California Obamacare (Affordable Care Act) Facts 2022

What California Residents Need to Know About Obamacare for 2022

Essential facts about the Affordable Care Act (ACA or Obamacare) in California, including whether you must get health insurance, how much it costs, and how you can save money.

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How To Sign Up for Obamacare in California
 
Do I Have to Get Health Insurance in California?

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Last Reviewed: Mon, Feb 7, 2022

In California, Affordable Care Act (Obamacare) open enrollment is over, but you may still qualify for 2022 coverage.

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:

1. California law requires you to have health insurance.

The federal tax penalty for going without health insurance ended in 2019, but a handful of states, including California, have enacted laws to replace it. If you are uninsured in 2020 and you don't qualify for an exemption, you'll face a penalty when you file your California taxes in 2021.

To learn more about the penalty and to find out whether you qualify for an exemption, see Do I Have to Get Health Insurance in California?

2. California open enrollment has ended, but you may be able to use a special enrollment period to get covered.

In California, open enrollment for 2022 Affordable Care Act (Obamacare) coverage has ended. This means that, unless you qualify for an exception or your income is low enough for Medicaid, you won't be able to get health insurance through Covered California until open enrollment for 2023 begins next fall.

If you’ve lost your job or significant income in the past 60 days, whether due to the COVID-19 pandemic or for any other reason, you might qualify for a special enrollment period (SEP). A SEP allows you to sign up for a new health insurance plan or change your current plan outside the open enrollment window.

In addition to job or income loss, many other qualifying events may make you eligible for a SEP. To learn more, see What Happens If I Missed the California Obamacare Enrollment Deadline?

3. You probably qualify for new Affordable Care Act subsidies.

Last year, President Biden signed the American Rescue Plan Act (ARPA). The law provides $1.9 trillion of federal aid to Americans struggling with the COVID-19 crisis. The relief measures include additional premium subsidies for those who purchase health insurance through Covered California. People who apply for 2022 coverage under a special enrollment period can access these subsidies, but the additional ARPA benefits are available only through the end of 2022. (This may change if Congress passes the Build Back Better act.) In addition, California offers state financial assistance. Here's a quick summary of the main programs available to you:

Federal tax credits. Until the passage of ARPA, the ACA provided premium subsidies only to those whose income fell between 100% and 400% of the federal poverty level. For example, the cutoff for a family of four in California used to be $104,800. For an individual, it was $51,040.

Now, no one will have to pay more than 8.5% of their household income for a mid-level plan purchased from Covered California. Technically, the subsidies are tax credits, but you can choose to have them automatically deducted from the cost of your monthly premiums when you purchase a plan through Covered California.

The new subsidies will be available only through 2022 unless Congress enacts legislation to extend them.

Cost-sharing subsidies. More than half of the people who purchase coverage through Covered California receive assistance in the form of cost-sharing reductions (CSRs). CSRs automatically reduce your premiums and lower your costs when you use your insurance benefits—for example, when you go to the doctor, get lab work, or have to stay in the hospital.

CSRs are available to people who make between 100% and 250% of the federal poverty level. (For 2021 health plans, that means a family of four in California can't earn more than $65,500 and an individual not more than $25,520.) But they are available only on silver plans. If you think you may qualify, look carefully at costs for the silver plans available at Covered California while shopping for coverage.

California state subsidies. The state offers its own subsidies to the following three groups:

  • Californians who earn between 400% and 600% of the federal poverty level are eligible to save an average of 23% on their monthly premiums. For 2021, 600% of the federal poverty level is $76,560 for an individual and $157,200 for a family of four.
  • Those earning between 100% and 400% of the federal poverty level (see above) are eligible to receive state subsidies in addition to federal assistance. The state subsidy will contribute additional average savings of 5% on monthly premiums.
  • State residents whose annual household income is less than 138% of the federal poverty level may see premiums for certain plans lowered to just $1 per person, per month. The 2021 earnings cutoff for this level is $17,609 for an individual and $36,156 for a family of four.

Medicaid. If your income is very low, you may qualify for free or low-cost coverage through Medi-Cal in California.

For more information, see Ways to Save Money on Obamacare in California.

4. More health insurance plans will be available in 2022 and premium rates are stable.

In California, several insurers are expanding their coverage areas for 2022, and Bright Health is participating in the marketplace for the first time. Most Californians will be able to choose between at least three different insurance companies. The average premium increase will be 1.8%. This cost difference should be more than covered by the new subsidies discussed above.

5. California bans the sale of "short-term insurance plans" lasting more than 12 months.

In 2018, the Trump administration made it easier to purchase short-term insurance plans. These plans don't have to cover preexisting conditions or the essential health benefits provided by Obamacare plans. The new federal rules say that short-term plans can last for as long as three years. But California placed its own limits on the expansion of short-term plans. Under California law, insurers may not sell short-term plans lasting longer than 12 months.

If you’re genuinely caught without health insurance and need it for a few months to cover a new health condition, you might want to consider a short-term plan to get you through to the next open enrollment period. Otherwise, be careful of plans that don’t meet the requirements of the Affordable Care Act. Shop around to look for coverage that truly meets your needs.

Remember, if your income is very low, you may qualify for free or low-cost coverage through Medi-Cal in California.

6. You can get help signing up if you need it.

The Biden administration is greatly increasing enrollment assistance plans, making it much easier to get the information you need to get covered. To connect with local support resources, see How To Sign Up for Obamacare in California.

 

Jurisdictional relevance: There are versions of this article for each State.
Selected State: California
How To Sign Up for Obamacare in California
 
Do I Have to Get Health Insurance in California?

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