Covered California vs Medi-Cal vs Obamacare

Life happens. People get injured or sick, which is why we have health insurance. Some people have health insurance through their employers, while others need to shop and pay for an insurance policy on their own. This process can be intimidating. What type of coverage do you need? What is your deductible? What is the monthly premium? Worries about the process and the cost can make it tempting to take a risk and go uninsured. But, California strives to make health insurance accessible and affordable. Learn about three different low-cost health insurance options in California to help you decide what is right for you.

What Is Covered California?

Covered California is a state-run insurance exchange where California residents can shop for and compare different health insurance plans. Learn about the different Covered California plans and how to get started.

1. Plan Options

All plans offered through Covered California are required to provide essential health benefits. Essential health benefits include:

• Ambulatory patient services
• Behavioral health treatment
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Pediatric care
• Prescription drugs
• Preventative care
• Rehabilitation services

Beyond these basics, you have your choice of different coverage levels and different insurance carriers. Covered California plans come in four different tiers. There are some variations among plans in each tier, but these are the general guidelines to help you understand the difference between them.

• Anthem Blue Cross
• Blue Shield of California
• Chinese Community Health Plan
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Medi-Cal
• Molina Healthcare
• Oscar Health
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

Insurance carriers affect which physicians are covered under your health insurance plan. If you want to see a particular doctor, be sure to check which plans consider that doctor in-network.

2. Cost

Covered California health plan costs will vary depending on several factors. The metal tier you choose is a good starting point for understanding your financial responsibility. The monthly premium cost for a Bronze plan will be the least expensive. Your premium will escalate with each step up in tier. The Platinum tier will have the most expensive monthly premiums.

Another cost to consider is your health plan’s deductible. Your deductible is the amount of money you will need to pay for services before your health insurance plan starts paying. Bronze plans tend to have the highest deductibles, while Platinum plans will have the lowest deductibles.

Consumers also need to be aware of their copays and coinsurance. Copayments are a fixed amount the consumer pays for a particular health service. For example, most health plans include a copay for an emergency room visit or a visit to a specialty doctor. Copays are typically higher with lower-tier plans and lower with higher-tier plans. When receiving health care, consumers pay coinsurance and their deductible. Coinsurance is your share of a particular cost, calculated as a percentage. Coinsurance varies between plan tiers and can be different for different services.

The cost can be the most intimidating part of getting health coverage, but Covered California offers consumers financial assistance. Financial assistance options include premium assistance and cost-sharing subsidies. Premium assistance is a tax credit, which reduces your monthly premium amount. Cost-sharing subsidies help you manage the cost by reducing out-of-pocket amounts, including your copay, coinsurance, deductible and out-of-pocket maximum.

3. How to Enroll

Open enrollment for Covered California plans begins each fall and typically runs through mid-January. During this period, consumers can shop for and select a health insurance plan on the Covered California exchange. The first step is to enter some information about yourself, which will help determine your plan options. Then, you can compare all of the different plan options. Next, you can apply online, over the telephone or with Health for California. During the application process, you will need to supply your Social Security number, birth date, current income and any applicable immigration documents. After applying, you can view your options for financial assistance. Finally, select a health plan and pay your first premium. Then, you are officially covered.

While you typically need to apply during the open enrollment period, Covered California offers special enrollment. This period outside of open enrollment allows people with a qualifying life event to apply for and gain coverage. Qualifying life events include losing coverage, moving, getting married or having a baby.

What Is Obamacare?

Obamacare is the widely recognized name for the Patient Protection and Affordable Care Act (PPACA), which President Obama signed into law in 2010. This federally mandated law is designed to reform health care and improve access to health insurance. Obamacare offers individuals and families financial assistance for purchasing health insurance, and the legislation expanded the Medicaid program to offer more coverage for low-income adults. Learn more about Obamacare health insurance plans.

1. Plan Options

Obamacare health plans are available through the federally run HealthCare.gov health insurance exchange for residents of some states. Other states, like California, offer Obamacare health insurance plans through state-run exchanges. Covered California is the state’s Obamacare exchange. This means your Obamacare plan options are the same as your Covered California options. The plans on Covered California are divided by carrier and into four different metal tiers — Bronze, Silver, Gold and Platinum. The different tiers determine how much your health plan pays and how much you pay out-of-pocket.

2. Cost

Obamacare plans are another term for the plans offered through Covered California. This means the cost is determined in the same way. Bronze plans typically have the lowest monthly premium and the highest out-of-pocket costs, including deductibles, copays and coinsurance. Platinum plans have the highest monthly premium and the lowest out-of-pocket costs.

Whether you think of these plans as Obamacare or Covered California, you have the option for financial assistance. During the application process, you will enter basic information about your income or your household’s income. This will determine your eligibility for premium assistance or cost-sharing subsidies.

