Signing up for Medi-Cal or Covered California: Everything you need to know

Starting in January, Californians will be required to sign up for health insurance or face a $695 tax penalty under the new state mandate.

Covered California open enrollment for 2020 runs from Oct. 15 through Jan. 15. If the enrollment period is missed, people won’t be able to sign up for coverage unless they qualify for a special enrollment period because of a major life event, such as having a baby, getting married or losing other coverage. Enrollment for Medi-Cal, the state’s free or reduced-cost taxpayer-funded health insurance program, can happen at any time.

Researchers estimate that 730,000 people who are eligible for Medi-Cal in 2020 will not enroll, according to a report from UC Berkeley and UCLA. In 2016-17, about 543,000 Californians were eligible but not enrolled.

The number of uninsured people is expected to increase because the federal individual mandate was repealed. California’s new state mandate is one method policymakers are using to push people to sign up for insurance.

California also will offer new subsidies in 2020 aimed at making health coverage more affordable for middle-income individuals and families. The subsidies are for individual Californians who earn between $50,000 and $75,000 and families of four earning $103,000 to $155,000.

Also new in the coming year, low-income undocumented young adults ages 19 to 25 will be able to sign up for Medi-Cal.

Despite these moves to make subsidized coverage accessible to a larger swath of people, experts predict that many still will not enroll because of lack of knowledge about the programs, confusion about how to sign up, or unfounded fears that signing up could expose family members who are undocumented to deportation. 

This guide is meant to explain what coverage options you might qualify for and how to do so. If you qualify for coverage, signing up will not put undocumented family members in danger of deportation or punishment because health providers are not allowed to give personal information to immigration authorities. 

Health Care Guide

Any U.S. citizen or green card holder living in California who does not have insurance offered by their employer can enroll in a health care plan regardless of income through Covered California, the state’s health insurance marketplace. Income determines whether you are eligible for free or reduced-cost health insurance or if you qualify for a subsidy (subsidized coverage may depend on whether a person has access to insurance through an employer). If you don’t qualify for financial assistance, you can still purchase private health insurance through Covered California.

What do I qualify for?

Medi-Cal: The free or low-cost state health insurance program. It’s California’s version of the federal Medicaid program.

o   Qualifications: An individual earning under $17,237 a year or a family of four with an annual household income less than $35,535 qualifies for Medi-Cal. Individuals may automatically be eligible for Medi-Cal if they receive cash assistance through Supplemental Security Income, CalWORKS, Refugee Cash Assistance, foster care, Adoption Assistance Program or Kin-GAP. Individuals who fall under Deferred Action for Childhood Arrivals (DACA) may qualify for Medi-Cal.

Medi-Cal for low-income pregnant women: This program provides immediate no-cost pregnancy-related care to low-income women while their application is evaluated for ongoing post-pregnancy Medi-Cal coverage.

o   Qualifications: Single women qualify if they are earning an annual income under $26,604, or are part of a family of four with a household income of $54,848 or less.

Medi-Cal Access Program for Infants and Mothers (AIM): AIM is a low-cost health insurance program for pregnant women who don’t have health insurance and whose income is too high for no-cost Medi-Cal. It’s aimed at providing health insurance to middle-income pregnant women.

o   Qualifications: Single women qualify if they make between $26,604 and $40,218, or if they are part of a family of four with a household income between $54,848 and $82,915. This program is also available to women who have private health insurance plans with a maternity-only deductible or copay greater than $500.

Medi-Cal for children: This program provides coverage for children under age 21, based on their parents’ income.

o   Qualifications: Children are covered in a family of four with a household income of $68,495 or less. Children qualify regardless of their immigration status.

C-CHIP, the County Children’s Health Initiative Program, provided through all counties in California: This program provides coverage for children up to age 19 who don’t meet the income requirements for Medi-Cal for children.

o   Qualifications: Children qualify if they are part of a family of four with a household income between $68,495 and $82,915. Children qualify regardless of their legal immigration status.

Medi-Cal for legally undocumented young adults ages 19 to 25: This coverage option starts Jan. 1, 2020,  and is for any undocumented young adult, including those who fall under Deferred Action for Childhood Arrivals (DACA).

o   Qualifications: Young undocumented adults would qualify based on the same income guidelines as Medi-Cal for adults.

American Indian/Alaska Native zero cost share: If American Indian or Alaskan Natives choose to purchase coverage through Covered California, many will not have to pay out-of-pocket costs such as copays and deductibles. If people choose not to enroll in coverage through Covered California, they will be exempt from the individual mandate tax penalty if they receive care from an Indian Health Services provider.

o   Qualifications: American Indian and Alaskan Native individuals who earn no more than $37,470, or a family of four with a household income at or below $77,250. For those making above those thresholds, there is also a limited cost share plan for American Indians and Alaskan Natives that helps lessen the cost.

