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Medi-Cal Eligibility and Covered California - Frequently Asked Questions

Back to Medi-Cal FAQs 2014

Below you will find the most frequently asked questions for current and potential Medi-Cal coverage recepients. If you do not find an answer to your question, please contact your local county office from our County Listings page or email us at  Medi-Cal Contact Us.

Getting Help with Covered California

1. How can I choose a health insurance plan?

If you qualify for private health insurance plans through Covered California, you can visit www.CoveredCA.com to easily shop and compare health insurance plans. Covered California health plan brochures are also available for you.

Covered California will offer choices of private health insurance plans and Medi-Cal plans. You can choose the level of coverage that best meets your health needs and budget.

You can choose to pay a higher monthly cost (called a premium) so that you pay less out of pocket when you need medical care. Or, you can choose to pay a lower monthly cost but pay more out of pocket when you need care.

If you qualify for Medi-Cal, the coverage and costs are different, and they may even be free. We will send you more information about Medi-Cal plans available to you.

 

2. What region am I in?

There are 19 pricing regions in California. For health plans that consumers can get through Covered California, either with or without premium assistance, the plans available and their prices vary by region. The easiest way to find the pricing region you live in is to use our Shop and Compare Tool online at www.CoveredCA.com/fieldcalc4calculator. After entering your home ZIP code, the Shop and Compare Tool will show you your pricing region. You may also call our Service Center for assistance by calling (800) 300-1506.

 

3. How much will my health coverage premium cost?

The cost depends on what health insurance programs and financial assistance you qualify for, as well as which plan you choose. You can use the cost calculator at www.CoveredCA.com to find the cost and see if you qualify for help paying insurance.

 

4. I don’t have all the information I need to answer the questions on the application. What should I do?

If you don’t have all the information, sign and submit your application anyway. We will call you to tell you what to do within 10 to 15 calendar days after we get your application. If you don't hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).

If you don’t have all the information, sign and submit your application anyway. We will call you to tell you what to do within 10 to 15 calendar days after we get your application. If you don't hear from us, please call us at 1-800-300-1506 (TTY: 1-888-889-4500).

 

5. Can I get help with my application or with choosing a plan?

Yes! Help is free. Certified Enrollment Counselors or Certified Insurance Agents are  available in communities across the state to give you information about new health insurance choices and help you apply. You can also  get help by visiting  your  county social  services office. You can  get help in many different languages.

Get help  with your application or with choosing a plan:

    • Online: Visit www.CoveredCA.com.
    • By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
    • By fax: Fax the appeal to 1-888-329-3700.
    • By mail: Mail the appeal to:
      Covered California – Appeals
      P.O. Box 989725
      West Sacramento, CA 95798-9725
    • In person: We have trained Certified Enrollment Counselors and Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free!

 

For a list of Certified Enrollment Counselors and Certified Insurance Agents near where you live or work, or a list of county social services offices near you, visit www.CoveredCA.com or call 1-800-300-1506 (TTY: 1-888-889-4500).

 

6. What if I don’t agree with the decision Covered California makes?

You can file an appeal. To appeal a decision you don’t agree with, contact Covered California in one of these ways:

    • Online: Visit www.CoveredCA.com.
    • By phone: Call Covered California at 1-800-300-1506 (TTY: 1-888-889-4500). You can call Monday through Friday, 8 a.m. to 6 p.m. and Saturday, 8 a.m. to 5 p.m. The call is free!
    • By fax: Fax the appeal to 1-888-329-3700.
    • By mail: Mail the appeal to:
      Covered California – Appeals
      P.O. Box 989725
      West Sacramento, CA 95798-9725
    • In person: We have trained Certified Enrollment Counselors and Certified Insurance Agents who can help you. Or you can visit your county social services office. This help is free!

 

For a list of Certified Enrollment Counselors and Certified Insurance Agents near where you live or work, or a list of county social services offices near you, visit www.CoveredCA.com or call 1-800-300-1506 (TTY: 1-888-889-4500).

 

7. How can I file an appeal regarding my Medi-Cal eligibility?

Consumers seeking to file an appeal regarding Medi-Cal eligibility and/or determination should contact their county human services agency.  The new telephone number for all Medi-Cal state hearing requests, including Affordable Care Act appeals, at the State Hearings Division is toll-free 1-855-795-0634 (Voice), 1-800-952-8349 (TDD), and 1916-651-2789 (fax).  In addition, appeal requests may be emailed to shdacabureau@dss.ca.gov or mailed to the following address:

    • California Department of Social Services
      State Hearings Division
      P.O. Box 944243, Mail Station 9-17-37
      Sacramento, California 94244-2430.

 

8. This application asks for a lot of personal information. Will Covered California share my personal and financial information?

No. The information you provide is private and secure, as required by federal and state law. We use your information only to see if you qualify for health insurance.

 

9. How can you use Covered California in conjunction with Medicare parts A, B and D?

Individuals who are eligible for Medicare will not be eligible to receive premium assistance through Covered California. Additionally, Medicare supplement insurance (Medigap) plans will not be offered through Covered California.

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Last modified on: 8/22/2014 8:58 AM