3. How to Enroll

California residents cannot enroll for Obamacare plans on HealthCare.gov. Instead, you enroll for health insurance coverage on the state-run exchange, Covered California, or Health for California. Typically, consumers need to sign up for a health plan during the open enrollment period, which begins in the fall and runs through mid-January. During this time, you can compare different plans and determine your eligibility for financial assistance. You can apply and enroll in a plan online, or you can enroll over the phone. Your coverage is finalized once you pay your first month’s premium.

If you have a qualifying life event, such as loss of coverage, moving, marriage or having a baby, you can sign up for health coverage outside of open enrollment during a period known as special enrollment.

What Is Medi-Cal?

Medi-Cal, another California health insurance program, offers children, adults and seniors with limited income low-cost health insurance. Learn about the different Medi-Cal options and how to enroll in this program.

1. Plan Options

Medi-Cal health plans are available through the Covered California health insurance marketplace. Like all plans offered through Covered California, Medi-Cal health plans must offer essential health benefits, including:

• Ambulatory patient services
• Behavioral health treatment
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Pediatric care
• Prescription drugs
• Preventative care
• Rehabilitation services

Medi-Cal plan options will vary depending on your county of residence. The majority of counties offer Medi-Cal plans administered by commercial carriers like Anthem Blue Cross and Kaiser Permanente. Other counties offer publically administered Medi-Cal plans. View to the health plan directory to see what Medi-Cal plans are available in your county.

Medi-Cal plans typically operate like managed care plans or health maintenance organizations, commonly referred to as HMOs. This means you will have a primary care doctor who helps you manage your health. If you need care from a specialist, your primary care doctor will refer you to one covered under your Medi-Cal health insurance plan.

2. Cost

Medi-Cal plans are designed for people with limited income, which means the plans are either low-cost or free. The cost will be determined by each individual’s or family’s income. Medi-Cal plans may have no out-of-pocket costs, such as copayments and monthly premiums. Others may have a manageable monthly premium. Individuals covered under Medi-Cal will receive the same level of benefits as those covered under other Covered California health insurance plans.

3. How to Enroll

You can enroll for Medi-Cal health coverage through the Covered California health insurance marketplace or with Health for California. The application process will help you to determine whether or not you are eligible for Medi-Cal coverage. The online application process involves entering some personal information, including your place of residence and household income. After applying, the county will consider your application and mail you confirmation or denial of your eligibility. You may receive your benefits identification card in the mail.

If you are eligible for Medi-Cal coverage, you can compare plans and select one. Note that some California counties may only have one Medi-Cal plan available. In this case, you will be enrolled in that plan. After choosing a plan, you will need to select a doctor or doctor’s group to serve as your primary care doctor. The Medi-Cal program has more than 400 hospitals and more than 130,000 doctors and other health care providers.

If you cannot apply online or uncomfortable with the online application process, you can enroll with Health for California. Our agents are always available to answer questions and help you pick a plan.

Which One Is Best for You?

Navigating the process of choosing and signing up for a health insurance plan can be confusing. Now that you know the difference between California health insurance options, you can decide which one is best for you.

1. Covered California

Covered California insurance plans are an excellent option for anyone — individuals or families — who does not have health insurance through an employer. Covered California health coverage is available to U.S. citizens, U.S. nationals and permanent residents. Immigrants can also apply for coverage through Covered California. If you fall into any of these categories and do not have health insurance through another outlet, Covered California is the right choice for you. Small businesses can also sign up for health coverage through the Coverage California Small Business exchange.

If you are eligible for Covered California, it is up to you to decide which plan to choose. If you are healthy but want insurance in case of a health emergency, a Bronze plan may be best for you. Healthy individuals and families who want more coverage with still reasonable out-of-pocket costs may settle on a Silver plan. Gold and Platinum plans may make more sense for individuals and families who use medical services more often. Monthly premiums will be higher, but many of these plans do not have a deductible.

2. Obamacare

Obamacare health insurance plans are available through the Covered California insurance marketplace and Health for California. If you sign up for insurance through Covered California, you are covered by Obamacare. Since these two options are the same, you do not have to worry about choosing between the two. Instead, you can focus on choosing which health insurance plan is right for you. Consider your health and what you will need to use your health coverage for when deliberating between metal tiers. Those with few health care needs can opt for the higher deductible and lower premiums of a Bronze plan, while someone with a chronic condition may opt for no deductible and higher premiums with a Gold or Platinum plan.

3. Medi-Cal

If you do not think you can pay for Covered California health coverage, even with financial assistance, you may be eligible for Medi-Cal. Medi-Cal offers low-cost or free health insurance to low-income adults, children, seniors and people with disabilities. The Covered California application process will help you to determine if you are eligible for Medi-Cal insurance coverage.

Find Insurance With Health for California

No matter your needs, it is possible to find affordable California health insurance. Start the process by getting a free quote for an individual health insurance plan or a family health insurance plan. Your quote will include the insurance carrier name, the plan category, the plan type, the total cost, how much you will pay and the financial assistance subsidy for which you qualify. You can compare quotes for different plans to help you decide what is best. Your health is a priority. Get covered to help protect your future and the future of your family.