Covered California for Families: What Changes After Open Enrollment? 

After Covered California open enrollment ends, it becomes harder to get health insurance through the ACA marketplace and make changes to your existing policy. You’ll need to have a special qualifying event to be able to sign up or make changes. 

Open enrollment, November through January, is the period during which California residents shopping in the ACA marketplace can choose from the offered Covered California health plans that meet their needs and match their budgets. Many Covered California families qualify for special enrollment rates as low as $10 a month or even less. 

But then what? Can you change the conditions of your coverage after open enrollment? How do qualifying life events enter the picture? Here’s a primer on what happens after you and loved ones have undergone — or missed — the Covered California open enrollment process. At Acceptance Insurance, we offer free, bilingual help navigating through the Covered California health marketplace. 

What Families Should Expect After Covered California Open Enrollment Ends 

Covered California open enrollment takes place between Nov. 1 of the current year and Jan. 31 of the next one. That gives you a full three months to apply for coverage and find out what you’ll pay. But what if you missed the deadline or something changed in your life after that period? Not to worry: In many cases, you’ll still be able to get health insurance through the Covered California marketplace, even if you miss open enrollment. 

Important Dates and Deadlines for Post-Enrollment 

While you do have a three-month window to enroll, it’s important to keep in mind that Dec. 15 is your deadline for your Covered California family coverage to take effect from the first day of the approaching year. In other words, get registered by Dec. 15 for assurance that your coverage will take effect on Jan. 1. 

Of course, it’s not always possible to apply for coverage within these three months. You might have to make mid-year changes. For instance, your move to the state might have taken place after that window. And what if conditions change after open enrollment, such as the loss of a job that was providing health insurance, or the arrival of a child through birth or adoption? 

These are examples of what are called qualifying life events. When such an event occurs after the Covered California open enrollment period, you have 60 days after the event to apply for affordable health insurance through this Golden State program. 

Your Options Once Open Enrollment Closes 

Don’t worry. You can still take action even if the Covered California open enrollment window has closed. 

How to Change or Update Your Health Plans Mid-Year 

If you experience a qualifying life event and need to sign up for health insurance through the Covered California site, here are some steps to take: 

1. Visit the application page and create an account or log-in if you already have one 

2. Select “Qualifying Life Event / Special Enrollment” as your reason for applying outside open enrollment 

3. Choose the correct event from the list 

4. Enter the date it occurred 

5. Upload or be prepared to provide documentation to support it 

Important documentation includes proof of your qualifying event, plus information such as household size and income level. Once your documentation has been verified,, you’ll be able to compare plans and find out what financial assistance you may be able to receive. 

Remember, the bilingual agents at Acceptance Insurance are happy to walk you through the whole process from beginning to end. This free service can be accessed by calling us at 877-423-1534. 

Qualifying Life Events That Allow Coverage Changes 

There are several reasons that justify mid-year enrollment or changes to your Covered California health plan. Just remember to have documentation of the qualifying life event triggering your need for the special enrollment period (SEP). This might include such paperwork as a birth certificate or a notice of dismissal from your job. 

Here are some of the leading qualifying life events that might allow you to enroll in Covered California or change plans after open enrollment ends. 

Birth or Adoption of a Child 

Adding a new family member increases the number of members on your health plan and can affect the premium you pay. In fact, it might take your coverage needs from a single person to a family plan. That’s a big change. 

Report the birth or adoption as a qualifying life event as soon as possible because you might wish to change coverage levels or apply for additional subsidies to help pay for your plan. 

Job Changes or Income Adjustments 

What happens if you lose your employer-sponsored health insurance due to job loss or change? Or maybe you’ve been making enough to pay for your own private health insurance, but you’ve just lost your main source of income. Losing your employer health insurance or having a major income change is a valid reason to apply for coverage through Covered California. 

If your income drops dramatically mid-year and you can no longer comfortably pay for your coverage or you lose your employer-sponsored health insurance, you have 60 days from the event to apply for coverage through Covered California’s special enrollment period. 

However it happens, this loss is an event that can qualify you for a rate drop. Just report it as soon as possible. You might be asked to prove the income change by showing a pay stub or a letter from your employer. 

