Covered California Is Not Medi-Cal

Covered California and Medi-Cal are health insurance programs in California, but they serve different purposes and populations. Here are the key differences:

Covered California

1. Type of Program: Covered California is the state’s health insurance marketplace established under the Affordable Care Act (ACA). It allows individuals and families to purchase health insurance plans.
2. Eligibility: Primarily for individuals and families who do not qualify for Medi-Cal and do not have access to employer-sponsored insurance. Eligibility is based on income levels between 138% and 400% of the federal poverty level (FPL).
3. Cost: Plans are purchased, and premiums vary based on the plan chosen, income level, and whether the individual qualifies for subsidies. Premium assistance and cost-sharing reductions are available to help lower the cost for eligible enrollees.
4. Coverage: Provides a range of health insurance plans from various private insurance companies. All plans cover essential health benefits such as preventive services, emergency services, prescription drugs, and more.
5. Application: Enrollment is through the Covered California website during open enrollment or special enrollment periods if qualifying life events occur.

Medi-Cal

1. Type of Program: Medi-Cal is California’s Medicaid program, providing free or low-cost health coverage to low-income individuals and families.
2. Eligibility: Based on income and other factors like age, disability, pregnancy, and family size. Generally, individuals with income at or below 138% of the FPL qualify. Additional eligibility for certain groups, such as children, pregnant women, and individuals with disabilities.
3. Cost: Typically free or very low cost. While there may be small copayments for some services, most enrollees have no monthly premiums.
4. Coverage: Comprehensive coverage including essential health benefits, long-term care, and other services like dental and vision for children and sometimes for adults.
5. Application: Enrollment can be done anytime through the California Department of Health Care Services (DHCS) or local county human services offices—no open enrollment periods.

Covered California is good for individuals and/or families who do not qualify for Medi-Cal. Our agents at Diamond Insurance Solutions will sit down with you and guide you through the process of choosing the right Covered California plan for you and your family.