Apply
Open enrollment is over, but individuals with qualifying life events can enroll at any time of the year. Medi-Cal enrollment is also year round.
Medi-Cal and Covered California use the same application. When you complete your application, depending on factors such as your family size, income and ZIP code, you will find out whether you qualify for:
- A Covered California health plan, with or without financial assistance.
- Medi-Cal.
- County Children’s Health Initiative Program.
- Medi-Cal Access Program for pregnant women.
Paper applications can be found below.
Paper Applications in English
-
Application for health insurance with financial assistance Large Print -
Application for health insurance with no financial assistance Large Print
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
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
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