Covered California

Covered California

Covered California is the health insurance marketplace in the U.S. state of California. Because of the Patient Protection and Affordable Care Act (ACA), the exchange enables individuals and small businesses to purchase health insurance at federally subsidized rates. It is administered by an independent agency of the government of California.

California was the first state in the U.S. to set up a health insurance marketplace. The California Health Benefit Exchange was created in September 2010 when then-Governor Arnold Schwarzenegger signed Assembly Bill 1602 (the "California Patient Protection and Affordable Care Act") and Senate Bill 900 into law. Organizations such as the California Taxpayers Association and California Chamber of Commerce had opposed the bills in whole or in part, but Schwarzenegger had made Obamacare in California a priority.

The program was named "Covered California" in October 2012. Efforts to educate potential enrollees about Covered California began in 2013, including $37 million in grants to 48 organizations.Enrollment started on October 1, 2013; during the first month of operation, 35,364 people enrolled in health plans offered through Covered California, more than were enrolled through the flawed website for the federal exchange ( in the same period. As of November 2013, over 360,000 people had completed applications.

By the close of the first open enrollment period in April 2014, the number of people enrolled in Covered California was about 1.4 million; furthermore, another 1.1 million had signed up for Medi-Cal (California's Medicaid program, which was expanded as part of the ACA) through the Covered California web portal. In the second open enrollment period beginning in November 2014, Covered California's goal was to enroll 500,000 more people. The California Medical Association and other professional organizations pledged to work with Covered California to promote enrollments. Furthermore, the United States Department of Homeland Security and immigrant rights groups tried to assure potential applicants that any personal information disclosed to Covered California would not be shared with U.S. Immigration and Customs Enforcement.

There were 474,000 potential new enrollees by the end of the second regular open enrollment period in February 2015. It was announced that a special enrollment period would be held between February 2015 and April 2015 to reduce tax penalties in 2015 for 600,000 Californians who needed to pay a tax penalty in 2014 because they were uninsured.

Coverage Levels
There are four different options. Each option will determine how much a consumer will pay.

Bronze level: On average, the health plan pays 60% of covered health-care costs; the consumer pays 40%.
Silver level: On average, the health plan pays 70% of covered health-care costs; the consumer pays 30%.
Gold level: On average, the health plan pays 80% of covered health-care costs; the consumer pays 20%.
Platinum level: On average, the health plan pays 90% of covered health-care costs; the consumer pays 10%.
Minimum coverage plan (worst case scenario): If the consumer is under 30 and cannot afford the other plans, this is another option. It covers three visits with no out-of-pocket costs and free preventative benefits. The services will cost full price until the consumer spends $7,150. At that point, the services are covered completely by the health plan.

Essential Health Benefits
Since Covered California is a part of the Affordable Care Act, there are some essential health benefits that the insurance companies must offer to consumers. This is a list of a few services:

  • Ambulatory services
  • Emergency/urgent care
  • Hospital care services
  • Maternity and newborn care
  • Mental health and substance abuse services
  • Prescription medication
  • Rehabilitation services
  • Laboratory services
  • Preventative and wellness care
  • Pediatric services
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