Individual Health Insurance

  1. When can I enroll in an Individual Health Insurance Plan? Open enrollment for all individual health plans is from November 15th to January 15th. Unless you have a "life event" this is the only time you can apply for health insurance under the ACA.
  2. Does my RX copay count towards my out-of-pocket annual maximum?Generally yes, but that's a check with your carriers for specifics about your plans type of question.
  3. Is Obamacare a Success in California?Yes! California was "all in" in supporting the 2010 Affordable Care Act (ACA): developing a robust an online exchange and aggressively marketing Cover California. California has more members enrolled in the ACA then anyother State.
  4. I currently have COBRA. Can I cancel it and enroll in a Covered California health insurance plan? Can my coverage start right away?Tricky question. COBRA is considered a qualified health plan under the ACA. Canceling COBRA  is not a "life event" so you must wait until the open enrollment period to enroll in a new individual health plan.
  5. What is the penalty for not having health insurance in 2019? The tax bill doesn't eliminate the penalty until 2019. That means that those who forgo health insurance for 2018 could still face a penalty. The penalty for not having health insurance this year is $695 per adult or 2.5 percent of household income, whichever is greater.What is the “penalty” for not having health insurance for 2019?
  6. I enrolled on a high-deductible plan because I hardly ever went to the Dr.   I am now sick and going to the Dr. a lot.  Can I change my plan to a better one? Yes, but only at open enrollment.
  7. Does it really matter if I go to an “in-network” or “out-of-network” provider when using my plan? Absolutely. You will pay a lot more out-of-pocket if you go out of network. You could also be subject to anything above the carriers contracted rate.
  8. I am on a “Short-Term” medical plan. Will that satisfy the Government’s requirement of having insurance? Short answer, NO.
  9. I earn a very high salary, but need to purchase my own health insurance.  Do I need to go through Covered California? No. The only reason to enroll in CoCA is to take advantage of the "premium subsidy", if you don't qualify for one you can just as easily enroll in an Off-Exchange individual plan
  10. What is the Premium “Subsidy” under Obamacare? The premium subsidy under ObamaCare is actually an "advance tax-credit." The amount of "subsidy" you get depends on the amount of your income and the number of dependents on your plan.
  11. What is my “Grace” period for paying premiums under the Affordable Care Act? If you are covered by Covered California you have a grace period of 90 days, otherwise you have a 30 day grace period.
  12. Does my Doctor have to take my Covered California health plan? If your doctor takes individual plans that includes your carrier, they also must take your CoCA plan with the same carrier
  13. To what age may my dependent children stay on my health plan? The ACA mandated that dependents can stay on your plan until they reach 26 years of  age?

 



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