This calculator* estimates the financial assistance that may be available to you when enrolling in a medical plan sold through Covered California. It will reflect the enhanced subsidies under the American Rescue Plan Act of 2021 (ARP) starting April 12.
Estimated subsidy amount:
You may qualify for the maximum amount of federal financial assistance to lower the cost of health coverage.
To learn about your options, call your broker/agent. Or call our Customer Care team, Monday through Saturday, 8 a.m. – 8 p.m.
Before you make the decision to switch from your plan direct from Blue Shield to one through Covered California, make sure you consider the following:
* Confirm the availability of your preferred doctor(s) in any new plan that you consider
* Confirm you still have access to the drug(s) you need by checking the formulary for any new plan that you consider
1. The results from this tool are an estimate based on the information you have provided. Only Covered California can determine your eligibility and actual subsidy amount. Additionally, this tool does not determine Medi-Cal eligibility. A single household may have a mix of eligibility with some family members eligible for Medi-Cal coverage and others eligible for subsidies. For more information please visit coveredca.com/medi-cal.
Our health plans include affordable pricing with Trio HMO and the flexibility to choose your provider with a PPO. If you see a plan you like, call us at (855) 836-9705.
EXPLORE 2021 BLUE SHIELD OF CALIFORNIA HEALTH INSURANCE PLANS
You’ll find an affordable balance between your monthly premiums and the cost when you see a doctor.
Great for those who want to be prepared for an emergency
We pay 70% of covered medical expenses after you pay the deductible
You’ll pay a low amount each month for your plan, and pay a high cost share when you get care.
Great for those who want coverage in case of emergencies but don’t expect to see a doctor often
We pay 60% of covered medical expenses after you pay the deductible
Based on the information you provided, it appears you may be eligible for Medi-Cal. Blue Shield of California Promise Health Plan currently serves Medi-Cal members in Los Angeles and San Diego counties. We are contracted with L.A. Care Health Plan and the Department of Health Care Services.
Visit www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx to learn how to apply for coverage.
If you have questions or need help, call us toll-free at (866) 820-6009 [TTY: 711], Monday through Friday, 8 a.m. – 6 p.m. Or, visit www.dhcs.ca.gov/services/medi-cal/pages/applyformedi-cal.aspx to learn how to apply for coverage.
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You may qualify for the maximum amount of federal financial assistance to lower the cost of health coverage.Shop plans
To learn about your options, call our health experts
On March 11, 2021, President Biden signed the American Rescue Plan Act of 2021. The new law provides a temporary boost in the amount of premium assistance (government tax credits) available and removes the “cliff” that makes people ineligible for subsidies if their income exceeds 400% of the Federal Poverty Level (FPL) for 2021 and 2022. Members who qualify will not have to pay more than 8.5% of their household income for the second lowest cost silver plan.
Federal premium assistance is only available for medical plans purchased through Covered California. If you purchased your plan through Blue Shield and you didn’t qualify for a subsidy when you renewed into your 2021 plan, use our subsidy calculator* to check again – you may now qualify. If you qualify, you can re-enroll in a Blue Shield plan sold through Covered California to obtain your subsidy.
Members who purchased their Blue Shield plan through Covered California and didn’t qualify for a subsidy previously may now qualify. Members who already obtain a subsidy through Covered California will be eligible for higher tax credit amounts to help with the cost of their health plan premiums, making your Blue Shield plan even more affordable.
If after using our calculator you still have questions, contact your broker, or a Customer Care Representative at (855) 836-9705.
*The new American Rescue Plan Act is fluid and pending ongoing updates from the federal government and Covered California. Blue Shield of California is committed to helping you and your clients stay updated as information gets released. Please continue to check back for updates.
**The results from this tool are based on the information you provide. If you decide to apply for a plan through Covered California, then Covered California will determine your eligibility and actual subsidy amount based on the information you enter in your application.
Advanced Premium Tax Credit (APTC), also called a subsidy, is federally funded financial assistance for medical premiums. For those who are eligible, it sets a limit on how much one pays based on a percentage of their annual income. The amount of premium assistance that one can qualify for depends on age, household income and size, and the cost of affordable health care coverage in their region. Premium assistance is only available for medical plans purchased through Covered California.
