Shoreline Health Insurance Services is here to help you navigate through the confusion that is health insurance today. Recent legislative mandates, namely the Affordable Care Act, have made for significant changes in the way we look at health care.
Important. Open Enrollment for individual and family health insurance plans occurs once per year. Once the Open Enrollment period ends, you can buy a health plan only if you qualify for a special enrollment period. You can apply for Medicaid and CHIP any time. Find out if you qualify for a Special Enrollment Period or Medicaid and CHIP.
- Private health insurance. Plans cover essential health benefits, pre-existing conditions, and preventive care. Some plans include dental coverage. In other cases, free-standing dental plans are available.
- Covered California. Lower costs based on your household size and income. You can preview plans available in your area right now, with prices based on your income and household size. Most people who apply will qualify for lower costs. Go to Covered California’s Shop & Compare tool for details.
- Medicaid/Medi-Cal and the Children’s Health Insurance Program (CHIP). These programs cover millions of families with limited income. Many but not all states are expanding Medicaid to cover more people. Go to Covered California’s Shop & Compare tool for details.
Most people are eligible to use the Marketplace. Learn more about immigration status and eligibility.
Other Insurance Products
Penalty for No Health Insurance Coverage
Most people must have health coverage or pay a penalty. The penalty may be adjusted slightly each year. In 2016, the annual penalty is the greater of:
- $695 for each adult and $347.50 for each child, up to $2,085 per family.
- 2.5 percent of the tax filer’s annual household income minus the federal tax filing threshold.
The penalty will be capped at the national average premium for the lowest-cost Bronze plan available through all of the marketplaces. Some people qualify for an exemption from the fee, based on income or other factors.
You’re considered covered if you have Medicare, Medicaid, CHIP, any job-based plan, any plan you bought yourself, COBRA, retiree coverage, TRICARE, VA health coverage, or some other kinds of health coverage. You can also buy a plan outside the Marketplace and still be considered covered. If you buy outside the Marketplace, you won’t be eligible for premium tax credits or lower out-of-pocket costs based on your income.
If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance isn’t considered affordable or doesn’t meet minimum requirements.
If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan. Click here for additional information on Medicare.