Covered California 2020 Open Enrollment
October 15, 2019 through January 31, 2020.
Having health insurance is the best plan, and starting October 15th, consumers can sing up for coverage for 2020.
Covered California is the state’s health insurance marketplace where consumers on the individual market can shop for and compare plans, see if they qualify for financial help with their health insurance costs, and enroll into affordable, high-quality health insurance.
In 2020, there are two important changes to health insurance coverage consumers should be aware of:
- New State Financial Help is Available - Under the Affordable Care Act, qualifying consumers can receive federal financial assistance to help them pay their health insurance premiums. However, starting in 2020, for the first time ever, the State of California will provide additional financial help to lower the monthly cost of health insurance. California is also the first state in the nation to provide financial help to middle income consumers who do not qualify for federal premium assistance.
Nearly one million Californians may be eligible for the new state financial help. The amount of financial help consumers may qualify for depends on where you live, your income, and the size of your family. While consumers can always buy a health plan directly from a health insurance company, Covered California is the only place consumers can go to get financial help they may qualify for.
Be sure to check out Covered California’s website at CoveredCA.com to see if you can get financial help with your health coverage. You may now qualify for financial help you didn’t qualify for in the past, or you may receive more financial help than you did before.
- Having Affordable Coverage is the Law - A new law requires California residents to have health insurance coverage starting in 2020 that meets state requirements. Fortunately, with additional state financial help available, you may find it easier to meet the requirements of the new state law.
If you aren’t covered, you could face a penalty when you file your taxes in 2021 unless you qualify for an exemption. But, the bigger penalty is not having coverage and getting a major hospital bill or other medical costs in the event of an unexpected illness or injury.
Visit www.ftb.ca.gov for more information about the requirement to have coverage and the penalty.
Don’t leave money on the table. Check to see if you qualify for financial help!
- It only takes a couple of minutes to see if you are eligible for financial help and to compare health insurance plans that are available to you.
- Just visit CoveredCA.com and provide your age, family size, income, and zip code into the Shop and Compare tool to learn what you would pay for health coverage.
Enrolling is easy.
- Covered California partners with thousands of certified insurance agents and enrollers in communities throughout the state who provide free and confidential in-person help in a variety of languages. You can visit Covered California’s Find Help page to find the nearest certified enroller or use Covered California’s Help on Demand tool to have a certified enroller contact you. You can also sign up online at CoveredCA.com or call Covered California’s Service Center at 800-300-1506.
New 2020 California Affordability Initiatives – Questions and Answers
Through the leadership of the Governor and California Legislature, California is taking significant steps to improve health insurance affordability and bring quality care within reach of more consumers in 2020. As a result of two new affordability laws (SB 78 &SB 106), California is both protecting and building on the Affordable Care Act (ACA) to make coverage more affordable than ever for many California consumers.
Starting January 1, 2020, new state financial help will be available to help eligible low- and middle-income California consumers pay their insurance premiums. Covered California enrollees who already qualify for federal financial help will receive additional state subsidies to make their premiums even more affordable. California will also become the first state in the nation to provide state subsidies to eligible middle-income consumers who, due to income, are not eligible for any federal financial assistance. These are middle class Californians who do not qualify for federal help, and who have historically had to bear the full cost of insurance premiums all on their own. Additionally, California restored the requirement for California residents to have health insurance or pay a penalty.
These new laws will make health insurance coverage more affordable for many consumers, and more Californians will be able to afford and keep their coverage in 2020.
What is the new state subsidy program and who is eligible?
Under the federal ACA, consumers with incomes up to 400 percent of the FPL may qualify for federal premium assistance in the form of tax credits that help reduce the cost of monthly premiums. Consumers can only receive these federal tax credits by purchasing coverage through Covered California.
Approximately $428.6 million is appropriated in the state’s Fiscal Year 2019-2020 budget to fund new state premium subsidies for the 2020 plan year to qualified individuals who purchase health insurance through Covered California. The new state subsidies would be available to eligible individuals with incomes between 0 to 138 percent of the FPL and 200 to 600 percent of the FPL. (See https://www.coveredca.com/PDFs/FPL-chart.pdf for complete listing of program eligibility by FPL 2020.
State subsidies will be provided in addition to federal premium tax credits. This means that consumers with incomes below 400 percent of the FPL who receive federal premium tax credits, could be eligible for additional state subsidies on top of the federal financial assistance they receive.
Additionally, California is now the first state in the nation to provide financial premium assistance to individuals with incomes above 400 percent of the FPL – all the way up to 600 percent of the FPL. As such, consumers who are ineligible for federal premium tax credits because their income exceeds 400 percent of the FPL could qualify for new state subsidies to help them pay their insurance premiums. These are middle-class Californians who have historically had to bear the full cost of their health insurance premiums and who could receive state financial assistance for the first time.
Eligible consumers must purchase coverage through Covered California to receive state subsidies, and they can go to www.CoveredCA.com to quickly check if they may qualify.
How many consumers may get state subsidies and how much might the subsidies be?
It is estimated that nearly one million California consumers could be eligible for the new state subsidies. The amount of state subsidies a consumer is eligible for will vary depending on age, household income, and the cost of health care in their region. However, on average:
- Consumers with household incomes between 400 and 600 percent of the FPL who previously did not qualify for financial help because they exceeded federal income requirement, could be eligible to receive an average state subsidy of $172 per household per month, which help them save an average of 23 percent off their current premiums. Many of these consumers, particularly those who live in high-cost regions, could see significant savings with annual reductions in their health care premiums in the hundreds or possibly thousands of dollars.
