Covered California Health Insurance

Open Enrollment

Open enrollment for 2017 coverage begins Nov. 1, 2016, and continues through Jan. 31, 2017. Medi-Cal enrollment is year-round.

Our staff is available year round to answer questions and assist with insurance enrollment, including special enrollments like qualifying life events.

Health insurance is an important way to ensure you receive medical care when you need it. Coverage includes preventive services and protects you from unexpected costs in the event of a serious injury or illness.  Call our enrollment hotline today to learn more about health coverage, (707) 791-7735 or email us at getcovered@phealthcenter.org.  To schedule an appointment with one of our expert Certified Enrollment Counselors, call us at (707) 559-7500.


Coverage that qualifies under the Affordable Care Act includes private insurance obtained on your own or through a job, Medicare, Medicaid, CHIP, Veterans Affairs, the Indian Health Service, or Tricare.

Fine for consumers without coverage:

2016 – $695 or 2.5% of your yearly household income, whichever is greater

2015 – $325 or 2% of your yearly household income, whichever is greater

*Some consumers are exempt from the fine.

Ready to Enroll?

Whether you are enrolling online or with one of our certified enrollment counselors, you will need the following information:

  • Number of people being enrolled and birth dates
  • Social security numbers for each person being enrolled
  • Most recent income tax filings, including dependent tax information
  • Citizenship or Immigration Status (birth certificate or permanent resident card, or passport)
  • Information about status as a member of a federally recognized tribe
  • Home ZIP code

Links to more detailed information:

www.healthcare.gov/

www.coveredca.com/

www.sonoma-county.org/healthcarereform/

www.hhs.gov/healthcare/rights/law/index.html

My present private insurance has offered early renewal to avoid premium increases. Is this a scare tactic or should I renew now?

No, this is not a scare tactic. Private insurance companies tend to do this for their customers.

I am a patient at Petaluma Health Center; will I be transitioned onto a program through the Affordable Care Act?

If you are a part of a public plan, such as MediCal or Path2Health, you need to renew the plan when it is time to do so. You will receive a notification from the county when it is time to renew.

If I want to change my current insurance, when is my enrollment period?

If you have insurance through your employer, you can change your plan during the employer’s enrollment period. If you have individual private insurance, you can cancel your insurance plan any time of the year. If you have private insurance through Covered California, you can only change your coverage during the enrollment period or with a life changing event.

As a parent of a young adult under the age of 26, MUST I provide insurance for them through my plan?

If you are a parent of a young adult, you do not have to provide insurance for your child. But, if you claim your child as a dependent on your taxes, then they will not be able to purchase their own coverage through Covered California.

If I belong to a Covered California plan and move to another state, will I have to sign up again for a new plan in that state?

Yes; if you move different state, you will have to sign up for a new plan that is offered in that state’s marketplace.

Can a married couple apply for insurance through the exchange separately, based on each individual income?

Yes, but only if the married couple files their taxes separately.

Who is NOT required to obtain health insurance?

A person will not be required to obtain coverage if they:

  • Have religious reasons for not purchasing coverage
  • Cannot afford coverage due to financial hardship
  • Are a members of an Indian tribe
  • Are incarcerated
  • Are an undocumented immigrant
  • Are not required to file taxes

However, individuals must provide documentation to meet these criteria. Please visit www.coveredca.com/FAQs/

Can I still have an HSA (Health Savings Account) with plans purchased through Covered California?

Yes, you can still have a Health Savings Account if you purchase a plan through Covered California.

If I qualify for government premium assistance, will I have to pay the full cost of the plan up front then receive a tax refund at the end of the year?

Three options are available if you qualify to receive assistance to pay for your premiums:

1.) You can receive monthly assistance to reduce costs for the monthly premiums
2.) You can receive the government assistance as a tax credit at the end of the year
3.) You can take a percentage of the monthly assistance and receive the rest as a tax credit*

*This option is encouraged for individuals whose income changes throughout the year.

Will my health plan premiums be based on my past salary or current unemployment benefits?

Covered California will use the information that was shown on your most recent tax return. If there will be a drastic income change on your tax returns, you can provide Covered California with an appropriate income estimate. Covered California will compare the two incomes and if there is a discrepancy then the consumer is responsible for paying back any assistance that was given when not needed.

What happens if my income changes year to year? Will I have to change coverage/plans?

You do not have to change insurance plans if your income changes year-to-year, but you should notify Covered California of any changes in income. If the income is low enough, a person might receive government assistance to reduce costs for premiums and cost-shares, but if there is an income increase, premium assistance may be reduced.

What should I expect to pay for name-brand prescriptions?

The costs for name-brand prescriptions will depend on the plan and tier an individual purchases.

I don’t currently have health insurance, what should I do?

The Marketplace, also known as the Exchange is where those that are uninsured can purchase health insurance.  In California, this will be run by the state’s program, Covered California, and you can sign up by phone, online, or in person.  Other information regarding cost and eligibility are also available through the site http://www.coveredca.com/

Legal residents of California cannot be denied coverage for a pre-existing medical condition and do not need to pass a medical exam. Coverage will include preventive care, immunizations, screenings, emergency care, laboratory services, prescriptions, mental health services, maternity, newborn and pediatric care.

Petaluma Health Center offers drop-in hours and scheduled appointments to meet with a certified enrollment counselor that can assist you in choosing a plan that’s right for you.  We can also help you enroll in other programs you may be eligible for.  For an appointment, call our main line (707) 559-7500.  To talk with one of our educators, call our hotline at (707) 559-7580.

I can’t afford to purchase health insurance, what are my options? 

To qualify for subsidized coverage, you must go through the Marketplace. You may qualify for financial assistance based on income requirements.  Financial assistance includes:

  • Premium Assistance: Tax credits that reduce monthly payments
  • Cost-sharing subsidies: Reduction of expenses at the time of care, including co-payments, deductibles, or other costs
  • Medi-Cal assistance: Free health coverage for those with qualifying incomes or disabilities

Adults with income up to 138 percent of the Federal Poverty Level and parents with an income between 106 percent and 138 percent of the Federal Poverty Level are eligible for Medi-Cal.

Petaluma Health Center also offers a sliding scale which patients may qualify for in addition to Medi-Cal.

I already have health insurance through my work (or privately), how will this affect me?

If you are currently covered through your employer or a purchased plan, it will not be necessary to make any changes. If you have affordable insurance from your employer, you will not be eligible for financial help.  However, if you change or lose jobs you will have access to health insurance.  Other people that will be exempt from buying insurance include undocumented immigrants, those in prison, Native American Tribes, and those that qualify for religious exemption.

Do I have to buy my health insurance from the Marketplace?

No. The Marketplace is just one way you can shop for health coverage.  However, you must buy coverage through a marketplace to get financial assistance from the government.

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