Health Care Coverage
Health insurance is an agreement between you and an insurance provider that the provider will cover some or all of your medical and surgical expenses. There are different types of insurance- some require you to pay first and get reimbursed, others will pay the doctor and then bill you for a portion of the cost. You may obtain health care coverage independently, from your employer, or through Covered California or Medi-Cal.
The Patient Protection and Affordable Care Act (ACA) requires that all plans pay for basic preventative care, like vaccines, screenings, prenatal visits, and well-baby check-ups.
Health Insurance protects you from high, unexpected medical costs resulting from an emergency, accident, or illness.
Children who have health insurance typically have better health because they are more likely to:
- get needed vaccines (shots that prevent disease)
- get help for chronic illnesses like asthma or ear infections
- receive preventative care through regular check-ups with a doctor that can identify small issues before they become big problems
Remaining healthy means that your child will have the energy to develop and grow. Your child will miss less days of preschool or child care.
Health insurance uses special vocabulary that you may not know:
- Premium- The ongoing amount that must be paid for your health insurance or plan. You usually pay it monthly. The premium may not be the only amount you pay for insurance coverage. Typically, you will also have a co-payment or deductible amount in addition to your premium.
- Deductible- The amount you are required to pay annually before reimbursement by your health care benefits plan begins. The deductible requirement does not apply to preventive services.
- Co-insurance – The percentage of a covered service that you are responsible for paying or the percentage paid by your plan.
- Co-payment – A fixed dollar amount you are required to pay for covered services at the time you receive care.
- Out-of-pocket maximum- This is the most you have to pay out of your own pocket for expenses under your insurance plan during the year.
- In-network- Services provided by doctors, hospitals and other health care professionals that have contracted with your insurance provider to deliver medical services to its members. This is sometimes known as a “Preferred Provider.”
For more definitions, visit the Covered California glossary.
Generally, if you have a low monthly premium, you will have a higher deductible. All plans are required to disclose the maximum you must pay out-of-pocket. This allows you to budget and plan your health savings.
If you or your family members do not have health insurance, you will have to pay a fine each year. The good news- there are lots of ways to get help. If you have a limited income, you may qualify for free or low-cost Medi-Cal. Through Covered California, you may qualify for a premium tax credit on a private plan. You may be surprised to see the income levels that qualify for assistance. The only way to know what options are available for your family is to apply.
With the help of community partners (schools, doctors, and family advocates) a new law went into effect in May 2016. This law will allow children under 19 years of age to apply for Medi-Cal benefits regardless of their immigration status, as long as you meet the income standards. Your information is strictly confidential and will not be shared with the immigration department. It will NOT hurt your chances of getting a green card if you, your children, or other family members use health care (such as Medi-Cal, Healthy Families, WIC, or prenatal care), food programs (Food Stamps, WIC, or school meals) or other programs that do not give cash, such as public housing, disaster relief, childcare services, job training, or transportation vouchers. If you receive cash assistance, you may have an issue. If you have questions about assistance and your immigration status, call (888)6-CHIRLA for assistance in Spanish and (213) 977-7500 in Chinese and Vietnamese.
You can also apply on your own through the Covered California website. Covered California is the place where Californians can get brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place to get federal premium assistance to help you buy private insurance. That means you may qualify for a discount on private insurance, or get health insurance through the state’s Medi-Cal program. Either way, you’ll get great health coverage.
For local help and to apply, call the Santa Barbara County Education Office’s Health Linkages Program. Enrolling now means your child will be eligible for coverage as soon as possible.
- Santa Maria: (805) 739-0992
- Lompoc: (805) 680-7805
- Santa Barbara: (805) 964-4710 x4404
You can also go to a Family Resource Center at a school near you or to enroll online, visit https://www.mybenefitscalwin.org/.
Call (866) 404-4007 for more information.
County of Santa Barbara – How to apply for Medi-Cal and information about recent expansions, including service to special populations such as pregnant women, disabled individuals, youth and young adults in foster care, and childless adults. You will also find a list of social service offices and outstation sites near you. For more information call (805) 737-7080 in Lompoc, (805) 681-4401 in Santa Barbara, and (805) 346-7135 in Santa Maria.
Covered California– Get local help and apply online for private insurance for adults and children. Call (800) 300-1506 for help by phone.
CenCal Health Programs – CenCal will be your health plan provider if you enroll in Medi-Cal health insurance. Get more information by phone at (877) 814-1861. Hearing Impaired CA Relay 711.