Welcome to the fastest way to find out about Obamacare in California.
Here, you'll find clear and accurate information about Obamacare, including:
whether or not you must get health insurance
what the available plans cover
how much coverage will cost
how to sign up for a plan, and
how to get help if you need it.
To begin, keep in mind these key points about Obamacare in California:
1. You are legally required to have health insurance, unless you qualify for an exemption.
The Affordable Care Act requires you to enroll in a health insurance plan unless you qualify for an exemption from the law. You will report whether you have coverage -- or whether you are exempt -- when you file your taxes in April.
Despite what you may have heard, you can’t be arrested or thrown in jail if you don’t have health insurance in California. You may, however, be forced to pay a tax penalty if you aren't enrolled in a health insurance plan that meets the requirements of the Affordable Care Act.
To avoid the penalty, you must either obtain qualified health coverage or prove your eligibility for an exemption.
What Qualifies as Coverage?
If you have any of the following types of health coverage, you won’t have to pay a penalty:
This article explains the costs of health care plans offered under Obamacare (the Affordable Care Act of 2014) for individuals or families who are currently uninsured or not covered by a job-based health plan.
What you'll pay for an Obamacare plan depends on five things:
The easiest way to sign up for a health plan under the Affordable Care Act is to go to the online health insurance marketplace for California. If you're not ready to enroll right now, you can get more information online, over the phone, or in person.
Where's the California Health Care Exchange?
You can find the health insurance exchange for California at Covered California. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online. Or, if you prefer, you can download and complete a paper application.
You might not see any mention of Obamacare or the Affordable Care Act when you visit the exchange website, but rest assured you’ve landed in the right place. The exchange was established solely for the purpose of informing consumers about the Affordable Care Act and providing plans under the law.
Did you purchase health coverage through the California health exchange last year? If not, are you still uninsured? If you answered yes to either question, you'll want to know these important facts about the next Obamacare open enrollment period.
1. For 2016, open enrollment starts earlier and ends sooner than last year.
For 2016, you can enroll in a new marketplace plan -- or change your existing plan -- from November 1, 2015 through January 31, 2016. If you want or need new coverage beginning January 1, you mst sign up by December 15, 2015.
Current Covered California members can renew their coverage beginning October 12, 2015. If this applies to you, visit Covered California any time on or after October 12 and log on to your Covered California account to review your current health plan. (You can also contact a Certified Enrollment Representative for assistance.) If you want to make changes, you can choose a new plan. If you do nothing, your current plan will be automatically renewed as long as it is still available.
Do you have to worry about new IRS Forms 1095, 8965, or 8962? The Affordable Care Act, aka Obamacare, requires almost everyone to do one of the following three things when they file their taxes this year:
confirm they had health insurance coverage for 2014
claim an exemption from health coverage, or
pay a penalty when when they file their return.
For some people, complying with the Affordable Care Act will mean filling out new tax forms. Fortunately, that’s not true for most folks -- and even those who need assistance with Obamacare’s new tax rules can get help.
Here’s what you should know about filing your taxes in the era of health care reform.
The Affordable Care Act Won’t Complicate Most People’s Taxes
The U.S. Supreme Court has upheld health care subsidies for residents of all states, including those that rely on Covered California, the federal government’s health insurance exchange. As described below, King v. Burwell could have ended tax-credit subsidies for states that use the federal marketplace to facilitate the purchase of health insurance plans under Obamacare.
Even though California operates its own health insurance exchange, the King v. Burwell decision is good news for consumers in the state. The 6-3 ruling means that almost 6.5 million Americans will continue to receive the financial assistance that lets them afford health insurance. This helps to keep insurance costs and coverage steady for everyone, avoiding the "death spiral" that might have undermined Covered California and destabilized the Affordable Care Act as a whole.
The following panel discussion from Kaiser Health News offers a comprehensive discussion of the Supreme Court decision:
Get a colonoscopy, mammogram, vaccinations, and other essential services for free
The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Covered California, the health care marketplace for California. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.
Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges
Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.
Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.
Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)
One way to satisfy Obamacare’s health insurance requirement is to obtain coverage under Medicaid. If you qualify for Medicaid and enroll in California's Medicaid program, you do not have to sign up for another insurance plan.
It’s Now Easier to Qualify for Medicaid in California
The Affordable Care Act expanded Medicaid eligibility to cover more people who can’t afford health insurance. The U.S. Supreme Court later decided that it was up to individual states to decide whether or not to expand Medicaid.
Because California did decide to expand its Medicaid program, you can qualify for Medicaid if you earn up to 138% of the federal poverty level. For 2015, 138% of poverty level is about $16,240 for an individual or $33,460 for a family of four.
Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest hassles they face. But this may change for the better under Obamacare, which provides new coverage options for the self-employed.
