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Paul Davis, pdinsure, insurance agent

Getting Health Insurance for You and Your Family

Individual Health Insurance FAQ

  • Effective 1/1/2014, health plans during open enrollment are guaranteed issue.


  • Rates are calculated based on the age of each family member, family size and region.


  • 2017 Open Enrollment is from November 1, 2016 thru January 31, 2017


  • California has 19 rating regions.


  • California has set up an exchange called “Covered California”.


  • If you are eligible for coverage through your employer or your spouse’s employer you may not be eligible for tax credits.


  • There are four standardized plan levels: Platinum, Gold, Silver and Bronze.


  • If you do not qualify for tax credits through Covered CA, those same plans are also available directly through the carriers.


  • There are three financial assistance programs available to those who qualify.


  • Certified Insurance Agents and Certified Enrollment Counselors can assist you with your Covered CA enrollment. 


  • Premium Assistance (Tax Credits) reduces the cost of your premium.


  • The price you pay for your plan is identical whether purchased directly from Covered CA or with the help of a Certified Insurance Agent.


  • Cost Sharing Reduction reduces costs of covered services.


  • In 2017 the penalty for not obtaining minimum essential coverage is $695 per adult and $347.60 per child, plus COLA (Cost of Living Adjustment), or 2.5% of your taxable household income.


  • Medi-Cal is a program that may be at no cost to those who qualify. Thresholds were expanded in 2014. See chart below.


  • Special Enrollment Periods (outside of open enrollment) are available. See below.


  • Premium assistance and cost sharing reduction programs are only available through Covered California.


  • In Los Angeles, participating carriers with Covered California are: Anthem Blue Cross, Blue Shield, Health Net, Kaiser, Oscar Health, L.A. Care Health Plan and Molina Healthcare.


  • Premium assistance (tax credits) can be applied towards monthly premium or at tax filing for those who qualify.


  • We partner with all above mentioned carriers including CIGNA and United Healthcare in the private market as well.Type your paragraph here.



Examples of Special Enrollment Periods

  • Lost other health insurance including Medi-Cal


  • Permanently moved to or within California


  • Birth or adoption of baby/child


  • Newly married or entered into a domestic partnership


  • Returned from active duty military service


  • Released from incarceration


  • Gained citizenship; Lawful presence


  • Income changed to Federal Poverty Guideline Level


  • Current individual grandfathered plan will renew outside of open enrollment period


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