Healthcare & Insurance

The 60-day clock

Moving to California is a qualifying life event. Coverage starts on the 1st of the month after you pick a plan, so enrolling in your arrival month is the whole game.

After the deadline there is no marketplace plan until open enrollment on 1 November, and California fines you $950 per adult for the gap. Enrolling in your arrival month is what keeps the bridge plan to around three weeks rather than a full extra month.

Enter the move date exactly on the application. The system counts your 60 days from what you type, and the plan is not active until the first premium payment clears at checkout.

• What other guides get wrong (1). You do not need proof of prior insurance. The federal rule does ask movers to show recent coverage, but the regulation says living in a foreign country during the 60 days before the move satisfies it on its own. Your Indian policy, or the lack of one, is irrelevant.
• What other guides get wrong (2). The document they actually ask for is proof of your new address: a lease, a bank statement, a paycheck stub, even a signed attestation. Not your old address, and not Indian paperwork.
• Eligibility, quickly. Lawfully present visa holders — H-1B, O-1, E-2 and dependents — can buy these plans from day one with no waiting period, and you can apply while your SSN is still in process. Subsidies just require agreeing to file a US tax return for the year.

The bridge plan

Buyable from India before you fly, no enrollment window, renewable in increments if things slip.

Know what you are buying. Catastrophe cover, not health insurance. No preventive care, no routine visits, and these sit outside US billing protections, so an out-of-network hospital can balance-bill you and you will often pay upfront and claim back with records. Buy 90 days even if you expect to need 30: the extra weeks are cheap and enrollment hiccups happen.

The temptation worth naming. Healthy and above the subsidy line, staying on a $90 visitor plan instead of a $550 marketplace plan all year looks like free money. The maths is real and I would still not do it: the state penalty stacks on top, and the first real illness lands on a plan built to reimburse, dispute and exclude rather than to treat.

Your salary is a healthcare decision

The enhanced federal subsidies expired on 31 December 2025, and the subsidy cliff is back. Drag your planned salary before you run payroll.

Planned annual salary · single filer

$85k

The cliff · $62,600

Unsubsidised Silver, SF, age 30

$500–$700

Above $62,600 the entire credit vanishes, so you pay sticker — roughly $500 to $700 a month depending on carrier. Per month, not per year.

If your planned income sits anywhere near the line, model the premium at both numbers before you run payroll. Covered California projected subsidised members' payments would roughly double for 2026: a 60-year-old earning $80,000 paid $554 a month in 2025 under the old credits, and pays $1,000+ in 2026 without them. Get your own quote at coveredca.com — pricing is set per region and re-set every January.

• The change nobody is writing about yet. Under the 2025 federal tax law, work- and student-visa holders lose subsidy eligibility entirely on 1 January 2027. Covered California’s implementation guide limits credits to green-card holders and a few narrow categories. You can still buy the plan, at sticker price. Whatever subsidy you get for 2026, budget 2027 at the full number.
• If you are above the cliff. The same Silver plan bought off-exchange, directly from the carrier, skips the Silver surcharge and has historically run cheaper. The trade is no route back to subsidies if your income drops mid-year.
• What beats all of this. Once the startup can offer a group plan: no windows, no cliff, and the 2027 change does not touch employer coverage. Whether a founders-only company qualifies for small-group coverage in California is broker territory, so ask one before counting on it.

Where to go when something hurts

The same non-emergency complaint costs roughly ten times more at the ER than at urgent care.

Save a telehealth app on your phone now. It is also the fastest prescriber you will have in your first months. For a mental-health crisis, 988 is the line, not 911.

• The ER protections are real. The federal No Surprises Act caps emergency care at in-network cost-sharing even at an out-of-network hospital, with no pre-authorisation needed. California goes further: since 2024, state-regulated plans — meaning every Covered California plan — cannot be balance-billed for ground ambulances either. Neither protection applies to visitor plans, and big-employer self-funded plans follow only the federal rules.
• Bills arrive in waves. Facility, physician, lab, sometimes weeks apart, and a scary number is often just an early draft. Pay nothing until the matching explanation of benefits arrives and the two agree. Since 2025 California bars medical debt from credit reports entirely, so a disputed bill cannot dent the file you are building. Billed wrongly anyway: CMS No Surprises Help Desk on 1-800-985-3059, or California’s DMHC on 1-888-466-2219.

Your Indian meds, briefly

The full brand mapping lives on the packing page (#23). These four bite people in month one.

• No US pharmacy can fill an Indian prescription. Most Indian antibiotics and chronic-condition meds are prescription-only here. Azithral over the counter is not a thing that exists in this country.
• Fly in with up to 90 days. Original packaging, an English prescription or doctor’s letter, declared at customs. Mailing more from India later does not work: the personal-use allowance applies at the border with you present, and mailed packages are routinely detained.
• Book the PCP in week one. New-patient waits run several weeks in big metros, so book before the strip runs low. A telehealth visit can bridge a refill gap for metformin, BP and thyroid meds same-day, after reviewing your Indian records.
• Generics are cheap even uninsured. Metformin, amlodipine and atorvastatin each run under $8 a month with a free GoodRx coupon.

Do this now

• ☐ Buy a 90-day visitor plan before you fly, even if you expect to need 30
• ☐ Week 1: create your Covered California account and enter your move date exactly
• ☐ Get proof of your new address ready: lease, bank statement, paycheck stub or attestation
• ☐ Model your premium at your planned salary before you run payroll, especially near $62,600
• ☐ Week 2 to 3: pick a tier, add every family member to the same application, pay the first premium at checkout
• ☐ Save a telehealth app on your phone, and book a new-patient PCP appointment in week one

Sources & further reading

• Covered California — qualifying life events — the 60-day window and what counts.
• 45 CFR 155.420 — the special-enrollment rule itself.
• FTB — uninsured penalty — California’s individual mandate.
• Covered California — 2026 open enrollment — dates and current pricing.
• CMS — No Surprises Act — emergency billing protections.
• Atlas America — the default bridge plan.
• Sesame Care — telehealth pricing.
• GoodRx — generic pricing without insurance.

This is general information, not medical/legal/tax advice — verify with a professional before acting.