Are You Self-Employed or an Employer?
Before you start evaluating your options for health coverage, you need understand whether you are in fact considered self-employed under Obamacare.
The law says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) Self-employed people can use the new health care marketplace to purchase individual health insurance plans.
If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace.
The difficulties of unemployment are often compounded by the lack or loss of health insurance. But millions of Americans who are currently without both a job and health coverage may find relief under Obamacare. That's because new coverage options are now available through Covered California, the health insurance marketplace serving California.
All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, as an unemployed person, you probably qualify for significant cost-saving subsidies.
When you sign up for a marketplace health plan, your coverage can start within a few weeks. Usually, you must sign up during an open enrollment period. (For 2014, open enrollment closed on March 31. The next open enrollment period begins on November 15.) But leaving your job and losing job-based health insurance makes you eligible for a special enrollment period. That means you'll have 60 days to sign up for a new health plan.
Here's an overview of your options for health insurance if you are unemployed, plus more information about what might happen if you don't get health coverage. (And if you're looking for information about applying or eligibility for unemployment, see our articles on California unemployment benefits.)
As a business owner, you may have heard a lot of buzz about Obamacare’s “employer mandate.” Maybe you’re still wondering what it is and whether it applies to you. The short answer is that if you have fewer than 50 full-time-equivalent (FTE) employees, you don’t have to worry about the employer mandate. (For a definition of FTE, see the end of this article.) The mandate requires only larger companies to offer health coverage to employees.
That said, there are plenty of important things for owners of smaller businesses to know about Obamacare. Here’s a summary of key points for California business owners who have between one and 49 employees:
You aren’t legally required to offer health insurance to your employees. If you have fewer than 50 FTEs, whether or not to provide coverage is entirely up to you.
You may be legally required to notify your employees about Obamacare. Whether or not you choose to provide insurance, if your business is covered by the Fair Labor Standards Act, you must notify all your employees about Obamacare’s basic provisions before October 1, 2013 -- and you must notify all new hires after that. The U.S. Department of Labor has published sample notices you can use. There’s no penalty under the law for failing to provide notice.
To learn whether the FLSA applies to your business, see this helpful article from Nolo.com.
Soon, businesses that employ 50 or more full-time-equivalent (FTE) workers will have to offer insurance coverage or face a tax penalty, called the "employer shared responsibility payment." This law, known as Obamacare's "employer mandate" will take effect in 2015 or 2016, depending on the size of the business.
Employers with 100 or more full-time employees will have to offer coverage to at least 70% of eligible workers in 2015. That number jumps to 95% in 2016. Employers who employ 50 to 99 full-time workers do not have to comply with the law until 2016.
The employer mandate will apply to your business if even one of your employees would qualify for cost-saving health insurance subsidies through Covered California, the health insurance marketplace for California.
For example, say you employ 105 full-time workers and don't offer a qualifying health plan. If just one of those workers can buy an individual health insurance plan at Covered California and qualify for reduced premiums with Obamacare's tax credit, you'll have to pay a penalty -- and it could be a hefty one.
On the other hand, if you offer coverage to your employees that is considered affordable and meets the legal requirements for coverage, your employees wouldn't be able to save money by purchasing an individual plan in the marketplace, so you won’t have to pay the penalty.
If you’re confused by your health care choices under Obamacare -- or if you’re having a difficult time completing an application -- there are many ways to get help. For example, you can call the California health insurance exchange for telephone support or obtain free, in-person guidance from trained assisters or “navigators.” You can also seek help from a licensed insurance agent or broker.
Given the technical flaws in many online health care marketplaces, getting help from an agent or broker is an attractive option for many people. Agents and brokers, while grappling with most of the same delays and hassles faced by individuals, can make the process easier in several important ways, including:
determining whether you qualify for subsidies
helping you compare plan prices and coverage details, while explaining any complicated features or terms
recommending plans that would be best for you (government assisters are not permitted to suggest specific plans), and
walking you through the application process.
A qualified broker will have years of experience and expertise, and may be able to help you understand your health coverage options in a way that less experienced navigators cannot.
Agents or Brokers Will Help You for Free
You won’t have to pay an agent or broker to help you. They usually receive payments from the insurance companies whose policies they sell. Before agreeing to let an agent or broker help you, be sure the one you choose is able to offer the full range of health plans available at Covered California.
When registered domestic partners or civil union partners apply for coverage in the new health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes, or must we include all the income we make as a couple?
The answer depends on the state where you live.
States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)
California, Nevada, or Washington. In these states, which extend community property laws to registered domestic partners, domestic partners must usually apply using half of the partners’ combined incomes. (We confirmed this with the legal department at Covered California after repeatedly receiving conflicting information from representatives staffing the exchange’s customer service phone line.) This is because IRS rules require that domestic partners registered in these community property states report half of their combined community income on their federal taxes each year.
