Understanding The Health Insurance Marketplace
What Is The Health Insurance Marketplace?
In California, Covered California helps you find health coverage that fits your needs and your budget. You can compare plans based on price, benefits, and networks, to make the best coverage decision for you and your family. Covered California was established by the Affordable Care Act (ACA) to help individuals and families access affordable health insurance. While the federal government operates the Health Insurance Marketplace in most states, some states, including California, run their own marketplaces. All health plans offered through Covered California are available from insurers like Anthem.
Who Qualifies For A Health Plan Through Covered California?
To be eligible for a health plan through Covered California, you must:
- Live in the United States.
- Be a U.S. citizen or national (or be lawfully present).
- Not be incarcerated.
Immigrants who aren’t lawfully present do not qualify for a health plan through Covered California; however, they may qualify for coverage through Medi-Cal up to age 19 or for pregnancy coverage.
Are Subsidies Available Through Covered California?
You may be eligible for free or low-cost coverage through premium tax credits, also known as health insurance subsidies. Most applicants will qualify for some kind of financial help.**‡
Premium tax credits are based on your income and family size (including yourself, your spouse, and anyone you claim as a tax dependent — even if they do not need coverage). Subsidies also consider the cost of health coverage in your state. If you are eligible, you may qualify for a health plan with a low or no cost monthly premium.*
How Does Coverd California Work?
Covered California offers plans in four “metal” levels: Bronze, Silver, Gold, and Platinum. Metal levels differ only in how you and your insurer share the overall cost. Check for availability, as not all metal level plans are available in all areas.
|
Plan |
Bronze |
Silver |
Gold |
Platinum |
|---|---|---|---|---|
|
What your plan pays |
60% |
70% |
80% |
90% |
|
Your cost |
40% |
30% |
20% |
10% |
What Does It Mean To Receive Coverage Through Covered California?
All health plans through Covered California cover 10 essential health benefits:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (surgery and overnight stays)
- Pregnancy, maternity, and newborn care
- Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
- Prescription drugs
- Rehabilitative services and devices (used to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision for children
While all health plans through Covered California provide essential coverage outlined above, you can also select plans through your insurer that include more comprehensive coverage like dental and vision insurance.
When Can I Enroll In A Health Plan Through Covered California?
You can enroll in a health plan through Covered California during the Open Enrollment Period, which typically runs between November 1 and January 31 annually in California. If you miss Open Enrollment, there is another way you may still be eligible to apply for health coverage.
A Special Enrollment Period lets you apply for health coverage if you experience a life event like losing your existing health plan, getting married, or having a baby.
Need Help Finding A Health Plan Through Covered California?
Anthem is here for you and can help assist you in selecting a health plan through Covered California that fits your unique needs and budget.
Related Articles
Understanding Metal Levels and Marketplace Insurance | Anthem
How to Choose a Health Insurance Plan
Learn How Premium Tax Credits Help You Save
References
** Centers for Medicare & Medicaid Services: Health Insurance Marketplaces 2023 Open Enrollment Report (2023): https://www.cms.gov/files/document/health-insurance-exchanges-2023-open-enrollment-report-final.pdf.
‡ Subsidies are only available for Qualified Health Plans purchased through Covered California. Anthem Blue Cross is a Qualified Health Plan issuer that offers such Plans through Covered California.
* Based on federal and/or state exchange requirements and subject to change. Anthem Blue Cross is a Qualified Health Plan issuer that in certain geographic areas offers some health plans with a $0 premium option (after subsidy applied) through Covered California. Anthem health plans with a $0 premium option are not available in all areas and eligibility for these plans is based on federal annual income guidelines. Call us for information because not everyone will qualify. For example, singles earning up to $20,385 and couples earning up to $27,465 may be eligible. Family income eligibility varies based on number of family members.