How to Maximize Your Covered California Health Plan Benefits
If you’re one of the millions of Californians who enroll in health insurance through Covered California, you may be able to get more from your plan. You can maximize your Covered California health plan benefits by simply learning more about features that apply to all plans.
All Covered California health plans include essential benefits for physical and mental health. But crucial services, from preventive care and mental health services to prescription savings and telehealth, often go unused. If you think your Covered California health plan doesn’t have much to offer, you may not know everything about your health insurance coverage.
Lack of information is the most common reason crucial health benefits go unused. We’re here to help with a guide to finding and accessing underused features in Covered California health insurance plans so you can make the most of your coverage without paying more.
Use Your Preventive Care Benefits
You don’t have to (and shouldn’t) wait to use your healthcare plan until you or your family members are sick. An important reason for health insurance is the preventive services for children, adults, and families designed to help members avoid illnesses or medical conditions through routine exams, immunizations, and screenings.
Most Covered California plans offer free preventive care with no copay (even if you haven’t met your yearly deductible), and coverage for children includes dental care benefits.
What’s Free Under Your Plan
Most California residents who don’t have coverage through Medi-Cal qualify for Covered California, giving them access to a range of free preventive care services for adults and children, including:
- Wellness exams
- Immunizations
- Blood pressure screenings
- Cholesterol screenings
- Depression screenings
- Autism screening for children at 18 and 24 months
- Developmental screening for children under three years old
- Screenings for newborns
- HIV screenings
- Vision screening for children
- And more
Women have different healthcare needs and may need to find coverage for various routine tests, as well as free or affordable pregnancy care. Several free preventive services to target women’s health concerns are available through Covered California plans, including:
- Anemia screening
- Breast cancer genetic test counseling (BRCA) for women at higher risk
- Mammography screenings every one to two years for women over 40
- Affordable pregnancy coverage
- Breastfeeding support
- Cervical cancer screening
- Contraception
- Domestic and interpersonal violence screening and counseling
- HPV DNA test every three years for women over 30
- Osteoporosis screening for women over 60
- And more
Visit Covered California’s Free Preventive Care page for a comprehensive list of all free services.
Take Advantage of Mental Health and Behavioral Services
Many California residents don’t realize their healthcare plans include mental health coverage. Yet, both federal and state laws ensure residents receive the necessary mental health and substance abuse services they need.
Under the Affordable Care Act (ACA), all health plans must cover mental and behavioral services and treatment for substance use disorder. These can be just as crucial as other medical services, with coverage for diagnosis, outpatient services, inpatient hospital services, partial hospitalization, and prescription medications.
California healthcare laws expand accessibility to equal care by requiring every health plan in the state to cover certain mental health conditions, including:
- Major depressive disorders
- Autism or PDD
- Bipolar disorder
- Schizophrenia
- Schizoaffective disorder
- Obsessive-compulsive disorder
- Anorexia nervosa
- Bulimia nervosa
- Serious emotional disturbances in children under 18
Save on Prescriptions and Generic Medications
Coverage for prescription medicines is a crucial part of any health insurance plan. Your prescription medication costs are most likely to be affected by your plan type and the type of medicine you take.
Covered California plans are divided into four basic categories, which include bronze, silver, gold, and platinum. Bronze and silver plans have lower monthly premiums but have higher costs (usually copays) for health services and medications. Gold and platinum plans are just the opposite, with higher premiums and lower out-of-pocket costs.
Prescription drugs are also divided into categories. There are four tiers:
- Tier 1 (generic): Lower copays and low or no deductible
- Tier 2 (preferred brand): Higher copay and may require you to pay full price until after meeting your deductible
- Tier 3 (non-preferred brand): Higher copay than lower tiers and may require you to pay full price until after meeting the deductible
- Tier 4 (specialty): Typically used to treat complex or serious conditions and often have the highest costs, including copays and deductibles
While this system may seem confusing, it’s designed to help you save on prescriptions based on medicine type. When comparing plans to maximize your Covered California health plan benefits, determine which plans cover the prescriptions you need and then compare how each plan pays for your drug tier. And don’t forget, a Cost-U-Less bilingual agent can walk you through all of this – for free. Just give us a call at 877-423-1543 for help navigating the Covered California system.
Access 24/7 Care with Telemedicine
If you live in a rural area or have limited access to transportation, you know the challenges of finding accessible healthcare. Telemedicine offers flexibility to drastically improve healthcare accessibility by allowing patients and medical professionals to use digital technologies (such as computers and mobile devices) to access healthcare services remotely.
All Covered California plans have some level of telemedicine coverage. If you’ve been reluctant to consider telehealth services in the past, you should know they offer many cost-saving benefits and are easy to use.
Telemedicine physicians or specialists treat patients through face-to-face video conferences on your preferred device. They can diagnose and treat many non-life-threatening medical issues, follow up on chronic health issues, and send prescriptions to your local pharmacy.
Telemedicine is a great way to maximize your Covered California health plan benefits to further cut costs on services by:
- Eliminating long drives to a care provider
- Gaining access to round-the-clock care
- Skipping the costs of urgent care for non-life-threatening emergencies
- Getting prescriptions filled or refilled at your local pharmacy
- Avoiding missed work for scheduled daytime appointments
While all Covered California plans offer coverage for telemedicine services, covered benefits vary by plan. Remember to review your plan to understand your benefits before making your first telehealth appointment.
Staying Informed and Updated: Health Insurance in California
Health care coverage options and regulations change frequently, often leading to more opportunities for improved services or benefits. Ensuring you stay up to date with such transitions can help you maximize your Covered California health plan benefits as you encounter life changes.
Open enrollment is the period in which you can sign up for new coverage or make changes to a current plan, and the ideal time to explore new benefit options and learn about different plans. In California, open enrollment runs from Nov.1 through Jan. 31.
However, if you experience a qualifying life event that changes your circumstances (such as losing employer-provided healthcare or having a baby), you can get a special enrollment period.
So, how can you stay informed about Covered California health plans in between open enrollment periods? Here are a few options.
- Give your friendly bilingual Cost-U-Less a call anytime for help at 877-423-1543. We’ll walk you through it all for free.
- Visit the Covered California website.
- Subscribe for email updates from Covered California.
- Follow Covered California social media accounts.
- Talk to your health insurance provider.
Take Full Advantage of Your Plan—Explore Better Coverage Options Today!
Now that you know about the many benefits Covered California health plans have to offer, you can get more from your benefits. Still, navigating your healthcare options alone can be intimidating.
Luckily, you can get help finding a health insurance plan that meets your needs and budget. Cost-U-Less agents specialize in providing free help making sense of it all. Call for quick, personalized assistance at 877-423-1543.
