Enrollment Information

Open enrollment for health coverage in 2018 is over, but you may be eligible for special enrollment if you experience a qualifying life event. Medi-Cal enrollment is 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.

Apply Now or Find Help to Enroll

Paper applications can be 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