Plans for Individuals and Families
Plans for Year
2024

Medicare is a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with permanent kidney failure. If you are eligible for the Medicare Program you should examine your options carefully, as delaying Medicare enrollment may result in substantial financial implications. You can get free counseling regarding your Medicare eligibility and enrollment options by calling the Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222. Visit www.cahealthadvocates.org/hicap to find a HICAP office near you.

1 Your location

2 What kind of coverage?

What kind of coverage?

3 Who will be covered?

Are you currently Health Net member?

Your Subscriber ID begins with a "U" or "R" and is 9 characters long. This optional field can also be left blank.

Primary Applicant

Birth Date
(MM-DD-YYYY)  

Spouse or Domestic Partner remove

Birth Date
(MM-DD-YYYY)  

Child remove

Birth Date
(MM-DD-YYYY)  

Parent/Step-parent remove

Birth Date
(MM-DD-YYYY)  

Requested Coverage Effective Date:

  • Your actual effective date may be different from your requested effective date. Your actual effective date is subject to you meeting the regulatory requirements for a "Special Enrollment Qualifying Event." In order to qualify for a "Special Enrollment," you must show proof of your qualifying event (e.g., if your qualifying event is a marriage, you must provide a copy of your marriage license, etc.). You must submit all supporting documentation WITH your application. Applications submitted without appropriate documentation cannot be processed. All documents (application and supporting documentation) must be submitted at the same time and through the same method (online application, envelope/email/fax). If supporting documentation is sent separate from the application there is no guarantee that it will be matched to the application.
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