Pathway to Enrollment: A Virtual Tour of Covered California’s Online Application

Catherine Teare, Associate Director, High-Value Care


When enrollment for health insurance under the Affordable Care Act (ACA) opened in October 2013, the performance of online portals like Covered California and were the subject of daily news updates. As California prepares for the second open enrollment period beginning in November, most of the expected early glitches with the system have been resolved, but consumers still face a complex application and enrollment process that plays out differently for families depending on their circumstances.

This flowchart illustrates the steps consumers take as they apply for health insurance affordability programs through Covered California’s web portal and shows the different paths families might take based on income, family structure, and other factors. Another infographic highlights the information consumers are asked to provide and the decisions they must make. It also shows at which points the California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS), which handles health insurance enrollment, and the Statewide Automated Welfare Systems (SAWS), which reviews county eligibility, determine eligibility for Medi-Cal and for subsidized and unsubsidized coverage through Covered California.

The infographic allows viewers to see the scenarios of three representative families: A part-time worker and her 14-year-old daughter, a married couple who have legal residency and are expecting their first child, and a single man who has an insurance offer from his employer. The infographic doesn’t represent every step in the enrollment pathway or every potential scenario; it is intended as a high-level map to the overall process. Covered California is making changes to the online application in advance of the open enrollment period that begins November 15, 2014; the information in the infographic is current as of August 2014.