Frequently Asked Questions.

Medi-Cal is a free and low-cost health insurance for California residents. The program covers essential health benefits as required by the Patient Protection and Affordable Care Act.

Covered California is the state’s health insurance marketplace. This marketplace enables individuals to purchase insurance at a subsidized rate.

Health insurances from Medi-Cal and Covered California both cover essential benefits including: ambulatory services, hospitalization, prescriptions, laboratory services, behavioral health care, and other treatments. Eligibility is based on income and family size. Individuals who qualify for Medi-Cal will pay little to no money for their health insurance. Premiums for health insurance purchased through Covered California vary and are dependent on age, income, family size, and zip code.

There are no asset tests for individuals up to age 64 who are enrolling in Medi-Cal or Covered California. You can own a home and/or other assets and still receive health insurance without worry of later receiving a property or tax lien.

To complete an application for health insurance, you will need to show a California driver’s license or state identification card; proof of permanent residency or certificate of citizenship (if born outside the United States); and proof of all income, such as recent paycheck stubs or a letter from your employer.

There is no enrollment deadline for Medi-Cal. You can enroll year-round and will typically receive an eligibility decision within 45 days. The Covered California open enrollment period is from November 1 to January 31. American Indians who are members of a federally recognized tribe may enroll in Covered California at any time.

You may be eligible for a special enrollment period if you have a qualifying life event such as losing health coverage, a change in income, a change in residency, and other personal circumstances. Your coverage will begin the first day of the month following enrollment, if you enroll prior to the 15th day of the month. If you enroll after the 15th of the month, your health coverage will begin the first day of the second month after enrollment.

American Indians who are members of a federally recognized tribe are eligible for unique benefits through Covered California. These include no health care costs for medical services provided by the Indian Health Program and tribal and urban clinics; the ability to enroll in or change Covered California health plans once a month; and, for American Indians who have a household income under 300 percent of the Federal Poverty Level, no co-pays or deductibles for any health plan purchased through Covered California.

To qualify for Medi-Cal as an adult, your total household income based on your household size must be less than 138 percent of the Federal Poverty Level which is updated annually. For current poverty level information, please visit https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines. You will be directed to a list of incomes based on total household size at 100 percent poverty level and have access to files that clearly shows the income limit at 138 percent. Children in the same household can qualify for Medi-Cal at 266 percent of the Federal Poverty Level. This can be calculated by multiplying the 100 percent poverty level limit by 2.66.

Individuals and families whose income is below 400 percent of the Federal Poverty Level are eligible to receive a subsidy to purchase health insurance through Covered California. For 2016 that income limit is $113,640 for a family of five.

Medi-Cal covers many medically necessary dental services including exams and cleaning, fillings, some root canals, crowns, and dentures. Covered California provides dental coverage for children through its health plans. Adults can purchase separate dental coverage through Covered California.

Certified enrollment counselors at San Diego American Indian Health Center can help you enroll in Medi-Cal or Covered California. Please call (619) 234-2158 to make an appointment for health insurance assistance.