What if you missed one of the most important deadlines of your life?
If you live in California, it’s important to understand Covered California open enrollment. This refers to a period in which Californians can sign up for healthcare via the Affordable Care Act (sometimes referred to as Obamacare). And this period is particularly important for people on a limited income who may need financial help with their plan.
Despite the importance of it, many in the state don’t have enough information about this period and how it affects their policy. This can impact your access to your ability to get the health care coverage that you and your family deserve.
When is Covered California open enrollment, and what else do consumers need to know to get the best marketplace plan for the upcoming year? Keep reading to discover the answer!
What Is Open Enrollment?
In California, this refers to a period in which everyone in the state can apply for subsidized health plans. This allows enrollees to get the most affordable options from their chosen provider.
If you already have private health coverage and are satisfied with it, you may not need to look into these ACA plans. Otherwise, you may wish to use the online tools provided by the Covered California website. The site lets you take advantage of this year’s period, and comparing different plans and rates is a very simple process.
When Is Covered California Open Enrollment?
It typically runs from Nov. 1 to Jan. 31 of the following year. As long as you complete your application by the open-enrollment deadline, you will be able to get an ACA health plan for the upcoming year.
What happens to individuals who miss this deadline, though? In some cases, that means you need to get policy through a private company. However, those who have experienced a qualifying life event may be able to take advantage of a special enrollment period.
What life events help you qualify? The most common qualifying event is losing your current policy. For example, if you are insured via your employer and lose your job, you lose your coverage. But you would be able to now get a new policy through special enrollment.
Household changes may also help you qualify. This includes getting married, getting divorced, having or adopting a child, or experiencing a death in the family.
If you get a new zip code or move to a new county, you can apply for health plans via the federal government. This includes moving due to school or work or even moving to or from transitional housing.
Other life events may help you qualify, including changes to your income (for example, you lose enough income that you are now seeking programs that offer financial assistance). Becoming a citizen is a qualifying event, as is getting out of jail. Finally, starting or ending your service with Americorp can help you qualify, as can joining a tribe that is recognized by the government.
Special Enrollment and Low-Income Families
Earlier, we discussed how a change in income lets you apply for the plan. However, depending on your income, you may be able to apply for state-run insurance year-round.
It all comes down to the federal poverty level. If your income is currently at or below 150% of the poverty level, you can apply for high-quality medical care at any time.
Understanding Expanded Health Subsidies
One question that many people have about the ACA marketplace is “what’s a subsidy?” This term basically refers to how much financial assistance you can get from the government. Regardless of your age or other factors, the law states that subsidies for ACA coverage are tied to your income and household size. The goal is simple: those with a limited income end up paying less.
When it comes to subsidies, there is a “catch:” if your employer offers minimal essential coverage you are able to afford, then you cannot get these subsidies. However, a recent change made these subsidies much more accessible to residents throughout the state.
Previously, some people were not eligible for these subsidies because the federal government’s affordability test focused only on the cost of insuring a single person. Now, they consider the cost of insuring your entire family. Therefore, if it would cost more than 9.12% to insure you and your family through your employer, then you may qualify for these special subsidies and benefits.
Even better, these benefits will apply to everyone in the household. And thanks to the changes made by the Inflation Reduction Act, the cost of the ACA “silver” plan (the standard plan for many using the marketplace) will be no more than 8.5% of your modified adjusted gross income. This makes it easier to protect you and your family with good coverage.
Avoiding the Tax Penalty for Having No Health Insurance
If you do not qualify for special or open enrollment, then you need to get private healthcare (in some cases, you may be able to get short-term health insurance plan before the next period). But what happens if you don’t have any protection whatsoever?
The short answer is that the government will fine you in some cases. In California, the minimum fine is $850 per adult and $425 per dependent child. This means that people in the state could end up owing thousands of dollars for having an uninsured family, and this is on top of the family being at risk due to the lack of coverage.
You may be exempt from these fines if you don’t earn enough money to pay income taxes, if your premiums are unaffordable, or if you are a member of a federally-recognized tribe. Generally speaking, though, those who can afford it should get it rather than risk being uninsured.
Incidentally, if you have children, it’s always worth looking into life insurance. This can help protect your family if anything happens to you.
How Can I Enroll?
To enroll, you can complete the application on their website. The site also lets you print out the application in different languages and physically mail it in if you choose to do so.
Don’t want to handle everything on your own? In that case, a good agent can help you complete the application. Alternatively, you may be able to get assistance via local enrollment counselors or social service workers.
And if you are comfortable using technology, you may wish to explore telemedicine options that allow you to consult with a doctor without leaving your home.
Are Premiums Higher Than They Were Before?
The premiums for 2023 are 5.6% higher than the average cost of premiums in 2022. While premiums typically increase in price from year to year, this was a larger bump in cost than usual.
Different factors can affect the cost of these premiums. Beginning in 2020, the pandemic caused many people to stay home for months and seek less medical treatment than they normally would. This helped keep the cost of premiums lower, but more recently, people have been settling back into their normal routines. This means more trips to the doctor and, in general, higher health costs.
It’s also important to keep an eye on your out-of-pocket maximum costs. This represents the maximum amount you would have to pay for costs in a single year. Starting in 2022, the maximum out-of-pocket cost has increased to $8,700 for individuals and $17,400 for families. Before this, the previous maximum was $8,500 for individuals and $17,100 for families. Relatively speaking, this is a small increase, but if you’re on a tight budget, it’s important to understand these changes!
The good news is that subsidies still take care of most of the costs for qualifying residents. But these increasing costs highlight the importance of staying on top of your plan and potentially shopping around each year for a better deal.
What are the Rules for Businesses?
The rules are different for large vs small businesses. Those who employ 50 or more full-time people must offer health plans that are equal to or better than the ones offered by the ACA. Companies who do not follow this rule may be penalized $2,000 per employee.
You cannot just drop all of your employees to part-time and skirt the law. The government adds up how many hours your employees are working, so two part-timers who are working 15 hours per week each equal one FT worker.
Small businesses that employ less than the equivalent of 50 FT workers do not have to offer coverage. Just keep in mind that good workers will gravitate to companies that offer good benefits.
Is This the Same as the American Rescue Act?
No. The American Rescue Act is the Biden administration’s list of benefits to improve American lives. It does contain some similar benefits, such as lowering premiums and providing a federal COBRA subsidy. It also provided checks to American families during the pandemic, extended unemployment insurance and provided small business support – all to help while the United States dealt with the effects of Covid-19.
Get the Most Affordable Health Insurance Today!
Did you know that Freeway can help you navigate the confusing healthcare marketplace? We offer help finding the best coverage with the best customer service.
Here at Freeway, we specialize in the kind of health coverage you and your family deserve. Ready to protect yourselves with the right policy? It’s very easy to get a quick online quote, though you can always chat with an expert online or in-person if you’d prefer!