Marriage or Divorce 

A change in marital status can greatly impact your need for coverage or your ability to pay for it. If you now have a new spouse, you might wish to upgrade your coverage – or at the very least, adjust your income level. Remember, your subsidy depends on your income at the time you sign up for a plan: If that income changes, it could affect you at the end of the year. 

For example, if a new spouse increases your income and this will be reported on your taxes, you may end up owing money for a subsidy you received based on your previous income level. Likewise, if your new spouse is not bringing in income but needs health care, you may qualify for a higher subsidy. 

A divorce can bring on a bundle of obstacles. If your family income is basically cut in half or more, you’ll likely qualify for extra state assistance in paying for coverage. And if your spouse had previously included you in a group plan from their employer, you no longer qualify for that coverage and might need a Covered California plan for the first time. 

Both marital changes are considered qualifying life events and can earn you the right to make an SEP. 

Relocation to or Within the State 

If you’ve just moved to California, that’s a qualifying life event that will enable you to apply for Covered California coverage outside of the open enrollment period. 

That’s also true even if you’re moving from one location in the state to another. That’s because some participating health insurance plans might be active in one part of the state but not another. If that’s the case, you’ll have to find another plan outside of open enrollment. 

How to Compare and Evaluate Family Coverage Options 

Covered California health plans are divided into what are called metal levels: Bronze, Silver, Gold, and Platinum. The value of the plans escalates to Platinum, but so does the cost. In other words, Bronze plans cost less than Silver, and Silver costs less than Gold. But the cheaper plans offer more limited coverage. It’s a trade-off you’ll have to decide on by weighing your family’s needs against your budget.  

Don’t forget: A bilingual and knowledgeable agent can help you sign up and choose the best coverage for you and your family. This service is free to you and could result in some real savings. Call us at 877-423-1534 to find out more. 

Balancing Premiums, Deductibles, and Out-of-Pocket Costs 

First, some quick definitions. Premiums are what you pay monthly for your coverage. Deductibles are the dollar amount that you pay before your insurer handles the rest of the claim. And your out-of-pocket costs are the amount you’re responsible for paying, based on the metal level you obtain and your deductible. 

As the metal level goes up, you pay more in premiums, but your deductible goes down. For instance, if you have Bronze coverage with a 40% deductible and your treatment costs $2,000, you’ll pay the first $800, and Covered California will pick up the remaining $1,200. 

If you have Platinum coverage and a 10% deductible and the same $2,000 charge, you’d pay $200 out of pocket, and the insurance company would pick up $1,800 — most of the charge. 

However, you’ll also pay more for Platinum coverage in monthly premiums than you will for Bronze or the two plans in between. What you must determine is whether you want to pay less per month and accept the risk of having to pay big balances out of pocket in deductibles if you or a loved one must obtain significant and costly care. 

Get Help Navigating Covered California Today 

Using our Covered California guide will answer many of your questions about Covered California. Open enrollment is your key to the most affordable health insurance on the market in this state. But it can sometimes be rather complex. That’s where we come in. At Acceptance Insurance, we have years of experience helping state residents with their Covered California health insurance concerns. 

Right from the start, we’ll help you crunch the numbers and determine which metal level policy best fits your pocketbook and your family’s likely needs. Trust Acceptance to guide and support you through the entire process and to be there if you have a qualifying event that makes special enrollment necessary. We’ll get you through the process easily. 

Just reach out to Acceptance before you apply for coverage. Call us at 877-423-1534 for free help navigating through Covered California. We’ll help you get and manage the most affordable health insurance you’ll find in the Golden State. 

FAQ 

Can I Change My Covered California Plan After Open Enrollment? 

Yes, as long as you have an accepted qualifying life event. Such an event can include a move into or within the state, a change of marital status, job or income loss, or the addition of a child to the family through birth or adoption, among others. 

Does My Income Affect Eligibility for Subsidies? 

Yes. The amount you’ll pay in monthly premiums is based on your annual earnings. You’ll be asked to report what you earn when you apply for a Covered California health plan, and that’s when you’ll learn your rate. 

What Happens if I Miss the Enrollment Window? 

If you have a valid reason for not applying during the Nov. 1-Jan. 31 Covered California open enrollment period, you can request a special enrollment. You’ll have 60 days after a qualifying life event takes place (such as the birth of a child or loss of a job) to request special enrollment.