Coming Soon New Health Care Benefits For Your Family

 COVERED CALIFORNIA

CC 2016-2017 Renewal Image

 Medi-Cal – No deadline! Apply any time of the year!

Covered CA Renewals & Plan Changes DEADLINE is December 15th

Covered CA Application Period is November 1st, 2016 – January 31st, 2016

Updates 2016!

MEDI-CAL IS NOW AVAILABLE TO ALL CHILDREN, REGARDLESS OF IMMIGRATION STATUS

 (Income & CA residency requirements apply) – Click Here for Details     

(PRINTABLE HANDOUTS ARE AVAILABLE AT BOTTOM OF PAGE) 

If you are uninsured, SYHC can help you find NO COST or LOW COST health coverage regardless of your income, health or immigration status!

Health Insurance Hotline

(619) 600-3000

Monday – Friday 8:00 am to 5:00 pm

SYHC’s Certified Eligibility Specialists can help you:

  • Apply for Covered California, Medi-Cal, & Medicare
  • Change or renew existing Covered California plans (Deadline is December 15th, 2016)
  • Renew existing Medi-Cal plans (Deadline is 90 days after receiving your letter)
  • Medi-Cal Health Plan Changes (Can be changed at any time during the year)
  • Temporary or Emergency Medi-Cal Coverage (Presumptive Eligibility)
  • Update changes in income or household information

CALL FOR A QUICK 5 MIN SCREENING AND TO MAKE AN APPOINTMENT WITH OUR SPECIALISTS!

– FREQUENTLY ASKED QUESTIONS

AM I REQUIRED TO GET HEALTH INSURANCE? WHAT HAPPENS IF I DON’T GET IT?

The Affordable Care Act (ACA) passed in 2014 and it requires most U.S. Citizens and Lawfully-Present Residents to have health insurance or risk being fined by the Internal Revenue Service (IRS) tax time. If you are eligible but you choose not to enroll, you may be fined for the number of months that you go without health insurance including anyone else in your household that does not have it. The fines are big this year! For every adult the fine is $695 ($347 per child) or 2.5% of your household income (whichever is higher).  You will find out exactly how much you owe when you file your taxes.

Generally the following groups may not have to have (exempted) health insurance and will not be fined:

  • Individuals with incomes below the IRS tax filing amount. For example, individuals with incomes $10,300 (under 65) and $11,850 (over 65) may not be required.
  • Consumers who go without coverage for less than three consecutive months during the year.
  • Members of a federally recognized American Indian tribe, or those who are eligible for services through an Indian Health Services provider.
  • Consumers who are not U.S. citizens, U.S. nationals or lawfully present in the United States.

Click here to find out if you are required to have health insurance

HOW IS HEALTH INSURANCE DIFFERENT TODAY?

The Affordable Care Act law provides more protection and benefits than ever before! Many people do not realize that prior to the law passing, insurance companies could deny individuals coverage if they had a chronic condition such as diabetes or cancer; they could raise the cost of monthly premiums at any time for any reason. In other words, the new law protects consumers and prevents health insurance companies from denying coverage or dropping you if you get sick.

As of 2014, all health insurance plans including Medi-Cal are required to cover the same 10 Essential Benefits. This makes it easier to compare prices and understand what you are paying for.

10 ESSENTIAL BENEFITS

  1. Preventive and wellness services (such as immunizations, health screening tests for Cancer, Diabetes,HIV, etc.), birth control, breast feeding supplies, domestic violence counseling.
  2. Medical services
  3. Emergency services
  4. Hospitalization
  5. Maternity and newborn care
  6. Mental health and substance use disorder services
  7. Prescription drugs
  8. Rehabilitative services and devices
  9. Laboratory services
  10. Pediatric services

WHAT IF I NEED ASSISTANCE IN APPLYING FOR HEALTH INSURANCE? IS THERE A COST?

There are various ways to get information and assistance. Regardless of the information out there, it is recommended that you consult with a CERTIFIED enrollment counselor or insurance agent. These individuals are certified by Covered CA to provide FREE counseling and application assistance. You should never be required to pay a fee, so beware of scammers that charge a fee to provide this service.

Visit any of our 12 convenient locations to speak to our Certified Enrollment Specialist

For more information on scams and how Covered Ca protects consumers, check out this page

WHAT ARE MY HEALTH COVERAGE OPTIONS?

The majority of the population has health insurance through their employer. Others have VA health benefits, Medicare, COBRA or some other type of private insurance. The rest have two other options: Medi-Cal and Covered CA. 

