When can I apply for health care through Covered California?
It depends. If you’re planning to buy a private health care plan from the Covered California marketplace, you must enroll during the “Open Enrollment period” to get coverage for the following year (unless you qualify for a Special Enrollment period, see PG. 464). The Open Enrollment period typically runs from fall to spring. If you don’t enroll during this period, you may not be able to find a private plan that can cover you (and you may have to pay the Shared Responsibility Fee, discussed above on PG. 462). To get the specific start and end dates for the next Open Enrollment period, call Covered California at 1-800-300-1506 (TTY 1-888-889-4500) or the federal government’s Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325). You can also check online at www.CoveredCA.com and www.healthcare.gov.
But, if you’re eligible for Medi-Cal based off your income—your income must be at or below 138% of the federal poverty level—you can apply to Medi-Cal at any time, even if it’s not currently Open Enrollment period. If you qualify for Medi-Cal, you can enroll right away. To learn more, go to PG. 466.
IMPORTANT: Remember, if you qualify, for Medi-Cal, then you are NOT eligible for private health care plans through Covered California.
Exceptions to the Open Enrollment requirement: Certain people with special situations may enroll in private health care through Covered California during a Special Enrollment Period (“SEP”). This is a 60-day period outside of the Open Enrollment period , typically starting from the day that the special situation started for a person.
Two types of situations may allow you to enroll in private health insurance through Covered California during a Special Enrollment Period:
- A “qualifying” life event suddenly creates a greater need for health coverage. For example: getting married or divorced, having a baby, losing a job, moving, losing your health coverage, or getting released from incarceration. Go to PG. 466. to learn more about Special Enrollment Periods.
- A complex problem that prevented you from enrolling successfully. For example: a major accident, a natural disaster, misconduct by someone who helped with your health care application, or an error by Covered California or an insurance company in processing your application.
If one of these situations comes up for you, you have 60 days to notify Covered California, get approved for a SEP, submit (or re-submit) an application, and enroll in a health care plan. If you don’t complete this process in 60 days, you may have to pay the Shared Responsibility Fee (a tax penalty, discussed above on PG. 462) for not having health care coverage.
IMPORTANT: You will not qualify for a Special Enrollment Period (SEP) if you voluntarily ended health care or lost health care coverage that didn’t provide the minimum essential benefits now required to avoid paying the Shared Responsibility Fee. For more information on SEPs and how to appeal if you were denied a SEP, please visit: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/, or call Covered California at 1-800-300-1506 (TTY 1-888-889-4500) or the federal government’s Health Insurance Marketplace at 1-800-318-2596 (TTY 1-855-889-4325).
If you don’t enroll during this period, you may not be able to find a private plan that can cover you (and you may have to pay the shared responsibility fee). ↑
For more information and a chart detailing Medi-Cal income guidelines, please visit: Covered California, https://www.coveredca.com/ShopAndCompare/2015/—incomeGuidelines. ↑
For more information on qualifying life events for special enrollment available at, Special Enrollment Period, Healthcare.gov, https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/. ↑