Covered California Health Insurance: Plans, Costs, Eligibility and Enrollment

Covered California health insurance gives individuals and families a way to compare private health plans, determine whether they qualify for financial help, and enroll in coverage through California’s health insurance marketplace.

Whether you are buying health insurance for yourself, your family, or because you recently lost other coverage, understanding how Covered California works can make comparing your options much easier.

This guide explains Covered California health plans, costs, eligibility, financial help, enrollment periods, and some of the most important factors to consider when choosing coverage.

What Is Covered California?

Covered California is California’s health insurance marketplace. Individuals and families can use it to compare health insurance plans and enroll in coverage.

One of the most important features of Covered California is that eligible households may qualify for financial help that reduces the cost of health insurance. Eligibility for financial assistance is based on factors such as household income and household size.

Covered California and Medi-Cal also use the same application process. Depending on the information entered on an application, household members may qualify for a Covered California health plan, Medi-Cal, or different programs within the same household.

For a detailed comparison, see our guide to Covered California vs. Medi-Cal.

Covered California Health Insurance Plans

Covered California health insurance plans are offered by private insurance companies. The specific insurance companies and plans available can vary depending on where you live in California.

Plans are generally organized into four primary metal tiers:

• Bronze — generally lower monthly premiums with higher costs when receiving medical care.
• Silver — a middle ground between monthly premiums and out-of-pocket costs, with additional cost-sharing reductions available to some eligible households.
• Gold — generally higher monthly premiums with lower costs when receiving medical care.
• Platinum — generally the highest monthly premiums with the lowest costs when receiving medical care.

A minimum coverage plan may also be available to people under age 30 and certain individuals who qualify for an exemption.

When comparing Covered California plans, it is important to look beyond the monthly premium. Provider networks, prescription drug coverage, deductibles, copays, coinsurance and expected medical usage can all affect which plan may fit your needs.

How Much Does Covered California Health Insurance Cost?

There is no single price for Covered California health insurance. Your premium can depend on several factors, including where you live, your age, household members, the health plan you choose and any financial help for which you qualify.

Two households choosing similar plans could therefore pay very different monthly premiums.

When comparing Covered California rates, consider both the monthly premium and what you may pay when you actually use your coverage. A plan with a lower premium is not necessarily the lowest-cost option overall if you expect frequent doctor visits, prescriptions or other medical care.

Covered California Financial Help and Subsidies

Many people who enroll through Covered California qualify for financial assistance.

Financial help may reduce monthly premiums, out-of-pocket costs, or both depending on eligibility. The amount of assistance available depends largely on household income and household size, along with applicable program rules.

Because income can have a major effect on the amount you pay, it is important to estimate household income carefully and update your application when circumstances change.

For a deeper explanation, read Covered California Subsidies: How Financial Help Works.

Covered California Income Limits

Income plays an important role in determining eligibility for financial help through Covered California and whether someone may instead qualify for Medi-Cal.

The applicable income ranges can change, which is why it is important to use current information rather than relying on an older chart or previous year’s eligibility results.

See our current guide to Covered California Income Limits for a more detailed explanation.

What Income Counts for Covered California?

Covered California generally looks at expected household income for the coverage year when determining eligibility for financial help.

Depending on your situation, income can include wages and other types of taxable income. Self-employed individuals may have additional considerations when estimating annual income.

Because the rules can become more complicated when income changes during the year, we created a separate guide explaining what counts as income for Covered California.

If you work for yourself, you can also read our Covered California guide for self-employed Californians.

Who Is Eligible for Covered California?

Covered California eligibility depends on several factors. Applicants generally need to be California residents and meet applicable eligibility requirements.

Household size, income, immigration status and access to other health coverage can affect which programs or financial assistance may be available.

Applying does not necessarily mean everyone in a household will receive the same eligibility result. For example, one family member could qualify for Medi-Cal while another qualifies for a Covered California health plan.

When Can You Enroll in Covered California?

There are two primary ways to enroll in Covered California health insurance: during Open Enrollment or through a Special Enrollment Period.

Covered California Open Enrollment

Open Enrollment is the annual period when eligible Californians can enroll in a new health plan, renew coverage or change plans without needing a qualifying life event.

For current dates and deadlines, see our Covered California Open Enrollment guide.

Covered California Special Enrollment

Outside Open Enrollment, certain life events may allow you to enroll or change coverage through a Special Enrollment Period.

Examples can include losing qualifying health coverage, getting married, having a baby or adopting a child, or moving under qualifying circumstances.

Learn more in our guide to Covered California Special Enrollment and qualifying life events.

How to Compare Covered California Health Plans

When comparing Covered California health plans, consider more than the advertised monthly premium.

Important factors can include:

• Monthly premium
• Deductible
• Primary care and specialist copays
• Prescription drug coverage
• Maximum out-of-pocket cost
• Doctor and hospital networks
• HMO, PPO or EPO plan structure
• Expected medical needs during the year

A lower-premium plan may make sense for one household, while another household may prefer paying more each month for lower costs when medical care is needed.

How to Get a Covered California Health Insurance Quote

Comparing plans and rates can help you understand what Covered California health insurance may cost based on your household information.

Rates and available plans can vary by location, age, household and other factors. If financial help is available, the amount you actually pay may also differ substantially from the full plan premium.

California Benefits Insurance Center can help individuals and families compare available health insurance options and understand the enrollment process.

Covered California and Form 1095-A

If you enroll in health insurance through Covered California, you may receive Form 1095-A for tax reporting purposes. The information on this form is important when reconciling advance premium tax credits on your federal tax return.

If information on the form appears incorrect, it may need to be corrected before completing your tax return.

See our guide to Covered California Form 1095-A and how to correct errors.

Choosing Covered California Health Insurance

The right health insurance choice depends on your individual circumstances. Premiums are important, but provider access, prescriptions, expected medical care and potential out-of-pocket expenses should also be considered.

Understanding your eligibility and financial assistance first can make comparing Covered California health plans much easier.

From there, you can compare available plans based on both what you pay each month and how the coverage works when you need care.

Covered California Health Insurance Resources

Explore our related guides for more detailed information:

• Covered California Income Limits
• What Counts as Income for Covered California?
• Covered California Subsidies
• Covered California vs. Medi-Cal
• Covered California Special Enrollment
• Covered California Open Enrollment
• Covered California for Self-Employed Californians
• Covered California Form 1095-A

California Benefits Insurance Center is a licensed insurance agency and is not affiliated with or operated by Covered California. Eligibility, financial assistance and plan availability are determined under applicable program rules and may change.