Open Enrollment Period in California

• Open Enrollment for 2025: November 1, 2024 – January 31, 2025.

• During this time, you can enroll in a new plan, renew your coverage, or switch plans.

• If you miss this window, you can only enroll if you qualify for a Special Enrollment Period (SEP).

Special Enrollment Period (SEP) Rules

You may qualify for a SEP if you experience a qualifying life event, such as:

• Loss of other health coverage

• Marriage or divorce

• Birth or adoption of a child

• Change in residence

• Loss of Medi-Cal or CHIP eligibility

You generally have 60 days from the date of the event to enroll, and you may need to provide proof of the event. In some cases, you have 60 days before and after the event to apply.

Types of Health Insurance Plans Available

Covered California offers plans in four “metal” tiers:

• Bronze: Lowest premiums, highest out-of-pocket costs; good for those who rarely use care.

• Silver: Moderate premiums/costs; required for cost-sharing reductions (CSRs).

• Gold: Higher premiums, lower out-of-pocket costs; good for frequent care needs.

• Platinum: Highest premiums, lowest costs; best for those needing frequent care.

Catastrophic Plans: Available to those under 30 or with a hardship exemption. These have low premiums, high deductibles, and cover essential benefits after the deductible is met.

Plan Types:

• HMO (Health Maintenance Organization): Lower premiums, requires use of network providers and referrals for specialists.

• PPO (Preferred Provider Organization): Higher premiums, broader network, no referrals needed.

• EPO (Exclusive Provider Organization): Hybrid of HMO and PPO; must use network providers, but no referrals needed.

• POS (Point of Service): Combines features of HMO and PPO, less common.

Eligibility for Subsidies and Cost Assistance

• Premium Tax Credits: Available to those with incomes up to 600% of the federal poverty level (FPL) in California, making coverage more affordable for middle-income families.

• Cost-Sharing Reductions (CSR): For those with incomes up to 250% FPL who select a Silver plan, CSRs lower out-of-pocket costs.

• Medi-Cal/CHIP: Medi-Cal is available to low-income residents, including undocumented adults, children, and seniors. CHIP covers children in families with incomes too high for Medi-Cal but below certain thresholds.

How to Compare and Choose a Plan in California

When comparing plans, consider:

• Premiums: Monthly cost

• Deductibles/Out-of-Pocket Maximums: What you’ll pay before coverage kicks in

• Provider Networks: Ensure your preferred doctors/hospitals are in-network

• Drug Formularies: Check if your medications are covered and at what cost

• Additional Benefits: Some plans offer wellness programs, telemedicine, or mental health services

Tips:

• Self-employed: Consider high-deductible plans with HSAs for tax benefits.

• Families: Look for pediatric dental/vision, family out-of-pocket limits, and robust provider networks.

• Retirees: Marketplace coverage can bridge the gap until Medicare at 65; check if you qualify for extra subsidies.

Top Insurance Providers on the California Exchange

Major insurers participating in Covered California include:

• Kaiser Permanente (best overall and HMO)

• Blue Shield of California

• Anthem Blue Cross (best EPO)

• Health Net (best PPO)

• Molina Healthcare

• Sharp Health Plan

• Western Health Advantage

• Valley Health Plan

• Chinese Community Health Plan

• L.A. Care Health Plan

Regional providers and county-based plans are also available, especially for Medi-Cal.

Navigating California’s Online Enrollment Portal

How to Apply:

Go to the Covered California website and create an account.

Enter household and income information to check eligibility for subsidies or Medi-Cal.

Compare available plans by premiums, coverage, and network.

Select a plan and complete enrollment.

Pay your first premium to activate coverage.

Where to Get Help:

• Free, in-person help is available from Certified Enrollment Counselors, Navigators, and insurance agents statewide.

• Community health centers and local agencies also provide assistance in multiple languages.

Alternatives to the Marketplace

• Short-term health plans: Temporary coverage; not ACA-compliant and may exclude pre-existing conditions.

• Off-exchange private plans: Purchased directly from insurers; no subsidies available.

• Faith-based health-sharing ministries: Not insurance and lack ACA protections, but may be an option for some.

Common Mistakes to Avoid During Enrollment

• Forgetting to update income, which can affect subsidy eligibility and lead to tax repayment.

• Missing enrollment deadlines, resulting in loss of coverage or waiting until the next Open Enrollment.

• Choosing the wrong metal tier for your needs (e.g., picking Bronze for low premiums, but facing high out-of-pocket costs if you need care).

• Not checking if your providers are in-network.

State-Specific Health Programs or Initiatives

• Medi-Cal Expansion: California now offers Medi-Cal to all low-income residents, regardless of immigration status.

• State Subsidies: California provides additional premium subsidies for middle-income residents.

• Access for Infants and Mothers (AIM): Low-cost coverage for pregnant women and newborns ineligible for Medi-Cal.

• County Programs: Some counties offer additional programs for children and adults who don’t qualify for other coverage.

Covered California continues to innovate with expanded eligibility, robust local health plans, and a commitment to universal coverage.