California

California

Overview of California’s Health Insurance Exchange

In 2010, California was the first state in the nation to enact legislation that implements the provisions of the federal Affordable Care Act by creating a health insurance marketplace called Covered California.

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Covered California has 11 insurance companies offering plans as of November 1, 2013. The key providers are Anthem Blue Cross of California, Blue Shield of California, and Kaiser Permanente. Also offering plans are Chinese Community Health Plan, Contra Costa Health Plan, Health Net, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, and Western Health Advantage.

Per the Affordable Care Act, all plans must offer the following ten essential services:

  • Ambulatory patient services (doctor visits)
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (Habilitative services are for people with chronic illnesses who need speech, occupational, or physical therapy.)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

Customers can start shopping for plans during the open enrollment period, which began October 1, 2013 and runs through March 31, 2014. To get help with registration, fill out this form on the Covered California website, and someone who can help you fill out an application will contact you. Plans will be effective starting January 1, 2014.

Costs

There are four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower percentage plans will have lower premiums, but higher out-of-pocket costs. There will also be a catastrophic plan with a high deductible available for folks under the age of 30. Additionally, depending on your income level, you may qualify for Medicaid, tax credits, or a subsidy to help offset the costs of coverage.

To see plans listed by region and learn more about available providers, see pages 11-33 of the “Health Insurance Companies for 2014” booklet Covered California has compiled. You can also use Covered California's Shop and Compare Tool to discover which health insurance plans you can purchase and whether or not you qualify for Medi-Cal or monthly premium assistance.

Adults living at or below 133 percent of the federal poverty level, (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), or pregnant women living at or below 208 percent of the FPL, will qualify for Medicaid in California, based on eligibility requirements that take effect January 1, 2014.

Tax credits are based on the Silver Plan, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to the Silver Plan. The Affordable Care Act (ACA) was designed so the Silver Plan would be affordable to people who had to buy their own insurance, regardless of how expensive the healthcare rates may be where they live.

The mid-level Silver Plan ranges from $224 to $423 per month for a 40-year old non-smoker in California, and the average rate across all 19 price regions is $325.24 per month. Consumers can use the aforementioned Shop and Compare Tool to check pricing for all ages and regions.

Many people will want to how much of a subsidy they qualify for, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan. For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 annually, or $244 monthly. The challenge is to compare the costs of Bronze, Silver, Gold, and Platinum, and then decide which plan offers the best value for you. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.

Starting in 2015, additional federal financial protection will include a maximum out-of-pocket cost of $6,350 for individuals and $12,700 for families. This financial protection will dramatically reduce the chances of someone going bankrupt due to medical bills not covered by insurance.

See the “Sliding Scale Benefits” document from the Covered California website to learn how much different services will cost a single person who is eligible for a subsidy.

To learn more about Covered California, please visit http://www.coveredca.com/ or call 800-300-1506.

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