FAQs

Covered California

 1. How to Qualify for Covered California Health Insurance

Covered California is California’s health insurance marketplace, designed to help residents find affordable health plans. You may qualify based on income, household size, and legal residency status.

To qualify, you must:

• Live in California
• Be a U.S. citizen, national, or lawfully present immigrant
• Not be eligible for Medicare or Medi-Cal (though some can qualify for dual coverage)

Tip: Many households qualify for subsidies to lower monthly premiums. Reach out to a certified agent (like us!) to find out what programs you’re eligible for.

 2. How to Report Life Changes to Covered California

Did you move, lose your job, or have a baby? You must report major life changes to Covered California within 30 days — or risk losing benefits or facing incorrect charges.

Common changes to report:

• New address or household move
• Change in income or job status
• Birth, adoption, or loss of a dependent
• Marriage or divorce
• Gaining other insurance coverage

We can help: Don’t wait on hold! Let Peace & Grace Insurance update your account quickly and correctly.

 3. Understanding Your Covered California Health Plan

Your Covered California plan includes essential health benefits — but do you know what they are?

All plans cover:

• Preventive care (checkups, screenings, vaccines)
• Emergency services and hospital stays
• Prescription drugs
• Mental health and substance use services
• Pediatric care, maternity, lab work, and more

Need help understanding your copays, deductibles, or network? We’ll explain your plan in plain English.

 4. Key Health Insurance Terms Everyone Should Know

Navigating Covered California is easier when you know the basics. Here are 5 terms every member should understand:

• Premium: What you pay monthly to stay enrolled
• Deductible: What you pay before insurance starts covering more expensive services
• Copay: A flat fee for services (like $40 for a doctor visit)
• Coinsurance: Your share of a bill (e.g., 20%) after you meet your deductible
• Out-of-Pocket Max: The most you’ll pay in a year before insurance covers 100%

Still confused? Let’s walk through your plan together.

 5. Covered California vs. Direct-to-Carrier Plans: What’s the Difference?

You can apply for health coverage through Covered California or directly through carriers like Anthem, Blue Shield, or Kaiser. What’s the difference?

Covered CA offers:

• Premium tax credits based on your income
• Medi-Cal eligibility screening
• A single platform to compare plans
• Certified agent support at no extra cost

Direct enrollment offers:

• Same plans, but without subsidy options
• May be useful for those over-income or undocumented

Let us help you choose the best route based on your household and budget.

 

 6. Is There a Penalty for Not Having Health Insurance in California?

Yes — in California, there is still a state-mandated penalty if you go without health insurance.

If you don’t have coverage for more than 3 months and don’t qualify for an exemption, the penalty when filing your state taxes can be $900 or more per adult (and $450 per child).

Exceptions may apply if:

• You had a short gap in coverage
• Your income was too low
• You experienced hardship (like eviction or illness)

Tip: Even a low-cost Covered California plan can save you from paying a much larger penalty. Let us help you avoid it.

 7. Why Do Some People Have to Pay Covered California Subsidies Back at Tax Time?

When you enroll in a Covered California plan, you may receive premium subsidies (also called Advanced Premium Tax Credits) based on your estimated income.

If your actual income turns out higher than what you reported, the IRS may require you to repay some or all of those credits when you file your federal taxes.

Common reasons people owe:

• Getting a raise or second job mid-year
• Going from part-time to full-time work
• Not reporting income changes within 30 days

How to avoid it:
Keep your income updated throughout the year, and work with a certified agent who can guide you through adjustments in real time.

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Dental & Vision HMO link  https://www.deltadentalins.com/shopping/delta/get-a-quote?issuerCode=DELTA&brokerId=191949

PPO link https://enrollment.ncd.com/589037

VISION link https://enrollment.ncd.com/589037

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Dental

 1. Why You Shouldn’t Wait to Buy Dental Insurance

Most people wait until a tooth hurts to buy dental insurance — but by then, it’s often too late.

Here’s why:

• Many plans have waiting periods (up to 12–24 months) for major procedures like root canals, crowns, and implants
• Some only cover a small percentage in the first year
• Emergencies cost more without coverage

Plan ahead: Enroll when you don’t need dental care so it’s there when you do.

 View PPO Dental Plans
 View HMO Dental Plans

 2. What Does Vision Insurance Really Cover?

Vision insurance helps reduce the cost of routine eye care and eyewear. Most plans cover:

• Annual eye exams
• Prescription glasses and lenses
• Contact lenses
• Discounts on LASIK or specialty services

Even if your vision is good now, having insurance can help with preventive care and reduce out-of-pocket costs for glasses or contacts.

 Explore Vision Plans

 3. PPO vs. HMO: Which Dental Plan Is Right for You?

Choosing between a PPO and an HMO dental plan? Here’s a quick guide:

FeaturePPOHMO

Choose dentist	Yes, any licensed dentist	Must use in-network dentists only
Referrals	Not needed	Usually required
Premiums	Higher	Lower
Waiting Period	Often applies for major services	Usually less or none

PPOs give you more freedom. HMOs give you more savings. Let’s find your fit.

