You May Be Eligible for Health Coverage Through Special Enrollment or Medi-Cal

Open enrollment for private health coverage through Covered California in 2016 is now over. However, Medi-Cal enrollment is year-round. Additionally, individuals who experience a qualifying life event may be eligible to enroll in private coverage through Covered California by applying for special enrollment.

Medi-Cal and Covered California use the same application. Click below to start.


If you are unable to enroll online or to get help enrolling online, you may use a paper application, found below.

Click here to start if you are a Certified Enrollment Counselor or Certified Insurance Agent or if you have a delegation code to enroll individuals and families.

Click here to learn how small-business owners can apply for coverage through Covered California for Small Business.


Paper Applications in English


Paper Applications in Other Languages

Arabic
طلب للحصول على تأمين صحي مع مساعدة مالية

طلب للحصول على تأمين صحي دون مساعدة مالية


Armenian
Բժշկական ապահովագրաության դիմում ֆինանսական աջակցության առկայությամբ

Բժշկական ապահովագրաության դիմում առանց ֆինանսական աջակցության


Chinese
提供經濟援助的健康保險申請表

沒有經濟援助的健康保險申請表


Farsi / Persian
درخواست برای بیمه درمانی با کمک مالی

درخواست برای بیمه درمانی بدون کمک مالی


Tagalog (Filipino)
Application para sa Health Insurance na may Pinansyal na Tulong

Application para sa Health Insurance na walang Pinansyal na Tulong


Hmong
Daim Ntawv Tso Npe Yuav Kev Pov Fwm Kev Kho Mob Uas Xav Tau Kev Pab Nyiaj Txiag

Daim Ntawv Tso Npe Yuav Kev Pov Fwm Kev Kho Mob Uas Tsis Xav Tau Kev Pab Nyiaj Txiag


Khmer
ពាក្យសុំការធានារ៉ាប់រងសុខភាពដែលមានជំនួយផ្នែកហិរញ្ញវត្ថុ

ពាក្យសុំការធានារ៉ាប់រងសុខភាពដែលគ្មានជំនួយផ្នែកហិរញ្ញវត្ថុ


Korean
재정 지원이 있는 건강 보험 신청서

재정 지원이 없는 건강 보험 신청서


Russian
Заявление на получение медицинской страховки с материальной помощью

Заявление на получение медицинской страховки без материальной помощи


Spanish
Solicitud para seguro de salud con asistencia financiera
Letra Grande

Solicitud para seguro de salud sin asistencia financiera
Letra Grande


Vietnamese
Đơn Ghi Danh Mua Bảo Hiểm Y Tế Với Sự Hỗ Trợ Tài Chính

Đơn Ghi Danh Mua Bảo Hiểm Y Tế Không Có Sự Hỗ Trợ Tài Chính