Your Information

Open Enrollment for Covered California ends February 15. When you enroll in Covered California, you will have a choice of health plans from four different tiers, bronze, silver, gold and platinum with different monthly premiums and different annual deductibles. If you would like to enroll in Covered California, complete the short form below.

Applicant Information

First Name
Last Name
Email Address
Zip Code
What is your family size?
What is your Income?

Please note that all fields are required.