Adriana Insurance is a health coverage program for uninsured and underinsured Californians

Adriana Insurance is California's program that helps people without health coverage or with coverage that doesn't pay enough. It is run by Covered California, the state's health insurance marketplace, and offers plans designed to be affordable for people with low to moderate incomes. The program is named after Adriana Saenz-Rodriguez, a California resident who died in 2006 because she could not afford insulin.

Unlike a separate government program you explore to directly, Adriana Insurance works through Covered California's regular enrollment process. When you shop for plans on Covered California's website, you see which plans may have access to as Adriana plans based on your income and household size. The main difference between an Adriana plan and other Covered California plans is the cost-sharing structure — Adriana plans have lower deductibles, copays, and out-of-pocket maximums if you meet the income requirements.

You do not explore for Adriana Insurance separately. Instead, you enroll in a may have access to health plan through Covered California during the open enrollment period or if you have a may have access to life event like losing your job or moving to California. The program is available year-round to people who are newly may be able to access or experiencing a may have access to change in circumstances.

Key Takeaways

  • Adriana Insurance is a cost-sharing program within Covered California that reduces your out-of-pocket costs if your income falls within the may have access to range.
  • You enroll through Covered California's website during open enrollment or after a may have access to life event, not through a separate process process.
  • Your income and household size determine whether you see Adriana plans and what your costs will be under the program.
  • Adriana plans cover the same services as other health plans — doctor visits, hospital care, prescription drugs, and preventive care — but with lower patient costs.

Who can enroll in an Adriana plan

To be part of Adriana Insurance, you must live in California, be a U.S. citizen or lawfully present immigrant, and have a household income that falls within the program's range. The income limits change each year based on the federal poverty level. Generally, Adriana plans are designed for people whose income is between 200% and 400% of the federal poverty level, though the exact range depends on your household size and the current year's guidelines.

You also need to be ineligible for Medi-Cal (California's Medicaid program) and Medicare. If you already have health coverage through an employer or another source, you may still be able to enroll in Covered California, but you would not receive the same subsidies or cost-sharing reductions. Covered California's website has an income calculator that shows whether you likely meet the requirements before you start the enrollment process.

How to enroll through Covered California

Start by visiting the Covered California website (coveredca.com) during the open enrollment period, which typically runs from November through January each year. If you have a may have access to life event — such as losing job-based coverage, moving to California, getting married, or having a baby — you can enroll outside the open enrollment window within 60 days of the event.

On the Covered California website, create an account or log in if you already have one. You will answer questions about your household size, income, citizenship status, and current coverage. Be honest about your income, because it determines which plans you see and what your costs will be. After you submit your information, Covered California will show you available plans and tell you what your monthly premium, deductible, and copays would be under each one.

Look for plans labeled as Adriana plans — these will show lower out-of-pocket costs than other plans at your income level. Compare the monthly premium (what you pay each month), the deductible (what you pay before insurance kicks in), and the copays (fixed amounts you pay per visit). Once you choose a plan, you complete the enrollment and select a start date. Your coverage typically begins on the first day of the following month.

What Adriana plans cover

Adriana plans cover the same 10 essential health benefits as all Covered California plans: ambulatory services (outpatient care), emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, and pediatric services including dental and vision care for children.

The difference is in how much you pay out of pocket. Under an Adriana plan, your deductible is lower, your copays for doctor visits and urgent care are lower, and your annual out-of-pocket maximum — the most you will pay in a year before insurance covers everything — is reduced. For example, a regular Covered California plan might have a $1,500 deductible and $40 copays for primary care visits, while an Adriana plan at the same income level might have a $500 deductible and $15 copays.

Preventive care services like annual checkups, cancer screenings, vaccinations, and contraception are covered at no cost under all Covered California plans, including Adriana plans. This means you do not pay a copay or deductible for these services, even if you have not met your deductible yet.

How much Adriana plans cost

Your monthly premium depends on your income, household size, and the specific plan you choose. Covered California uses a sliding scale, meaning people with lower incomes pay less per month. The federal government provides tax credits that reduce your premium, and these credits are built into the price you see on the Covered California website — you do not have to claim them separately on your taxes, though you can if you prefer.

In addition to your monthly premium, you pay out-of-pocket costs when you use care: copays for doctor visits, coinsurance (a percentage of the cost), and deductibles. Adriana plans reduce these costs compared to other plans. Your total out-of-pocket costs — copays, coinsurance, and deductibles combined — cannot exceed an annual maximum set by federal law. For 2024, that maximum ranges from roughly $1,500 to $9,200 depending on your income and household size, though these amounts change yearly.

You do not pay anything upfront to enroll. There are no process fees, enrollment fees, or hidden charges. You only pay your monthly premium once coverage begins.

What happens after you enroll

Once your coverage starts, you will receive an insurance card in the mail within 1 to 2 weeks. Use this card when you visit a doctor, go to the hospital, or fill a prescription. Your plan has a network of doctors and hospitals — you will pay less if you use providers in the network, though you can see out-of-network providers at a higher cost.

You can use Covered California's website or your insurance company's website to find doctors and hospitals in your network. Most plans also have a nurse hotline you can call with health questions, and many offer telehealth (video or phone visits with doctors) at a reduced cost or no cost.

Your Adriana plan coverage lasts for one year. Before your coverage ends, Covered California will send you a notice asking whether you want to renew. You can renew your plan, switch to a different plan, or let your coverage end. If your income or household size changes during the year, you can update your information on Covered California's website, and your costs may change as a result.

Frequently Asked Questions

Do I have to pay taxes on the subsidies I receive through Adriana Insurance?

The tax credits that reduce your premium are not taxable income, so you do not owe taxes on them. However, if your actual income for the year is higher than what you reported when you enrolled, you may have to repay some of the credits when you file your taxes. Covered California recommends updating your income information if it changes during the year to avoid this.

Can I switch plans or cancel my Adriana plan if I change my mind?

You can switch to a different Covered California plan during the open enrollment period each year. If you have a may have access to life event like losing your job or moving, you can switch outside the open enrollment window. You cannot cancel mid-year without a may have access to reason, but your coverage automatically ends if you stop paying your premium.

What if my income goes above the Adriana range?

If your income rises above the Adriana threshold, you will no longer see Adriana plans when you renew, but you can still enroll in other Covered California plans. Your premium will be higher because you will receive a smaller tax credit or no credit at all. Update your income on Covered California's website as soon as it changes so your costs reflect your actual situation.

Is Adriana Insurance the same as Medi-Cal?

No. Adriana Insurance is a program within Covered California for people who do not may have access to for Medi-Cal. Medi-Cal is California's Medicaid program for people with very low incomes. If you may have access to for Medi-Cal, you will be directed to that program instead of Covered California when you explore.

Can I use my Adriana plan if I move out of California?

No. Adriana Insurance and Covered California plans only work in California. If you move to another state, your coverage will end, and you will need to enroll in your new state's health insurance marketplace. If you move within California, you can keep your plan or switch to a different one.