When Obamacare launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.
Because of these difficulties, some individuals and application assistants turned to the old-fashioned way of getting health insurance -- paper applications.
Applying on Paper May Not Be Better or Faster
When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.
The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.
It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. Follow these steps to apply on paper.
How to Get a Paper Application for Obamacare
If you want to use a paper application to apply for coverage under the Affordable Care Act, you have a couple of options:
If you live in a state that uses the federal health insurance marketplace -- or in a state that operates its own exchange and provides a link to a downloadable paper form -- you can get the forms right now.
In any state, you can call the health insurance exchange customer service center or contact an in-person assister -- such as a navigator, certified application counselor, or certified agent or broker -- to get a paper application and help filling it out.
All health plans purchased through the Covered California, the health insurance marketplace for California, must include the following benefits. These are known under Obamacare as “essential health benefits”:
Ambulatory patient services (meaning outpatient care you receive without being admitted to a hospital)
Hospitalization (including surgery)
Maternity and newborn care
Mental health and substance use disorder services (including counseling and psychotherapy)
Rehabilitative and habilitative services and devices (for people with injuries, disabilities, or chronic conditions, to strengthen their mental and physical skills)
Preventive and wellness services and chronic disease management
Pediatric services (including oral and vision care)
Companies that offer plans through a state exchange will compete on price and quality of service in delivering these benefits.
Am I exempt from Obamacare?
Under Obamacare, most people who don't have health insurance will be required to pay a tax penalty. But you may not have to pay if you qualify for one or more of the following exemptions:
You are uninsured for fewer than three months of the year.
You prove that you can’t afford coverage -- that is, premiums for the least-expensive policy cost more than 8% of your earnings.
You don’t have to file a federal income tax return because your income is too low.
You are a member of a federally recognized Indian tribe.
You are a member of a health care sharing ministry.
You are a member of a recognized religion that objects to health insurance.
You are in the United States illegally.
You are incarcerated.
You may be eligible for an exemption under other circumstances, as well -- for example, if you can show that obtaining coverage would subject you to serious financial hardship.
If you used the marketplace to purchase a plan last year. Most people who purchased their 2015 insurance plan from an online marketplace will be able to automatically renew their coverage for 2016. While automatic renewal sounds convenient, it has serious downsides:
If your insurer decides to cancel your current plan, you could be switched to another plan without warning. The new plan may cost you more or change your eligibility for financial assistance.
Automatic re-enrollment could mean you aren't getting the right subsidy package. That could leave you facing higher monthly premiums now or -- if you take more assistance than you're eligible for -- a big tax bill later.
You may miss out on a better deal or better coverage if you don't compare all available plans to your current plan.
While allowing yourself to be automatically re-enrolled is better than going without insurance, it's best to take advantage of open enrollment and research your options. Shop around and evaluate new plans and costs. Even if you decide to stay with the plan you have, you can use open enrollment to confirm your personal information and ensure you're getting the right amount of financial aid.
If you purchased an individual or family insurance plan outside the online marketplace. As long as the plan meets Obamacare's coverage requirements, you can keep it. Or, you may use Covered California to compare plans and replace it. If you keep your current plan, you won't be eligible for the cost-saving subsidies available for plans purchased through the exchange.
Be sure to check with your current insurance provider before canceling a health insurance policy; you may have to wait until the end of your current policy year to make a change.
If you have insurance through an employer. As long as you're happy with your plan, you can keep it. You're considered covered under Obamacare. On the other hand, if you're not satisfied with the coverage you have, you may be able to switch to an individual plan through Covered California.
Keep in mind that if you buy a plan through the exchange:
Your employer will not have to pay a portion of your monthly premiums.
You may not qualify for cost-saving subsidies, even if your income falls within the eligible range. If your employer offers coverage that is considered affordable and sufficient under the law, you won't qualify to save on premiums or out-of-pocket costs for plans purchased through Covered California.
What is the health insurance marketplace?
The health insurance marketplace (sometimes called an "exchange") is where to go to get health insurance under the Affordable Care Act. The marketplace for California is Covered California. You can use the marketplace to compare plans, learn whether you qualify for cost-saving subsidies, and sign up for the plan that works best for you.
Where can I get in-person help with my application?
In California, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free assistance from a certified enrollment counselor, certified insurance agent, or from a “navigator” at a local human services agency.
Navigators and certified counselors aren’t allowed to recommend a plan for you. Rather, they can explain your options, answer your questions, and help you apply for the plan you choose. Private insurance agents or brokers can also help you understand your health care coverage options under Obamacare. Unlike government-trained navigators and counselors, they are allowed to suggest the best plan for you.
To find in-person help in California, go to Find Help Near You at Covered California. You can then search for a navigator, certified enrollment counselor, or certified agent in your area.