MEDI-CAL

Medi-Cal is a state sponsored program where low income individuals/families may be eligible for FREE or LOW-COST health insurance that covers more benefits than ever before. Several changes have been made to the program to now allow more people to qualify. The following new groups are now eligible:

  • All children up to the age of 19, regardless of their immigration status
  • Deferred Action For Childhood Arrivals (DACA) Recipients
  • Low income adults without children
  • Adults under the age of 65 who were previously denied due to the “asset test” (they used to count the value of your home or car as income but no longer do this).

NOTE: Income and CA residency requirements apply for every applicant. For more information on eligibility, click here.

COVERED CA – LOW COST PLANS

If you don’t qualify for Medi-Cal, you can purchase low-cost private health insurance with the possibility of qualifying for financial assistance to help pay for it. As of 2014, every health insurance plan is required to cover the same services (see 10 Essential Benefits Above) including a FREE annual physical (also called a preventive exam). In San Diego the health insurance plans you can choose from include 1) Anthem Blue Cross 2) Blue Shield 3) Health Net 4) Kaiser 5) Molina and 6) Sharp. The differences between the plans are the doctors and hospitals in the network, extra benefits and out-of pocket costs (co-pays, deductibles).

For those who purchase a plan, the monthly premium cost depends on these factors: 1) Number of people in your household (head of household, spouse, children or dependents); 2) Household Income (combined incomes of all members over the age of 18); 3) Ages of those in need of health insurance; 4) Zip Code and 5) Level of Coverage – you will pay a higher amount if you choose a plan that pays for more of your care.

Financial assistance (called tax credits or subsidies) is available for most people with incomes of less than $40,000. These individuals can receive the “discount” at the time of purchase OR wait to get the credit at the time of tax filing. Many individuals and families may also qualify for tax credits to pay for out-of-pocket expenses (such as co-pays).

You can visit the Covered California website for information on the insurance plans and financial assistance available at: http://www.coveredca.com/

WHAT I QUALIFY FOR?

If you or your family’s household income falls below the amounts in the table below then you qualify for Medi-Cal! Individuals and families with incomes above these amounts may qualify for low-cost health insurance through Covered CA and receive financial support to help pay for it! Better yet, if you don’t qualify for either then we can still find you help to cover health services at SYHC.

NUMBER OF PERSONS IN FAMILY/HOUSEHOLD ADULTS UNDER 65 AND OR FAMILIES WITH CHILDREN/DEPENDENTS OVER 18 (Combined income for head of household +spouse (if any) + children/dependents) CHILDREN UNDER AGE 19(Based on income of parent(s) in household)

PREGNANT WOMEN

1

$16,394

$31,600

$25,304

2

22,107

42,613

34,122

3

27,820

53,625

42,940

4

33,534

64,638

51,759

5

39,247

75,650

60,577

6

44,960

86,662

69,395

7

50,687

97,701

78,234

8

56,428

108,767

87,095

Add additional person

5,741

8,860

11,066 

Answer a few questions using the Covered CA Shop & Compare Tool to find out what you qualify for and whether you are eligible for tax credits to reduce the monthly premium. 

WHAT ARE THE OPTIONS FOR IMMIGRANTS?

All lawfully-present California residents are eligible for the state-sponsored Medi-Cal and Covered California private insurance plans. Lawful residents have permission to live and work in the U.S.; including individuals with green cards, naturalization papers, refugees, asylees and others with protected status.

NEW in 2016: All children, regardless of immigration status (undocumented) are eligible for full-scope Medi-Cal! For more information click here

Individuals who have been granted Deffered Action for Childhood Arrivals are eligible for full-scope Medi-Cal.

Individuals who are not eligible for full Medi-Cal or Covered CA, including those without immigration documents, may still qualify for limited Medi-Cal for emergencies and pregnancy as well as other free or discount programs. Individuals are encouraged to meet with a SYHC Certified Eligibility Specialist to learn about their options. SYHC does not turn anyone away!

WHAT INFORMATION DO I NEED TO APPLY? 

If you apply on your own or you get assistance from us, you will need the following information. It is recommended that you gather all documents PRIOR to completing the application.

  1. Number of family members living in the household (head of household, spouse, children and/or dependent(s))
  2. Identification for every family member applying for health insurance (i.e. Driver’s License or identification card, birth certificate, school identification, immigration documents (such as green card or naturalization papers, etc.)
  3. Information about current or previous health insurance for any family member; such as Medi-Cal, Medicare or private insurance.
  4. Social Security numbers for family members applying for health insurance

IMPORTANT: A Social Security number is NOT required when applying for health insurance on behalf of family member

  1. Most resent federal tax returns AND last two pay stubs or other income information for each family member applying for health insurance.

You can print out this check-list to help you collect the required information.

RESOURCES TO HELP YOU UNDERSTAND YOUR OPTIONS  

Health insurance can be complicated. We have created several documents that can give you more information on the basics of health insurance, new options, how to apply, and what to expect once you have enrolled:

A portion of these services is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

 

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