What's health insurance and how does it work?

You’ve probably heard a lot about how expensive healthcare is–but it’s important to know that you have access to a BUNCH of different affordable reproductive healthcare options. In the US, most people use health insurance to pay for medical care. The idea here is that everybody pays money to a health insurance company at the start of the year. Then services they receive throughout the year may be “covered” by insurance. The benefit is that these services might be expensive, but your insurance will pay for them. For example, say your insurance cost  you $1,000 at the start of the year. A few months later, you need surgery, which costs $10,000. If your surgery is covered, you don’t have to pay for it!

How do I get health insurance?

People get insurance from their employer, through the government, or by buying it themselves. It gets a bit complicated. Young people can be on their parents’ insurance until they are 26, and young people have access to low- or no-cost coverage in California. So it’s possible you’ve had health insurance your whole life! If you don’t, you can take our quiz, “How can I get the care I need for free?”

What programs exist for accessing free or low-cost reproductive healthcare in California?

There are SO many options for accessing sexual and reproductive healthcare here in California. All of these resources were designed for people just like you, so you have the right to use them! Make sure you continue reading to learn about each of the resources.

• For birth control and STI testing: Family PACT (FamPact)
• For prenatal care or abortion: Presumptive Eligibility for Pregnant Women (PE4PW)
• For more abortion support: Abortion funds
• For HIV prevention: PrEP Assistance Program (PrEP-AP)
• For at-home STI testing: TakeMeHome

What is Family PACT?

Family PACT is a program through the state of California that offers free family planning services to people who are low-income, without insurance, or need to keep their healthcare confidential. 

What does it cover? Family PACT covers contraceptive options like birth control pills, condoms, and IUDs. Plus, it covers STI testing and treatment. 

Who is eligible? You need to be a resident of California, but citizenship status is not required. The program is designed to keep your family planning needs confidential, so this is a great program if you are interested in birth control but want to make sure that others don’t find out. You can check if you are eligible for the program by taking our quiz, “How can I get the care I need for free?” and selecting ‘birth control’.

How can I sign up? Signing up for Family PACT is a lot easier than you think! Take the quiz to determine if you are eligible. Once you’re at the clinic, just be sure to tell the person at the front desk that you would like to sign up for the Family PACT program and they’ll help you fill out paperwork. You can find clinics that have Family PACT by going to our service finder here (we have pre-selected the Family PACT filter for you).

What is Presumptive Eligibility for Pregnant Women (PE4PW)?

PE4PW is a program to help people who become pregnant get quick access to health services to prenatal care and/or abortion services by enrolling them in temporary Medi-Cal health coverage. It's like a fast pass to get healthcare if you are pregnant. 

It's important to keep in mind that PE4PW does not include Minor Consent services. That means that if you're applying for this program and are under 18 years old, your parent(s) could find out. If you don't want them to know you're applying for coverage, we recommend you ask someone at the clinic to help you apply for PE4PW under the ‘Minor Consent Program’. See PE4PW providers in your area here

What does it cover? PE4PW is for pregnant people and covers prenatal care and abortion services. It's designed to make sure pregnant people can see a doctor and get the care they need without worrying about costs. 

Who is eligible? This program is for people who are pregnant in California. You need to be a resident of California. You can check if you are eligible for the program by taking our quiz, “How can I get the care I need for free?” and selecting either ‘prenatal care’ or ‘abortion’.

How can I sign up? Signing up for PE4PW is relatively easy. Check if you are eligible by taking this quiz. If you are eligible, just click on our Service Finder here, and plug in your zip code to see a list of providers near you that work with PE4PW. Once you’re at the clinic for your first appointment, tell the person at the front desk that you would like to sign up for the PE4PW program and they’ll help you fill out paperwork. Once you complete the paperwork at the clinic and they determine your eligibility, they will issue you a temporary immediate needs card (paper) for PE4PW services.

What abortion funds exist near me?

Abortion funds are community-supported sums of money that help people pay for the logistical costs around having an abortion, like travel, food, and lodging. Here is some information about different abortion fund programs. 

• National Network of Abortion Funds
• California Abortion Access

What is TakeMeHome?

TakeMeHome is a free sexual health home testing program that provides HIV tests, STI tests, and PrEP panel tests that you can take without going to a clinic or testing site. It’s as easy as filling out your zip code, birthday, biological sex, and the last time you took an HIV or STI test. It’s important to note that some tests are restricted to folks 18 and older.  Go to TakeMeHome.org

If I use my health insurance to pay for services, will my parents find out?

