enrolled in Medicare, they cannot purchase a Covered California health plan. Purchasing a Covered California health plan would give consumers the same health benefits they are already receiving on Medicare.

However, consumers may still be eligible for Medi-Cal, depending on their income and assets, and should still apply through Covered California. A Medicare beneficiary whose income is low or who meets other requirements may qualify if they are over age 65, blind or have other disabilities.

Medicare and Medi-Cal
If consumers qualify for both Medicare and Medi-Cal, Medi-Cal will help pay for Medicare premiums and cost-sharing requirements. Medi-Cal may also cover additional benefits, such as dental services, nursing home care, and personal care services. Medi-Cal may also provide extra financial assistance to help with the cost of Medicare Part D prescription drug coverage.

Covered California, Medi-Cal, and Disabilities
An individual who has a permanent disability, but is not yet eligible for Medicare due to the two-year waiting period for people receiving SSDI payments, may purchase health coverage through Covered California. Depending on income and if otherwise eligible, the individual may get help paying for a health plan through Covered California or get low- or no-cost Medi-Cal. An individual could be eligible for Medi-Cal either through the newly expanded adult program or through other Medi-Cal programs, such as those based on age, disability or blindness.

SSDI recipients who apply for and receive premium assistance and/or cost-sharing subsidies for a health plan through Covered California, will lose eligibility for the premium assistance and/or cost-sharing subsidies when they become eligible for Medicare. At that point, they will be able to drop their health plan through Covered California and enroll in Medicare. Similarly, if SSDI recipients enroll in the newly expanded adult Medi-Cal program (covering adults 19-64 up to 138 percent of the federal poverty level, or up to $16,105 for an individual) they will lose eligibility for that program when they become eligible for Medicare. Medi-Cal will automatically reevaluate their circumstances to see if they are eligible for another Medi-Cal program.

Medicare Options and Enrollment
Consumers can review and compare their Medicare options on the Medicare website or by calling (800) MEDICARE. For questions about changing your address, Medicare Part A or Part B, or a lost Medicare card, a consumer may call the Social Security Administration at (800) 772-1213. Consumers can also contact the Health Insurance Counseling & Advocacy Program (HICAP) for free, individual counseling on Medicare coverage questions, rights, and health care options. Call (800) 434-0222 to schedule an appointment at a HICAP office near their home.