 Compare PPO Plans
 Compare HMO Plans

 4. Does My Family Really Need Dental and Vision Insurance?

If you’re raising kids, dental and vision insurance is more than a luxury — it’s protection against expensive surprises.

• Children may need orthodontics (braces), sealants, and fluoride treatments
• Annual eye exams can detect vision problems early
• Many plans offer family rates and bundled options to save you money

Let us help you choose a plan that fits your family’s needs.

 Shop Family PPO & HMO Plans

 5. Discount Dental & Vision Plans — Are They Worth It?

If full insurance isn’t in your budget, discount dental and vision plans can still offer savings.

These aren’t insurance, but they provide reduced rates at participating providers for services like:

• Cleanings, fillings, and X-rays
• Eye exams, glasses, and contacts

They’re ideal if you need immediate savings and want something in place quickly.

 View Discount Dental & Vision Options use the link below

https://brokers.dentalforeveryone.com/?Portal=4a0221a3-1e8e-46b2-bede-a12a9d8cba96

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Medicare 

 1. Original Medicare vs. Medicare Advantage: What’s the Difference?

Original Medicare (Parts A & B) is government-run and covers hospital and outpatient services. It doesn’t include dental, vision, or prescription drugs unless you add a Part D or Medigap plan.

Medicare Advantage (Part C) is offered by private insurers and combines A, B, and often D — with extra benefits like dental, vision, hearing, and gym memberships.

Pro tip: Medicare Advantage plans can offer more value — but make sure your doctors and medications are covered.

 2. What Are the Different Types of Medicare Advantage Plans?

There’s no one-size-fits-all plan. Common types of Medicare Advantage plans include:

• HMO: Must use in-network providers, referrals required
• PPO: More flexibility with doctors, even out-of-network
• SNP (Special Needs Plan): Tailored for people with specific health or financial needs
• PFFS (Private Fee-for-Service): Less common; provider must accept plan’s terms
• MSA (Medical Savings Account): Combines high-deductible health plan with a savings account

Need help deciding which one fits your situation? Call us for a free review.

 3. Extra Benefits You May Get With a Medicare Advantage Plan

Medicare Advantage plans may include more than just medical coverage. Many offer:

• Dental cleanings, fillings, and dentures
• Vision exams and eyeglasses
• Hearing aids and exams
• Meal delivery after hospital stays
• Over-the-counter (OTC) allowances
• Transportation to doctor visits
• Gym memberships like SilverSneakers®

These benefits vary by plan and zip code — let us help you compare!

 4. How to Choose the Right Medicare Plan for You

The “right” Medicare plan depends on your:

• Health conditions and prescription needs
• Preferred doctors and hospitals
• Budget (premium, copays, MOOP)
• Lifestyle (travel, network flexibility, extra benefits)

Tip: Avoid choosing based on premium alone. It’s about total cost and coverage. We can help you run the numbers.

 5. 5 Ways to Save on Prescription Drug Costs

• Compare plans every year — formularies change!
• Use preferred or mail-order pharmacies
• Apply for Extra Help (low-income subsidy)
• Ask your doctor about generics or alternatives
• Use discount programs like GoodRx if your meds aren’t covered

Need help reviewing your Part D or Advantage drug coverage? We do that for free.

 6. Medicare Late Enrollment Penalties: How to Avoid Them

You could pay a lifetime penalty if you miss these deadlines:

• Part B: Enroll within 7 months of turning 65 unless you have qualifying group coverage
• Part D: Must enroll within 63 days of losing creditable drug coverage

Avoid penalties: Talk to a licensed agent early to avoid surprises.

 7. What Is a Medicare Special Enrollment Period (SEP)?

Missed the Annual Enrollment Period? You may qualify for a Special Enrollment Period if you:

• Move out of your plan’s service area
• Lose employer or Medi-Cal coverage
• Gain/lose eligibility for a Special Needs Plan
• Qualify for Extra Help or LIS
• Enter or leave a long-term care facility

SEPs are time-sensitive — don’t miss your window to switch!

 8. Does Medicare Cover You While Traveling Overseas?

Original Medicare generally does NOT cover medical care outside the U.S., except in very limited emergency situations.

Some Medigap policies and travel insurance plans include foreign coverage. Medicare Advantage plans may include limited worldwide emergency care — check the details before traveling.

Planning a trip? We’ll help make sure you’re covered.

 9. How Medicare and Medi-Cal Work Together (Dual Eligibility)

If you qualify for both Medicare and Medi-Cal (California’s Medicaid program), you’re considered “dual eligible.”

This means you may receive:

• $0 premiums and copays
• Enhanced benefits through Dual Special Needs Plans (D-SNPs)
• Help paying for prescription drugs
• Transportation, meals, and more

Not sure if you qualify? We can help you apply and choose a D-SNP plan that fits.

 10. What Is a Special Needs Plan (SNP) in Medicare?

SNPs are Medicare Advantage plans for people with specific needs, such as:

• Chronic conditions like diabetes, COPD, or heart failure (C-SNP)
• Dual eligibility for Medicare and Medi-Cal (D-SNP)
• Institutional care needs (I-SNP)

They offer tailored provider networks, case management, and extra support. If you qualify, these plans often come with $0 premiums and generous extra benefits.
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Life insurance