"Open enrollment" is the period of time, once a year, when you can choose or change your insurance provider or what kind of plan options you want -- for example, monthly premium and annual deductible amounts -- for the upcoming calendar year.
For 2016 health care plans, the open enrollment period runs from November 1, 2105 to January 31, 2016.
Choose carefully, because after you make your choices, you must usually live with them until the next open enrollment period.
"Special enrollment" is an exception to the usual enrollment rules. If you qualify for special enrollment, you can sign up during a time period outside of the open enrollment period. The circumstances under which you may qualify for special enrollment include:
You should purchase a plan from the marketplace in the state you consider your primary residence -- where you vote, pay taxes, and so on. But snowbirds need to be sure they choose an appropriate “multistate” plan.
Some multistate plans may be restricted to a certain region – for example, a metropolitan area that straddles state boundaries. Others will be more appropriate for someone who migrates longer distances, spending, say, summers in Alaska and winters in Arizona.
Ask the insurance provider for details, and don’t sign up for a plan until you’re sure it will cover you where and when you need it.
What if I travel frequently?
Traveling shouldn't present any problem under a marketplace insurance plan. Simply sign up for a plan in the state of your primary residence. The plan will cover you in case of emergencies that happen out of state.
For more information about Obamacare in any state, including a link to the state’s health insurance exchange, choose the state from this list.
Information & Documents to Have on Hand
Here's a checklist of information to gather before you apply for health coverage at Covered California.
Social Security numbers for you and other members of your household who will be covered by your insurance plan
Policy numbers for any current health insurance plans
Documents to help you calculate your annual income. Include all sources, such as employment, pensions, alimony, rental property, or other income. If you have a job, gather together pay stubs or W-2 forms. If you’re self-employed, have last year’s tax return handy, as well other records that can help you estimate your yearly income.
If you or anyone in your household is eligible for job-based health insurance, a completed Employer Coverage Tool for each available plan
A good idea of your budget for health insurance, so you know how much you can afford to spend each month. This will help you choose the best plan from among those offered to you.
HealthCare.gov offers an Application Checklist you can print to help you keep track of everything you'll need to sign up.
Finally, keep a list of any questions you want answered before you sign up for a health insurance plan. To get answers to your questions, or for information on signing up for a plan, see How Do I Sign Up for Obamacare in California?
Press Release: New Website Provides Local Obamacare Information
September 23, 2013
A new website, ObamacareByZipCode.com, gives people the answers they need about the Affordable Care Act (Obamacare). In plain English, it guides consumers to reliable, local information about their new health insurance options.
When users choose their state or enter their zip code, they will quickly find:
whether or not they’re required to get health insurance
what the available plans cover
how much coverage will cost, and
how to sign up in each state.
For consumers concerned about cost, the site shows how to determine whether they qualify for subsidies. It also explains the new rules about expanded Medicaid eligibility.
The new site was created by Albin Renauer, founder of LegalConsumer.com, and is coauthored by Renauer and legal editor and writer Shae Irving. LegalConsumer, which until now has concentrated on consumer bankruptcy, began in 2005, when Congress overhauled federal bankruptcy laws.
“When politicians tried to make it harder to file bankruptcy, I vowed to make it easier. When I read about politicians making it hard to get information about Obamacare, it got my blood boiling -- and I realized I could help folks find that information the same way I do with bankruptcy.”
Some states, says Renauer, are hiding the ball when it comes to the new options for healthcare coverage under Obamacare. Missouri, for example, has not created an insurance marketplace (exchange), forbids state officials from cooperating with the federal government, and provides no information. “It is being run like a covert operation, with no marketing or detailed information about its products or their prices,” wrote the New York Times. (Missouri Citizens Face Obstacles to Coverage, Aug. 2, 2013.)
On ObamacareByZipCode.com, all consumers need to do, says Renauer, is start with a zip code. The site will guide them to all the official local resources they need to make sure they get the maximum benefits under the law.
Another reason for expanding a bankruptcy website to cover health care reform? It’s obvious to Renauer: “Huge medical bills are a major reason that people are forced into bankruptcy.”
LegalConsumer.com has helped more than a million consumers navigate the bankruptcy process by providing a free online “means test calculator,” which shows people whether or not they’re eligible to file for bankruptcy.
After receiving his J.D. from the University of Michigan Law School in 1985, Albin Renauer worked for various public-interest law firms in the Bay Area and as a staff attorney for Chief Justice Rose Bird of the California Supreme Court. He spent 17 years as an editor at leading do-it-yourself legal publisher Nolo, where he helped create numerous books and software programs, including the bestselling Quicken WillMaker. He also edited Law on the Net, the first online directory of legal resources, and was the architect of Nolo's Webby Award winning website.