By law, once you turn 12, reproductive healthcare like appointments and test results are confidential from your parent or guardian. But, if you’re on your parents’ health insurance, it is possible to receive bills or an ‘explanation of benefits’ (EOB; like a receipt) in the mail. If you really don’t want your parents to find out about the healthcare you receive, you need to make a phone call or two before you get care. We know, picking up the phone is a pain, but you got this! 

1. Know your health plan and policy number (on your insurance card).
2. Contact your health plan administrator (should also be on the card).
3. Submit a “Confidential Communications Request” and ask that they send the explanation of benefits digitally (over email) or to your name in the mail. The person who works with your health insurance plan will know all about this and be able to make those changes.

If I use Medi-Cal for healthcare, will my parents find out?

As a minor in California, you have the right to free or low-cost reproductive healthcare, even if you don’t want to use your parent, guardian, or spouse’s insurance, or can’t afford it on your own. Under federal and California law, when a person turns 12, they have the legal right to health information privacy, which limits the health information that parents and guardians are able to see.

For example, the Medi-Cal Minor Consent Program covers abortion care for people who are under the age of 21 who still live with a parent, or who temporarily live somewhere else but are financially supported by their parents. Learn more about Medi-Cal Minor Consent.

Does insurance in California cover abortion?

For most people, under California law, abortion care is considered basic healthcare (because it is basic healthcare) and most insurance plans must cover basic healthcare services. 

But heads up, you’ll still need to check your specific health insurance coverage that you get through your employer or your parents. You can check by logging into your plan online or by calling your insurance provider. Calling your insurance provider to find out if something is covered sounds like a pain, but it’s super common for all kinds of procedures or care.

Does my age matter to access to certain services?

No matter your age, you have a right to make a lot of your own healthcare decisions, and that includes accessing sexual health services. Here’s the legal break down here in California:

• People of any age have the right to access and consent to their own abortion care, without a parent’s consent.
• There are no age restrictions when it comes to buying condoms in the US. You should never be carded or asked how old you are, no matter where you are getting condoms. 
• People of any age can get birth control without a parent’s consent and the healthcare provider is not allowed to inform a parent or legal guardian without your consent.
• People 12 years old or older can get tested and treated for HIV or STIs without a parent’s consent.

Can I use a ride sharing app like Uber or Lyft to get to the clinic if I'm under 18?

Ride sharing platforms can help you get around if there aren’t good public transit options in your area, but you need to be over 18 to have your own account. You can ride Uber when you’re under 18, but the app will notify your parents or guardians about the ride.

Is it confidential when I get sexual health services?

In California, anyone between the ages of 12 and 18 years old has the right to access certain sexual health services in private and without parental consent. Some of these services include testing and treatment for STIs, birth control, and pregnancy testing. Just make sure you ask the provider before seeing them if this is something they can work with you on during your visit. 

What about if I’m using my parents’ insurance?

Insurance is tricky; we get it. When it comes to coverage for sexual health services under your parent or guardian's insurance plan, there are some things to consider and ask your provider about. 

Feel free to take a screenshot of this list and bring it to your doctor:

• Confidentiality: Because of confidentiality laws, doctors and insurance companies aren't allowed to disclose the details of any service to a parent or guardian without the minor’s consent. The only case where this confidentiality would be breached is if you disclose to your medical provider that you are being abused, as this triggers mandatory reporting laws.
• Explanation of Benefits (EOBs): Sometimes an insurance company will send an EOB to the parent or guardian whose insurance you’re using. An EOB is basically a document or letter that explains the details of the service that was provided. Just make sure to tell your provider that you want your visit to be confidential so that they tell the insurance company not to send an EOB home.

What is PrEP Assistance Program?

The PrEP Assistance Program, or PrEP-AP for short, is a program that helps California residents get access to HIV testing, PrEP and PEP for free. 

What does it cover? PrEP-AP covers the cost of PrEP medication and sometimes even doctor visits. PrEP is a pill you take every day to lower your chances of getting HIV if you're at risk. It's like a shield that helps keep you safe! Learn more about PrEP and PEP here in our FAQ.

How can I sign up? Signing up for PrEP-AP is easy! We think the telehealth option is the easiest to use and you can follow this link to check your eligibility and sign up. They'll help you sign up, get the medicine you need, and give you all the info to use it right. Don't worry, it's all confidential, so you can feel comfortable asking for help!

If you want to read more about this program or you would prefer an in-person option instead of telehealth you can check out more information on the PrEP-AP website by clicking here.