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Wednesday, August 21st, 2019

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California Obamacare Home Page


What California Residents Need to Know About Obamacare in 2019

The Affordable Care Act, also known as Obamacare, has not been struck down or repealed.

The recent federal court decision is still moving through the courts, and the exchanges are still open for business and we will continue with open enrollment. There is no impact to current coverage or coverage in a 2019 plan. ~ Federal Medicare & Medicaid Services, December 14, 2018

This website provides information about getting health insurance under the Affordable Care Act (ACA), including:

To begin, keep in mind these key points about health insurance in California:

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How To Sign Up for Obamacare in California

To sign up for a health plan under the Affordable Care Act (Obamacare) you can go directly to the online health insurance marketplace for California -- or you can get help in person or over the phone.

Where's the California Health Care Exchange?

You can find the health insurance exchange for California at Covered California. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online. 

Getting In-Person Help with Enrollment

In California, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a navigator (often called a "certified enrollment counselor" in California) or from a licensed health insurance agent or broker.

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How Much Does Obamacare Cost in California?

This article explains the costs of health care plans offered under the Affordable Care Act (commonly called Obamacare) for individuals or families who are currently uninsured or not covered by a job-based health plan.

What you'll pay for an Obamacare plan depends on five things:

  1. The level of coverage you choose
  2. Whether you qualify for a subsidy
  3. Where you live in California
  4. Your age
  5. Whether you smoke

Read on to learn more about each of these factors.

1. The Level of Coverage You Choose

Obamacare insurance plans offer four levels of coverage:

Platinum -- covers approximately 90% of health care costs
Gold -- covers approximately 80% of health care costs
Silver -- covers approximately 70% of health care costs
Bronze –- covers approximately 60% of health care costs

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Do I Have to Get Health Insurance in California?

Until 2019, you may be required to pay a tax penalty if you aren't enrolled in a health insurance plan that meets the requirements of the Affordable Care Act. After January 1, 2019, the penalty goes away.

To avoid a tax penalty for 2018, you must have had qualifying health coverage for the year or prove your eligibility for an exemption.

What Qualifies as Coverage?

If you have any of the following types of health coverage, you won’t have to pay a penalty:

  • an individual insurance plan, whether purchased on your own or through Covered California, the exchange serving California
  • a plan (including COBRA or a retiree plan) provided by your employer
  • Medicare, Medicaid, or coverage under the Children’s Health Insurance Program (CHIP) 
  • TRICARE (coverage from the U.S. military)
  • coverage under a veterans health care program  more...  

What Happens If I Missed the California Obamacare Enrollment Deadline for 2019?

For 2019, in most states, open enrollment for health insurance under the Affordable Care Act ended on December 15, 2018. That means it’s too late for most people to use a health insurance exchange to get coverage for 2019.

If you let the ACA deadline pass you by this year, here are some things to know.

You Can Still Enroll If You Qualify for a “Special Enrollment” Period

Certain life events make you eligible to sign up for health insurance outside of open enrolllment. The circumstances under which you may qualify for special enrollment include:

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Obamacare and Taxes: What You Need to Know Before You File

Do you have to worry about IRS Forms 1095, 8965, or 8962? The Affordable Care Act, aka Obamacare, requires you to do one of the following three things when you file their taxes this year:

  • confirm you had health insurance coverage for 2017
  • claim an exemption from health coverage, or
  • pay a penalty when you file your return.

This remains true even though the Trump administration has issued an executive order allowing the IRS to accept tax without health insurance disclosures. Under the Affordable Care Act, you are still required to pay any Obamacare tax penalty you owe, and the IRS may question you if you fail to report your health insurance status on your tax return. The new rule does, however, imply that the Trump administration may not aggressively pursue people who don't pay their penalties.

Here’s what you should know about filing your taxes in this confusing era of health insurance reform.

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Understanding Obamacare's Preventive Health Care Benefits

Get a colonoscopy, mammogram, vaccinations, and other essential services for free

The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Covered California, the health care marketplace for California. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.

Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges

Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.

Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.

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Obamacare for Self-Employed California Residents

Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.

Are You Self-Employed or an Employer? 

Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.

The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.

If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.

If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.

What Obamacare Means for Self-Employed People in California

Here are six things self-employed people should know about the Obamacare health insurance reforms:

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How Obamacare Affects Unemployed California Residents

The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because low-cost coverage options may be available to you through Covered California, the health insurance marketplace serving California.

All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.

When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan. 

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What Domestic Partners Need to Know About Applying for Health Insurance Under Obamacare

When registered domestic partners or civil union partners apply for coverage in the new health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?

The answer depends on the state where you live.

States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)

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Obamacare and Seniors

If you’re over the age of 65, your health insurance options under the Affordable Care Act depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.

You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through a health care marketplace.

The Affordable Care Act enhances your existing Medicare coverage in a couple of important ways:

  • You get more preventive care benefits, such as cancer screenings and an annual wellness visit.
  • If you fall into the prescription drug “donut hole,” there are new discounts to help you save money until the hole closes completely in 2020.

For more information on Medicare coverage, go to Medicare.gov. To learn about Medicare Advantage plans -- which include traditional Medicare benefits, prescription drug coverage, and more -- see Medicare Advantage By Zip Code.

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Can I Use a Paper Application to Get Obamacare?

When Obamacare launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.

Because of these difficulties, some individuals and application assistants turned to the old-fashioned way of getting health insurance -- paper applications.

Applying on Paper May Not Be Better or Faster

When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.

The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.

It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. Follow these steps to apply on paper.

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When Are You Legally Required to Report "Life Changes" to the California Health Insurance Exchange?

Are you planning to get married, change jobs, or move to a new state? If so, you might have to share your big news with Covered California.

Which Changes Must You Report? 

If you buy a health insurance plan through the California marketplace, the Affordable Care Act requires you to report changes that may affect your insurance coverage. These changes include: 

  • moving to a new state or insurance coverage area
  • significant changes in income
  • getting new health coverage through a job
  • signing up for Medicare or Medicaid
  • getting married or divorced
  • becoming pregnant, having a child, adopting a child, or placing a child for adoption
  • losing or gaining a dependent
  • becoming disabled, and
  • other changes that affect your income or household size.

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About This Website

We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.

When you choose your state or enter your zip code above, you will quickly learn:

  • whether or not you're required to get health insurance

  • what the available plans cover

  • how much coverage will cost, and

  • how to sign up in your state.

For those concerned about cost, we show you how to determine whether you qualify for subsidies. We also explain the rules about expanded Medicaid eligibility.

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