Covered California’s four private health insurance plan groups: 

Platinum plans have the highest premium, or monthly fee, but they cover about 90% of your health care expenses. Gold plans pay about 80%, silver plans pay about 70%, and bronze plans, with the lowest premium, cover about 60% of health costs.

• Qualifications: Any U.S. citizen in California, a lawfully present immigrant or a green card holder. Income guidelines are the same for everyone who qualifies. (DACA recipients do not qualify to purchase insurance through Covered California, but they may qualify for Medi-Cal.)

Covered California has several subsidized enhanced silver plans that have income requirements. They are:

• Covered California, Silver Enhanced 94 Plan: This plan covers 94% of the average annual cost. A primary care or urgent care visit carries a $5 copay.

o   Qualifications: An individual earning over $17,237 but not more than $18,735, or a family of four earning over $35,535 but not more than $38,625. (These plans are for people who narrowly exceed the income limits for Medi-Cal.)

• Covered California, Silver Enhanced 87 Plan: This plan covers 87% of the average annual cost. A primary care or urgent care visit would cost $15.

o   Qualifications: An individual earning from $18,736 to $24,980, or a family of four earning from $38,626 to $51,500.

• Covered California, Silver Enhanced 73 Plan: This plan covers 73% of the average annual cost. A primary care or urgent care visit would cost $35.

o   Qualifications: An individual earning from $24,981 to $31,225, or a family of four earning from $50,501 to $64,375.

Covered California State Subsidies: California is offering new subsidies in 2020 aimed at making health coverage more affordable for middle-income individuals and families.

o   Qualifications: An individual who earns between $50,000 and $75,000, or a family of four earning from $103,000 to $155,000.

Medicare: This is the federal health care program for seniors.

o   Qualifications: U.S. citizens 65 or older or permanent legal residents who have lived in the United States for at least five years. To receive full benefits, a person or the person's spouse must have worked long enough to be eligible for Social Security or railroad retirement benefits. For more information, go to www.medicare.gov

How can I apply? 

• By visiting the website www.CoveredCA.com
• By calling your local county human services office. Riverside County’s can be reached at (877) 410-8827.
• By filling out a 36-page form and mailing it to: Covered California, P.O. Box 989725, West Sacramento, CA 95798.
• By visiting a local county human services office in person. Find a location nearest you by calling (800) 300-1506 or going to this website.

o   Riverside County Medi-Cal offices are at:

•  63 S. Fourth St., Banning
•  1225 Hobson Way, Blythe
•  68615 Perez Road, Suite 9A, Cathedral City
•  1283 6th St., Coachella
•  65753 Pierson Blvd., Desert Hot Springs
•  541 N. San Jacinto St., Hemet
•  44199 Monroe St., Indio
•  1400 Minthorn St., Lake Elsinore
•  201 Redlands Ave., Perris
•  12625 Heacock St., Moreno Valley
•  517 W. Parkridge Ave., Norco
•  11060 Magnolia Ave., Riverside
•  5961 Mission Blvd., #125, Riverside
•  43264 Business Park Drive, Temecula
• Private health insurance brokers can help people navigate Covered California while health navigators at local nonprofits and federally qualified health centers are able to help patients sign up for Medi-Cal.
  • In Riverside County, people can find assistance at Borrego Health, The Desert AIDS Project, the Coachella Valley Rescue Mission, Martha’s Village and Kitchen, the Inland Empire Health Plan and Molina Healthcare, among others.

After applying, the state will send you a letter within 45 days to tell you which program you and your family members qualify for.

What documents and information do I need?

• Demographic information: Including name, address, phone number, and information about a spouse, children who live with you, and anyone else on your federal tax return.
• Other insurance: Information about any job-related insurance you may qualify for or about health insurance others in your household receive through a job or elsewhere.
• Social Security number: A Social Security number if you are a U.S. citizen.
• Legal immigration documents: Documentation information for immigrants with eligible status. Families that include immigrants can apply. Parents who aren’t eligible for coverage can still apply for their children. Applying for your eligible child won’t affect your immigration status or chances of becoming a permanent resident or citizen.
• Income information: Employer and income information for everyone in the family, such as W-9 forms.
• Federal tax information: Including the person who files taxes as head of household and dependents claimed on your taxes. If you don’t file taxes, you can still qualify for free or low-cost insurance through Medi-Cal.
• Proof of identification: Driver’s license, passport, or state identification card
• Proof of finances: This could include pay stubs or bank statements

If you don’t have all the information needed, send in your application anyway. An enrollment agent will call to help finish the application process.

Follow the USC Center for Health Journalism Collaborative series "Uncovered California" here.