Covered California/Medi-Cal

   (Also known as The Affordable Health Care Act)

Help Me Help You hosts successful Covered California Enrollment Event

with event sponsor LA Care

Peter V. Lee thanks agents

Peter V. Lee thanks agents

Peter V. Lee, Executive Director of Covered California visits event to thank Enrollment Counselors and Agents.

Guests registering for event

Guests registering for event

Guest registering to meet with agent

Guest registering to meet with agent

A BIG "Thank you" to the following sponsors for providing gifts for The Covered California Enrollment Event and Health Expo held March 29th at the Carson Community Center:


  • Antonio's Barber Supply - 742 Pine Ave

  • Buono's Authenic Pizzeria - 250 W. Ocean Blvd.

  • Cold Stone Creamery - 25 Aquarium Way

  • CVS Pharmacy - 596 Long Beach Blvd

  • Brew Haus - 250 W. Ocean Blvd.

  • Elev8 - 132 Linden Ave

  • Fresh & Easy - 450 The Promenade N

  • Gaucho Grill - 200 Pine Avenue

  • Zen Baby Shop - 406 E. 3rd Street

  • Spray for your Sol - 500 E. Broadway

The Basics


The Affordable Care Act has 3 main goals:

  1. Increase health care coverage

  2. Reduce health care costs and improve affordability

  3. Improve people's health


Previously, not all low-income Californians qualified for Medi-Cal coverage.  Because of limited resources, eligibility was restricted to a narrow group within the low-income population.  In 2014, coverage expanded to include adults without minor children living at home, with incomes up to 138% of the federal poverty level (FPL). 


Who is Eligible?


To be eligible for no-cost Medi-Cal with full benefits, individuals must be US citizens or legal permanent residents with low incomes


What about undocumented immigrants?


Undocumented can receive Emergency Medi-Cal which is emergency services with no follow-up coverage.  The undocumented cannot receive full-scope Medi-Cal.  Undocumented pregnant women are eligible for prenatal and maternity care, but are ineligible for full scope services.   The undocumented may be eligible for other programs.


What is MAGI?


For most populations, MAGI, or Modified Adjusted Gross Income, is the income counting standard that is now used to determine eligibility.


These populations will be able to enroll in Medi-Cal in a more simplified fashion without an asset test:

  • Children (up to 250% of FPL)

  • Adults (up to 138% of FPL)

  • Pregnant women (up to 200% of FPL)



Which plan is right for you?   HMO vs PPO


Understanding a HMO

  • You’re required to select a primary care physician (PCP), who will determine what treatment you need.

  • You will need a PCP referral to be covered when you see a specialist or have a special test done.

  • If you opt to see a doctor outside of an HMO network, there is no coverage,

      meaning you will have to pay the entire cost of medical services.

  • Premiums are generally lower for HMO plans, and there is usually no deductible or a low one.


Understanding a PPO

  • You can see the doctor or specialist you’d like without having to see a PCP first.

  • You can see a doctor or go to a hospital outside the network and you may be covered.

      However, your benefits will be better if you stay in the PPO network.

  • Premiums tend to be higher, and it’s common for there to be a deductible.


Enhanced Silver Plans


For lower-income consumers, Enhanced Silver Plans are available with additional financial support.  These subsidies can significantly reduce the amount you pay when you seek care (copayments or coinsurance).  If your income is less than $29,175 for an individual or $59,625 for a household of four (under 250% of FPL), you may beeligible.   These subsidies are only available for silver plans.



The Individual Mandate


What fulfills the mandate?  Individual insurance or coverage through an employer, union, the Veteran's Administration, Indian Health Services, Medi-Cal, Medicare, or Covered California.


Who are exempt? People who would have to pay more than 8% of their income on health insurance.  People with incomes below tax-filing threshold ($10,000 for an individual, $27,100 for a household of 4 in 2012).  People who qualify for religious exemptions.  Undocumented immigrants. Member of Native American tribes.




Special Enrollment (Enrolling outside of Open Enrollment)


People with certain life events qualify for special enrollment.

  • Events that cause people to lose health insurance

    • Job loss or reduction in hours

    • Divorce or death of policyholder family member

    • Turning 26 and aging out of parent's insurance

    • Becoming ineligible for Medi-Cal

    • Expiration of COBRA

  • Marriage

  • Becoming a citizen or legally present individual

  • Moving to an area with different plans

  • Birth or adoption

  • Exceptional circumstances loss of eligibility for hardship, natural disasters, etc.

  • Error by Covered California or enrollment counselor

 You MUST enroll within 60 days of the "life event."



Late Premium Payments


  • If you are late 1 to 30 days, your coverage is still active

  • If you are late 30 to 60 days, your coverage is suspended

  • If you are late 60 to 90 days, your coverage is suspended

  • If you are late more than 90 days, your coverage is terminated

  • Coverage can be reactivated between day 1 to 90 if full premium balance has been paid

  • After termination, you cannot sign up until the next open enrollment (unless you have a qualifying life event)




Additional Information

  • Your plan choice sticks with your for 1 year.

  • When you change plans, your deductible starts all over again

  • The federal government will determine if an individual or household received the proper amount of premium subsidies when taxes are filed.  Actual earned income for the year and the subsidies received vs. entitled to will be examined.

  • It is extremely important for households to update their income information as frequently as needed during the year.  Otherwise, you will be responsible for the difference.

  • Married couples must file jointly to receive premium subsidies.

  • Medi-Cal enrollees age 65 or older, disabled, or individuals in long-term care are subject to asset tests. (you cannot have property worth more than $2,000 for an individual and $3,000 for a couple, with the exception of your home and car.  If you cannot pass the asset test, you must "spend down" to qualify for Medi-Cal.

  • Medi-Cal enrollees age 55 or older, or other members utilizing long-term care services are subject to estate recovery after the death of the beneficiary.


Please contact the outreach team if you have questions or need assistance.  (562) 653-7001


Help Me Help You povides in-person enrollment assistance. Meet with state certified enrollment counselors for the assistance you need.


Contact our office for enrollment assistance. (562) 653-7001  



Please bring the following to to your appointment for enrollment assistance:

  • Birth certificates, or US passport, or resident alien cards (green card)

  • Proof of income: recent paycheck and 2012 tax forms

  • Proof of Residency: California ID, Drivers License, utility or phone bill

  • Social Security Card for everyone applying



¡Asistencia en español!


Ofrecemos asistencia en la inscripción en persona. Reúnase con consejeros de inscripción certificados por el estado para la asistencia que necesita.
Póngase en contacto con nuestra oficina para obtener asistencia de inscripción.

(562) 653-7001


Por favor traiga lo siguiente a su cita para asistencia de inscripción:

1) Acta de nacimiento, o pasaporte de los Estados Unidos, o tarjetas de extranjero residentes (tarjeta verde)

2) Prueba de ingresos: recibo reciente y formularios de impuestos 2012


3) Prueba de Residencia: California ID, licencia de conducir, utilidad o factura telefónica

4) Tarjeta de Seguro Social para todos los solicitantes


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Help Me Help You

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