Medi-Cal vs Covered California vs Obamacare

What is Covered California?

Covered California is the California state based ACA healthcare exchange or Obamacare. It is an insurance exchange where private health insurance companies go to provide health insurance to people living in California. Additionally, for Californians the exchange provides an easy to navigate way to choose a health insurance plan. Additionally Covered California provides financial assistance to Californians to ensure that their insurance coverage is affordable. 

Plan Options

Every plan offered through Covered California must cover at least 10 essential health benefits. These benefits are:

• Ambulatory patient services
• Behavioral health treatment
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Pediatric care
• Prescription drugs
• Preventative care
• Rehabilitation services

These benefits, and more, are offered through private health Insurance companies that participate in the Covered California Health Exchange. There are four different levels of coverage that are available : Bronze, Silver, Gold and Platinum. Each of the health insurance companies in the Covered California exchange offer one or more of these plan levels. The insurance companies who participate are :

• Anthem Blue Cross
• Blue Shield of California
• Chinese Community Health Plan
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Oscar Health
• Sharp Health Plan
• Valley Health Plan
• Western Health Advantage

Although the plan benefits within the same metal tier are the same, the doctors you have access to will change based on the health insurance plan that is chosen. It is important to check if the plan you enroll into, will allow you to continue to see the healthcare provider you prefer.

Cost

Covered California plans have a monthly cost called a premium. But the monthly premium can change based on the level of plan you choose (metal tier) as well as your personal household information. As an example, a bronze level plan is generally less expensive than a platinum or a silver plan.

In Addition to the monthly premium there are costs for health services that you receive through your plan. These costs can include copays, co-insurances and deductibles depending on the plan. Copays are fixed amounts that you will pay for a particular service like a doctor’s visit. If you have a $15 copay for a doctor’s visit. Every time you visit the doctor you will be required to pay the $15 at the doctor’s office.  Most plans that have a less expensive monthly premium, will have a higher usage cost for copays. While plans that have higher monthly premiums will usually have lower usage costs or copays.

Although the cost of health insurance can be expensive, in many cases through Covered California, you may be eligible for financial assistance that will help reduce the monthly cost for your health insurance plan. The financial assistance can come in the form of a tax credit, which lowers your monthly premium , or Cost Sharing Reductions which lower the cost of your copays, coinsurance or deductible, and out of pocket maximums.

How to enroll into Covered California?

Californians are not able to enroll directly into Obamacare through Healthcare.org. This is because California has its own exchange called Covered California.  If you live in California and want an health exchange plan must enroll into Covered California, to get access to Obamacare benefits.  Most Californians will enroll into a Covered California plan during the Open Enrollment Period  (OEP) which occurs from November 1st through January 31st every year. This is the time when there are no requirements to enroll. During this time Californians can enroll, renew, and make updates to their Covered California Plans. Once this time is over they will typically have to wait until next year’s open enrollment period and may face a California state penalty for not having health coverage. Outside of this time frame Californians may enroll if they have specific qualifying life events that allows them to choose a Covered California Plan. These events give Californians access to what is called a Special Enrollment Period (SEP).

Medi-Cal

How to enroll into Medi-Cal?

Medical is another California specific health insurance program that is specifically designed for Californians with low income. It is health coverage that provides services at low or no cost monthly. But Californians must qualify based on income and household size eligibility requirements. It is possible to apply for Medi-Cal through the Covered California Program.

Medi-Cal Plan options

Like Covered California plans, Medi-Cal health coverage provides coverage for the minimum essential coverage required to count as health coverage in the state of California and to avoid the health insurance penalty.  These are the benefits under Medi-Cal:

• Ambulatory patient services
• Behavioral health treatment
• Emergency services
• Hospitalization
• Laboratory services
• Maternity and newborn care
• Pediatric care
• Prescription drugs
• Preventative care
• Rehabilitation services

It is important to understand that Medi-Cal plans are not managed by Covered California. Rather they are run by each individual County, so policies and procedures may be different from county to county. In general plans can be applied for any time through the year, as long as somebody qualifies based on income and household size. Almost all Medi-Cal plans are Managed plans HMO’s.  This means you will have a primary care doctor who must recommend you to go to a specialist or other types of care before you are able to.

Costs

The plans available through Medi-Cal are designed for low income individuals. For most people enrolled into a Medi-Cal plan their monthly premium will either be low cost or free. Additionally they do not have any out of pocket costs  like copays, monthly premiums or co-insurance. But they may limit which doctors a person in the program can go see. A small minority of people on Medi-Cal have a “share of cost” which means they will have to pay a portion of their healthcare costs out of pocket before Medi-Cal will pay. 

Enrolling into Medi-Cal

There are a variety of ways to enroll into a Medi-Cal plan. The fastest and easiest is through Covered California. This is because the application, once completed, is sent directly to the county of your residency if you are eligible. Alternatively, you are able to contact your local county office and request a paper enrollment application that can be mailed or faxed back into the county office for review and approval.

Which is better Covered California or Medi-Cal?

The answer to this question really depends on which type of coverage you qualify for. In general, if you qualify for Medi-Cal you will not be able to enroll into a Covered California plan with subsidy. This means that you will have to pay full price for the health insurance, this can be very expensive. Inversely if you qualify for a Covered California plan with subsidy you will generally not be able to enroll into a Medi-Cal plan. 

Covered California

Covered California is a great option if you are eligible for the monthly subsidy to help bring down the cost. This is because they are identical to private health insurance plans  you can get directly through a major health insurance. Additionally, there is assistance that can bring down your monthly costs. But there are limitations about who is able to apply, for example people who do not live in California, or do not have lawful presence in the USA will not be able to apply for health insurance through the Covered California program. Additionally if you have health insurance offered to you from some other place, you may not be able to qualify  for the financial assistance, even if you normally would be based on your household size and income. Overall Covered California is a very good option for people who can qualify for the financial assistance

Obamacare

Obamacare are generally the plans through Healthcare.gov. These plans are only available in California through the state’s own state-based health insurance marketplace Covered California. Additionally, the state of California includes additional benefits and more monthly financial assistance than most plans offered through Healthcare.gov.

Medi-Cal

If you are able to qualify for Medi-Cal based on our household size and Income limits, it is the most economic way to get health insurance and avoid the California state health insurance penalty. Although there can be a lot of paperwork, renewal is often automatic and it can be a great way to ensure you have healthcare coverage for you and your family. Some important things to know about Medi-Cal is that for individuals who are not yet citizens of the US, it is possible that enrollment in Medi-Cal may affect that ability to obtain US citizenship.

We are the Covered California Enrollment Center, your place to get free assistance with your health insurance plan. We can assist you to sign up, enroll and update your private health Insurance, Covered California plan, Medi-Cal, Obamacare and Medicare insurances. Our California agency is certified by Covered California, to assist you in-person, over the phone or online in English and Spanish. 

We specialize in individual and family health insurance plans, Medicare, Medicare Advantage plans, Medicare Supplement (MediGap plans), Medicare Prescription Drug plans (Part D), as well as, Dental and Vision coverage. We can help you get enrolled into health insurance plans, compare healthcare options, provide required health coverage tax documents and review the plans that best fit your budget and healthcare needs.  

Call us today at 844-367-6555 for free assistance over the phone, visit our website at www.EnrollSocal.Com to make an appointment at our California Enrollment Centers Serving San Diego County, Los Angeles County and Imperial County.