Enrollment for Covered California—the state’s health insurance marketplace—has begun and this year, even more Californians can get coverage.
Earlier this year, the state expanded Medi-Cal—the free, state healthcare insurance program— to those ages 26 through 49 regardless of immigration status. Eligibility for the program is based on income level and household size. For example, a family of three must earn less than $35,632 to qualify for free Medi-Cal.
“The situation with Medi-Cal has been the best thing California has given migrants,” said Jesus Velasco, Manager of the Enrollment Department at Clinica Romero. “I never thought they would get the full Medi-Cal, but we are fortunate to live in a state where migrants are important.”
Velasco has worked at Clinica Romero for over 20 years, starting at the front desk and moving on to helping people with insurance enrollment in 2014.
“I’ve always liked working with people because I know that the job I do benefits a lot of people,” said Jesus Velasco, Manager of the Enrollment Department at Clinica Romero.
For those who don’t qualify for Medi-Cal, there’s Covered California, and “open enrollment”—the period in which you can enroll for this program began on November 1 and lasts through January 31. Those already enrolled in the Covered California must renew their coverage every year, and the renewal period lasts from October 15 through December 31, so that their new coverage kicks in on January 1, 2025.
Nearly 6 million people have received health insurance through Covered California since the healthcare exchange program first began in 2014. Currently, nearly 1.8 million are enrolled.
And this year, thanks to funding through the Inflation Reduction Act, health care is expected to be more accessible and affordable to Californians, thanks to increased and expanded financial aid that will be available in 2025.
“In California, we are maximizing the Affordable Care Act by providing greater access to coverage and quality care to more Californians,” said California Gov. Gavin Newsom in a statement. “Reducing out-of-pocket costs for millions of Californians is an important step in creating a healthier California for all.”
“Dreamers” Now Qualify for Covered California
This year also, due to a rule change by the Biden-Harris administration and enhanced federal support, Deferred Action for Childhood Arrivals (DACA) recipients are eligible for coverage. Estimates indicate there are about 40,000 DACA recipients in California that will be eligible for coverage.
The cost of insurance under Covered California depends on the type of plan you purchase, but they all come with government subsidies that reduce the costs based on your income. Nearly 90 percent of Covered Califrnia’s enrollees need financial help, the program indicates.
“The government helps you as long as people do their taxes,” said Velasco, who noted that subsidies are unique to each individual.
Enrolling in the program begins with presenting an identification and tax documents. You can also present your ITIN number, check stubs, and if you get paid in cash, a letter from your employer certifying your income.
Velasco explained that Covered California coverage does not include vision or dental health care. Enrolees must get extra insurance for that. But it does cover specialists, basic healthcare coverage and ambulances, with people having a co-payment for each service.
While some may consider that Covered California prices are high, Velasco notes that it’s always better to have some insurance—even if it’s the most basic kind—than nothing at all.
“I, who have worked helping people enroll for insurance, I see the need that all people have for health coverage, especially those with medical conditions,” Velasco said.
He added that having health coverage helps people in two ways: “If you get sick, you don’t have to pay for the high costs of healthcare and if you don’t get sick, you don’t have to make co-payments for services, only your monthly premiumds,” he noted.
And secondly, “In California we’re forced to have health insurance. When we do our taxes, and we don’t have health insurance, the IRS demands a penalty.”
The penalty for not having coverage is of at least $900 per adult and $450 per dependent child under 18 in the household.
One thing Velasco warns about when enrolling for health insurance is to tell the truth about your income and other personal information.
He said, on some occasions, he’s had patients who come to him after they receive a letter indicating their enrollment for Medi-Cal was rejected because the information about income was incorrect.
“Sometimes, people have two jobs and they only declare one,” he explained. “It takes abou t 40-45 days for the County to review your application and verify the information. And if they reject you, they’ll tell you why.”
He recommended that when it comes to applications of such type, “it’s better to tell the truth, and the whole truth.”
This may not be an issue when enrolling for Covered California, where the person chooses the level of coverage they want and the price is based on where they live, their age, household size, and income level.
But he warns about waiting too long to sign up.
If you don’t sign up during the “open enrollment period”, you won’t be allowed to sign up until another year has passed. So not only will you have to pay a penalty later when you do your taxes, but you’ll be without health coverage for all that time, and you never know when you might need it.
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