Covered California

Learn about the new free and low-cost health insurance options through Covered CA!

The deadline to sign-up for a Covered CA health insurance plan has been extended to APRIL 30, 2015 for individuals/families that did not realize there was a tax penalty in 2014 for being uninsured.

NOTE: Individuals can apply for Medi-Cal all year-round. There is no deadline.

CALL US TODAY TO APPLY! 

(619) 600-3000 Monday – Friday 8:00am to 5:00pm

In addition to the extension mentioned above, there are other conditions that may qualify you to enroll in coverage between now and the next enrollment period. Below are some examples of what may qualify you:

  • Losing health coverage. For example, you are no longer eligible for Medi-Cal, or you lose your job and/or health coverage through your job.
  • Getting married or entering into a domestic partnership.
  • Having a child or adopting a child, receiving a foster child, or placing a child in adoption or in a foster home.
  • Moving to California from another state. This also applies to individuals who are released from jail or prison.
  • Income changes so much that it will affect how much tax credit are eligible or ineligible for. For example, if you are already getting help paying for your insurance premium, and your income goes down, you might be able to get extra help.
  • Becoming a U.S. citizen, national or lawfully present individual. This event applies only to people who were not previously citizens, nationals or lawfully present.

IF YOU THINK YOU QUALIFY TO APPLY, CALL US TO FIND OUT MORE INFORMATION.

NOTE: Individuals can apply for Medi-Cal all year-round. There is no deadline.

Covered CaliforniaSan Ysidro Health Center is proud to partner with Covered CA, our state health insurance marketplace where you can apply for free or low-cost health insurance plans. We have nearly 30 certified enrollment specialists that are available to answer your questions by phone or in-person. With a quick phone call, we can tell you what you qualify for and whether you are eligible for financial assistance to help pay for your insurance. You can also make an appointment to have one of our specialists help you apply!

 CALL US TODAY FOR YOUR FREE CONSULTATION!

(619) 600-3000 Monday – Friday 8:00am to 5:00pm

READ MORE ABOUT THE NEW HEALTH INSURANCE PROTECTIONS, BENEFITS, COSTS AND MORE!

Health insurance can be complicated. We want to make it easy for you. Below you will find key information about the new health care changes. In addition, we have created several documents that can give you more information on the basics of health insurance, new options, how to apply, and what to expect once you have enrolled: 

  1. A Guide to Understanding Your Health Insurance Options
  2. Health Care Options for Immigrants
  3. Guide the Health Insurance Part I: What you need to know before you apply
  4. Health Insurance Application Checklist (contains all required information needed to apply)
  5. Guide to Health Insurance Part II: How to access your benefits and services
  6. Important Information for Medi-Cal Applicants
  7. Important Information for Covered CA Applicants
  8. Health Care Options for Individuals with HIV/AIDS – Please click on the link.

NEW PROTECTIONS

Children and adults can no longer be turned away from insurance plans based on a pre-existing condition such as Diabetes or other chronic disease or disability. In addition, insurance companies cannot charge these individuals more, nor can they put a cap on how much they will cover.

MEDI-CAL CHANGES

If you did not qualify for Medi-Cal before, you may be eligible now. For example, adults without children now qualify. For individuals under the age of 65, the “asset test” is no longer required. Also if you make less than $16,000 or you have a family of four with a combined income of less than $32,000 then you are now eligible for Medi-Cal.

Medi-Cal has also included more benefits and now covers dental services, behavioral health services and counseling, substance abuse services and more!

NEW LOW-COST INSURANCE PLANS

If you don’t qualify for Medi-Cal, you can purchase low-cost private health insurance with the possibility qualifying for financial assistance to help pay for it. In San Diego the health insurance plans you can choose from include 1) Anthem Blue Cross 2) Blue Shield 3) HealthNet 4) Kaiser 5) Molina and 6) Sharp. The differences between the plans are the doctors and hospitals in the network and extra benefits and services.

The new law requires that all plans cover at least 60% of the costs and include the following

10 ESSENTIAL BENEFITS:

  1. Preventive and wellness services (such as immunizations, health screening tests for Cancer, Diabetes,HIV, etc.), birth control, breast feeding supplies, domestic violence counseling.
  2. Ambulatory patient services
  3. Emergency services
  4. Hospitalization
  5. Maternity and newborn care
  6. Mental health and substance use disorder services
  7. Prescription drugs
  8. Rehabilitative services and devices
  9. Laboratory services
  10. Pediatric services

COSTS AND FINANCIAL ASSISTANCE

Individuals under the age of 65 with an annual income of less than $16,000 or a family of four with a combined income of less than $32,000 are eligible for NO-COST Medi-Cal through the State of California. All other individuals and families (U.S. citizen or lawfully-present) are eligible to purchase health insurance through Covered CA.

For those who purchase a plan, the cost depends on several factors: 1) Number of people in your household (head of household, spouse, children or dependents); 2) Household Income (combined incomes of all members over the age of 18); 3) Ages of those in need of health insurance; 4) Zip Code and 5) Level of Coverage – you will pay a higher amount if you choose a plan that pays for more of your care.

IMPORTANT: Your current health condition or gender DOES NOT affect the cost of your health insurance.

Financial assistance (called tax credits) is available for most people with incomes of less than $45,000. These individuals can receive the “discount” at the time of purchase OR wait to get the credit at the time of tax filing. Most individuals with incomes less than $28,000 and families of four with incomes less than $58,000 will ALSO qualify for tax credits to pay for out-of-pocket expenses (such as co-pays) as well.

An online calculator is available on Covered California’s website to determine amount of assistance and the individual’s share of cost.

FINES

The new law called the Affordable Care Act states that every U.S. citizen and lawfully-present individual must have health insurance or they may get fined at tax time (April). These fines are going higher every year. For example, if you are a citizen or permanent resident and you did not have health insurance in 2014, you will be fined 1% of your annual income.  Example: An individual who earns $35,000 a year will need to pay approximately $350 for the whole year they did not have health insurance (you will not be fined for months that you did have it). Fines will be applied for all eligible family members in the household including children.

There are some individuals that are not required to have insurance and will not be fined:

  • Individuals with income below $9,750 for a single person and $27,100 for a married couple with two children
  • Those who belong to certain religious groups that are already recognized by the Social Security Administration as exempt from Social Security requirements
  • Undocumented immigrants
  • Incarcerated persons
  • American Indians and Alaskan Natives

For a more complete list of exemptions and how to apply for one visit HealthCare.Gov (link: https://www.healthcare.gov/fees-exemptions/exemptions-from-the-fee/

OPTIONS FOR IMMIGRANTS

All U.S. citizens and lawfully-present California residents are eligible for the state-sponsored Medi-Cal and Covered California private insurance plans. Lawful residents have permission to live and work in the U.S. and include individuals with green cards, naturalization papers, Deferred Action for Childhood Arrivals (DACA), refugees, asylees and others with protected status.

Individuals who are not eligible for full Medi-Cal or Covered CA, including those without documents, may still qualify for limited Medi-Cal for emergencies and pregnancy as well as other free or discount programs. Individuals are encouraged to meet with a SYHC Certified Eligibility Specialist to learn about their options. SYHC does not turn anyone away!

For more information click on the LINK to view our flyer.

 Call us for more information or to set-up an appointment with one of our Certified Eligibility Specialists! 

(619) 600-3000 Mon-Fri/8am-5pm

You can also visit the Covered California website for information on the insurance plans and financial assistance available at: http://www.coveredca.com/

This service is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number H80CS10748 and Health Center Outreach and Enrollment Assistance grant program. Grant funds totaled $443,601. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

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