*The results from this tool are based on the information you provided. If you decide to apply for a plan through Covered California, then Covered California will determine your eligibility and actual subsidy amount based on the information you enter in your application.
Learn more about how subsidies are calculated.
Read more about what you should consider before switching from your current plan sold directly through Blue Shield to a plan sold through Covered California and how you can stay covered with a Blue Shield plan.
Follow these steps to switch your current Blue Shield medical plan to a Covered California Blue Shield plan.
Download our simple checklist to stay on track.
A health insurance policy determines the types of medical services or benefits you are covered for, which doctors you can see, and what hospitals you can visit. Your plan also determines what you pay for care and services.
After purchasing a health plan, you can then visit a doctor or hospital in the Blue Shield of California network. A network is a group of doctors, hospitals, and healthcare providers that work with a health plan like Blue Shield. That means you only have to pay a certain amount for healthcare services instead of the full cost. By using in-network doctors and hospitals, you can keep your costs lower.
Health insurance is for preventive and event-based care – meaning you don’t have to wait until you’re sick to see a doctor. Preventive services like annual exams and flu shots are available to you at no additional cost.
Having continuous coverage ensures you have access to care when you need it and protects you from unexpected healthcare costs, among other benefits. Having health coverage also helps you avoid the California tax penalty.
In other words, if you do not have health coverage, you may have to pay more in taxes.
We are not tax professionals and cannot provide tax advice. If you need help, please get advice from a professional tax preparer or adviser.
California enacted legislation to restore the individual mandate and tax penalty starting in 2020. Those who choose to go without coverage may be subject to a penalty as part of their annual state tax filing if they have access to affordable coverage within the cost limitations set by the state. There can be penalties of up to nearly $2,250 per family, which is based on 2.5 percent of household income or a minimum of $750 per adult and $375 per dependent child under 18 in the household, whichever is greater. The California Franchise Tax Board, which administers the state mandate, will assess the penalties for the coverage year when consumers file their taxes.
If the federal individual mandate penalty is reinstated at any point, the state tax penalty will be adjusted.
You’ll pay a fixed monthly rate for your health insurance policy. The amount depends on the plan you choose, where you live, and the age of each person on the policy. The lower your plan’s monthly rate, the more you typically pay when you see the doctor, and vice versa. Identifying how often you see a doctor can help you choose the right plan for you.
Depending on your household size and income, you may be eligible for financial assistance through Covered California to lower your plan’s monthly rate or even your costs for medical care.
Your bill for visiting the doctor will depend on the reason for your appointment and your plan’s benefits. Some services have a copay (a fixed dollar amount) and other services have coinsurance (a fixed percentage amount). When you pay a copay or coinsurance, Blue Shield of California will pay the rest of the charges for your visit. You should check to see if your health plan has an annual deductible, which is the amount of money you pay for services before the coinsurance and health plan begins paying for them. A high deductible could affect what you pay at each doctor’s visit.
To protect you and your family from unexpected costs, most plans have an annual out‑of‑pocket maximum. Once you reach the out-of-pocket maximum, your health plan covers 100% up to the allowed charges for most covered medical services.
The medically necessary services and supplies covered by Blue Shield.
The approved amount Blue Shield will pay for a service or benefit. If your doctor charges more than what’s allowed by your health insurance policy, you may be responsible for the difference.
A fixed percentage of the cost of your services that you’re responsible for. This is usually after you’ve met your deductible.
A fixed amount you pay for benefits such as doctor’s visits or any wellness services. This is usually after you’ve met your deductible if your plan has one.
The amount you pay each calendar year for most benefits before Blue Shield begins to pay. Some benefits, such as preventive care, are covered before you meet your deductible.
A health plan where you choose a primary care physician (PCP) who treats you regularly. This includes preventive visits and referrals to specialists. You’ll need to see only other doctors or specialists in your PCP’s medical group. There is no coverage for services received from doctors who are outside your PCP’s network.
A group of providers – including hospitals, doctors, specialists and other healthcare providers – that have agreed with Blue Shield to provide benefits for a specified amount.
A health plan in which members can choose to see any provider in the PPO provider network without a referral. Members also have the freedom to use non-network providers for most services if they are willing to pay a higher share of the cost.
The most you are required to pay in combined deductible, copayment, and coinsurance amounts for all of the covered services each year.