Healthcare Reform Frequently Asked Questions

To see what type of health insurance you or your family can qualify for health coverage view the Healthcare Insurance Income Chart (PDF).

Uninsured

Q. What healthcare coverage options will be available to me?
A.  Your healthcare coverage options will be mostly based on your income (see below).                                                                                                     

  • Medi-Cal expansion
    Who will qualify?
    Adults without children or children over the age of 18 with incomes up to 133% of the Federal Poverty Level (FPL) will be able to qualify. For example, a family of four can earn up to $30,657 per year and qualify. A single adult (without children) can earn up to $14,856 per year and qualify.
  • Covered California
    Who will qualify?
    Covered California will be an insurance “marketplace” where individuals, families and small businesses can compare and purchase a health insurance plan. Families with incomes between 133%-400% FPL will be eligible for tax credits (subsidies) from the government that will help pay a large portion of the total cost of their health insurance.

Q. What kind of benefits will be offered through Medi-Cal and Covered California?
A. Benefits will vary depending on the type of health insurance product and/or the plan selected, but most packages will include Doctor visits, hospitalization, preventive care and medications.

Q. How can I apply for Medi-Cal or Covered California?
A. You will be able to apply online at coveredca.com or at your local Department of Public Social Services (DPSS) office.

Q. After I apply and get enrolled into Medi-Cal or Covered California for health insurance, how will I get my health benefits?
A. Your benefits will be provided by the health plan that you select.

Q. Will I have to pay for health insurance?
A.  That depends on what type of health insurance you will be eligible for. For example, if you qualify for Medi-Cal, you won’t pay any premiums or co-payments. If you qualify for health insurance provided through Covered California, you will pay a monthly premium. The amount will depend on your income, the benefit package and the health plan that you purchase.

Q. If I choose not to have health insurance what will be my penalty?
A. The penalty will be either 1 percent of the family’s annual income or the following penalties listed below (whichever is greater). The penalty fee will go up each year until it caps in 2016 at 2.5 percent of the family’s annual income or $695.

  • Uninsured adult – up to $95 
  • Uninsured child –up to $47.50
  • Uninsured family – up to $285

Young Adult (under the age of 26)

Q. If my employer offers health insurance, can I choose to stay on my parents’ health insurance policy?
A. Yes, until the age of 26.

Q. If I don't have health insurance, what are my options?
A. Depending on your income you can apply for Medi-Cal or buy  insurance through Covered California.

Individual or Families with health insurance

Q. If I already have health insurance, will anything change for me?
A. If you have health insurance that you purchased on your own, you can keep your same policy or you can buy health insurance through Covered California.

If you have health insurance through your job, here are two points to keep in mind:

  1. Employers with 50 employees or less are not required to offer health insurance.
  2. Employers with 50 employees or more must offer health insurance or pay a penalty.

Talk to your employer to find out if health insurance will continue to be offered as a benefit.

People with Medicare

Q. If I have Medicare, will I see any changes to my benefits or coverage?
A. Yes. As of January 1, 2011, you no longer have cost sharing for many preventive care services, such as an annual checkup.

People with a pre-existing condition

Q. If I have a pre-existing condition, will I be eligible to buy health insurance?
A. As of September 2010, those under the age of 19 can no longer be denied coverage because of a pre-existing condition.  In 2014, adults with a pre-existing condition cannot be denied coverage.