- Covered California enrollees whose household income falls between 200 and 400 percent of the FPL, and who currently receive federal financial help, could be eligible to receive an average additional subsidy of $15 per household per month which will help them save an average of 5 percent on their current premiums.
- Covered California enrollees whose annual household income falls below 138 percent of FPL could see their premiums for the benchmark plan lowered to $1 per member, per month.
Are subsidies available if a consumer purchases a plan directly through a health insurance company?
Like federal premium tax credits, Covered California is the only place consumers can go to receive state subsidies. Consumers must purchase coverage through Covered California and otherwise meet eligibility requirements for federal premium subsidies, except for the federal income requirements which limit eligibility at 400 percent of the FPL. While consumers can purchase a plan directly from a health insurance carrier, they should come to CoveredCA to see if they qualify for financial help so they don’t leave any money on the table.
What is the requirement to have health insurance coverage and penalty?
From 2014 to 2018, it was the law nationally to have health coverage or pay a penalty if you opted out of coverage you could afford. Federal policy actions reduced the penalty to $0 for 2019, but through the bold actions of the Governor and Legislature, California restored the requirement to get coverage or face a penalty. California’s individual mandate and penalty closely mirror the federal structure in place prior to the penalty being “zeroed out,” with adjustments for California’s tax filing threshold and a state-level penalty.
Starting January 1, 2020, Californians will be required to maintain health insurance throughout the year or potentially face a penalty for each month they lack coverage. The Franchise Tax Board is responsible for administering the penalty, and Californians who owe a penalty will pay when they file their 2020 state income tax return in 2021.
How much is the penalty?
Similar to how the penalty was calculated at the federal level, a taxpayer who fails to maintain coverage in 2020 could be subject to a penalty that is the greater of $695 per adult ($347.50 per dependent child) or 2.5 percent of gross income above the tax filing threshold based on tax filing status and number of dependents.
The best way to avoid the penalty is to get health insurance, making the new state subsidies even more important to help consumers pay for and maintain their coverage throughout the year. Covered California and the Franchise Tax Board are working together to make sure consumers are aware of the requirement to maintain health insurance and the penalty and will continue driving home the message that having health coverage is the best plan.
Are there exemptions to paying the penalty?
Yes. Some individuals may not have to pay a penalty if they qualify for an exemption. Exemptions from the penalty largely mirror the exemptions previously applied under federal law, and include:
- Affordability Exemptions - Consumers will not pay a penalty if the cost of their coverage exceeds a certain percentage of their income.
- General Hardship – Hardships can include homelessness, eviction, foreclosure, domestic violence, death of a family member, bankruptcy, and other circumstances.
- Religious Conscience – Members of a recognized religious sect or division who is opposed to acceptance of the benefits of public or private insurance.
These exemptions will be granted by Covered California throughout the year, and more information will be available on Covered California’s website soon.
The Franchise Tax Board will also grant various exemptions that can be claimed when filing their 2020 tax return. Consumers can visit the Franchise Tax Board website at www.ftb.ca.gov for more information about the penalty and exemptions.
What impact will these new laws have?
These new state laws mean that more Californians will be able to pay for and keep their coverage in 2020. We already see the positive impact of these new laws on premium rates for next year with lowered costs for all in the market. The statewide average rate change for California’s individual market in 2020 is less than one percent – the lowest rate increase since Covered California launched in 2014. Further, consumers who shop and switch to the lowest-cost plan in the same metal tier could see a rate reduction of up to 9 percent while maintaining the same level of benefits.
This is great news for consumers, but it is important to remember that health care is local and plans and rates vary depending on where a consumer lives, how old they are, and their family size. Consumers can use Covered California’s Shop and Compare Tool to can check if they may qualify for financial help, as well as the health plans and rates available to them.
When is open enrollment and where can consumers go if they have questions about state subsidies or want help enrolling?
Sign-ups start on October 15, 2019 and consumers have until January 31st to enroll into 2020 coverage. Also, there are key enrollment deadlines within the open enrollment period to remember:
- October 15th: Sign-ups begin
- December 15, 2019: Deadline to sign up for coverage starting January 1, 2020
- January 31, 2020: Final deadline to enroll. Consumers who sign up after December 15 and by the January 31 deadline will have their coverage effective on February 1, 2020.
As a reminder, consumers must make their first month’s premium payment for their coverage to be effective.
Consumers can go to www.CoveredCA.com to quickly check if they are eligible for financial help. They can also sign up for coverage online and purchase a plan.
Covered California also partners with thousands of certified insurance agents and enrollers in communities throughout the state who provide free and confidential in-person help in a variety of languages. Consumers can visit Covered California’s Find Help page to find the nearest certified enroller or use Covered California’s Help on Demand tool to have a certified enroller contact them. Consumers can also contact Covered California’s Service Center at 800-300-1506.
[The presence of a link does not constitute or imply any endorsement, sponsorship, or recommendation of the content of any linked site. The Assembly does not monitor, control or fund any linked site and is not responsible for its content. If the link site solicits funds, this should not be construed to mean that the Member is soliciting funds for that site.]