They’ve got you covered: What to know about Covered California

When making important decisions about your healthcare coverage, being fully engaged and informed is crucial. Unfortunately, this is easier said than done. Making sense of jargon like “premium” and “deductible” can be overwhelming for most people — let alone those who speak English as a second language, or juggle multiple jobs and have limited time to learn about the technicalities of health insurance.

According to an eye-opening report from the U.S. Department of Education, only 1 in 10 people in the U.S. have “a proficient level of health literacy.” Meanwhile, research from the USC Schaeffer Center for Health Policy & Economics found that in 2015 — just two weeks before Open Enrollment began—more than 40% of Americans couldn’t explain what a deductible is.

This is why Covered California, the state’s Affordable Health Care (ACA, or Obamacare) health insurance exchange, is such a useful hub of information for Californians seeking brand-name health insurance. As the first out of 11 states and the District of Columbia to set up a health insurance Marketplace, California has fine-tuned the process of connecting individuals with insurance that works for their needs. Covered California has been a critical part of this success.

A lot of this is thanks to Covered California’s commitment to transparency and accessibility. It understands the time restraints and language barriers that make the search for health insurance so daunting. One of the ways Covered California addresses this reality is by providing a clear, straightforward glossary that explains the headache-inducing jargon. That way, you can figure out what you need and what you are signing up for.

What’s more, by providing language options ranging from Spanish to Arabic to Korean (to name a few), Covered California also makes it much easier to overcome language barriers that often complicate the enrollment process.

Ease of use is of particular importance because in California (as in the rest of the country), Obamacare requires most U.S. citizens, nationals, and permanent residents to obtain coverage that meets minimum coverage requirements.

Of course, one of the most common questions when shopping for a healthcare plan is: what are the available coverage levels, and what are their differences: Covered California clearly breaks down the different options:

  • 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 preventive 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.

The natural follow up question is: what exactly is covered in each of these plans? Under Obamacare, all health plans must meet minimum coverage requirements. These include (but are not limited to): ambulatory services, emergency or urgent care, hospitalization services, maternity and newborn care, mental health and substance abuse services (including counseling), and prescription medications.

What about dental and vision care? Although not required, all Covered California health insurance plans provide dental and vision care for children. Adults may choose supplemental dental and vision care services in their plan if they wish.

That seems simple enough. Of course, the most overwhelming aspect when shopping for health insurance is determining exactly what plan is best for you. Luckily, Covered California, along with partners like HealthSherpa, quickly create customized options for you according to the basic information that you provide. You can then further customize your preferences based on the coverage level you prefer, the insurance provider, the cost, plus more.

Speaking of providers, Covered California works with a wide range of insurance companies. Oakland-based Kaiser Permanente is among them, as are, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, and Health Net.

Finally, the million dollar question: what will health insurance cost you?

Well, it varies from plan to plan, but here’s a good ballpark estimate: based on the first two months of the 2017 Open Enrollment Period, an average premium for an individual costs $393. The average premium for families was $1,021.

If these prices are on the steep side, bear in mind that Californians with limited income can qualify for help with these costs. Depending on your income level and eligibility, you may qualify for lower premiums. In addition, in some cases, you may also be eligible for help with cost-sharing expenses like copayments, coinsurance, deductibles, and out-of-pocket maximums.

The search for affordable healthcare that best suits your needs can be incredibly complicated — as evidenced by the fact that the people most likely to benefit from Obamacare (uninsured and low-income Americans) have the least awareness of it. That’s why Covered California, and partners like HealthSherpa, are such valuable resources. Your unique needs and circumstances are crucial in picking the perfect plan. These Marketplaces not only take those into account, but help you navigate the often tricky health insurance terrain in a way that is fast, straightforward, and—above all—easy to understand.


HealthSherpa is a free website and team of real people who can help you find, enroll in, and make the best use of your marketplace health insurance.

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