COVERED CALIFORNIA

What is it?

Covered California (CA) is the health insurance marketplace/state exchange where California families and businesses can go to to shop for healthcare options. This is the state run marketplace to shop for your health insurance needs and can be purchased directly through our firm at direct insurance rates.  We do not charge fees for our service.

Why the state exchange?

Covered California primary objective is to insure the 5.3 million uninsured Californians. About 2.6 million will be eligible for subsidies, and 2.7 millions Californians will not be eligible for subsidies. Subsidies will lower the health insurance cost for income challenged families, and in addition will provide language assistance, and stream-line the healthcare enrollment process.

Do I have to sign-up for health insurance through the California state exchange?

The rates are the same whether you enroll with our firm direct or with the state.  The rates are also the same whether you enroll on-exchange through the state or off-exchange and direct with the carrier. There is one compelling reason to enroll on Covered California. If you believe you will be eligible for premium assistance, it is the only way to get the assistance or reduced cost sharing. If your income is less than the maximums listed in the chart below, you you may be eligible for a subsidy and should enroll on-exchange.

The rates are the same whether you enroll on-exchange or off-exchange.
If your household income is over the limits shown in the chart above, off-exchange enrollment may be for you.

Off-exchange enrollment offers several benefits, including:

• No Financial Disclosure
• More Plan Selection
• Faster Enrollment
  
  

As your broker, I am an important and vital partner for Covered California and will be able to enroll you into any of the plans offered in California based on your specific needs and situation.

Enrollment Periods:

Individuals/Families:
November 15, 2014 to March 31, 2015

What about dental insurance:
Yes, pediatric dental health plans are mandated as part of the ACA for children under the age of 19 as of Jan 1, 2014 (ACA).  Depending upon where the child lives, three different product options are available including: DHMOs, DPPOs and DEPOs.

Adult Vision and Dental Plans:
ACA only requires children be covered as Essential Health Benefits, so there are individual adult plans available from the very same dental insurance companies but are not mandated. Prices are very reasonable for adult individuals. Health and dental coverage is important since they screen for diseases to ensure early detection and prevention, many times not detectable with medical health screenings only. 

Penalties

The Affordable Care Act (ACA) legally requires everyone to have health insurance, so there are penalties if you choose not to buy health insurance. It will be assessed a % of  family income.

I've heard about financial assistance. Do I qualify?

Depending on your household size and income level, you may be eligible to receive a subsidy to help pay for your insurance. The following chart provides general information on whether you and your family may qualify for a subsidy:

*Subsidy will be based on estimated 2015 modified adjusted gross income.

10 Key Health Reform Topics

The Affordable Care Act (ACA) is changing the healthcare industry. We’re here to help you make sense of what these changes mean for you. Here are the 10 key terms and topics you should know.

1. Guaranteed Issue
2. The Individual Mandate
3. Grandfathered Plans
4. New Marketplaces
5. Open Enrollment
6. Essential Health Benefits
7. Metal Level Plans
8. Federal Subsidies and Tax Credits
9. ACA Taxes
10. Play-or-Pay

1. Guaranteed Issue

As of January 1, 2014, health insurance issuers must accept every individual in the state that applies for coverage regardless of health, age, gender, or other factors (including pre-existing conditions).

2. The Individual Mandate

Starting in January 2014, individuals have been required to have health insurance that qualifies as minimum essential coverage or risk paying a tax penalty for every month they are uninsured.

3. Grandfathered Plans

When the Affordable Care Act (ACA) was enacted on March 23, 2010, President Obama said that if Americans liked their coverage, they could keep it.  Therefore, the ACA allows carriers to distinguish plans that existed prior to March 23, 2010 (Grandfathered Plans) and those that came afterward (Non-Grandfathered Plans). Since Grandfathered Plans were intended to stay as they existed as of March 23, 2010, they are not subject to many of the ACA’s requirements.

4. Open Enrollment

November 15, 2015 is the first day individuals, families and small businesses can apply for coverage beginning in 2016. This Open Enrollment period lasts until February 15, 2015.

Individua/Family Open Enrollment

In the past, individuals and families who were purchasing their own health coverage could apply at any time. However, beginning with coverage effective on January 1, 2015, applications will generally only be accepted during the open enrollment period. There are exceptions for “special enrollment” within 60 days of a life-changing event, such as the loss of a job, death of a spouse or birth of a child. This is similar to how Open Enrollment periods work for coverage through an employer.

Open Enrollment for 2016 and beyond: Annual open enrollment periods for individuals and families purchasing their own health coverage will be held November 15-December 15th of each year for an effective date of January 1st of the following year.

6. Essential Health Benefits

All non-grandfathered health plans offered in the individual and small business markets, both inside and outside of Covered California, will be required to offer a core package of benefits and services known as "essential health benefits," which must include coverage within at least the following 10 categories:

7. Metal Level Plans

Under the Affordable Care Act, all non-grandfathered, health plans offered in the individual and small business markets, both inside and outside of Covered California, will be required to provide coverage at a "metal level" – Platinum, Gold, Silver and Bronze. The metal levels are based on the actuarial value (AV): Bronze (60 percent AV), Silver (70 percent AV), Gold (80 percent AV) or Platinum (90 percent AV). What this means is that someone who buys a silver plan would have to pay 30 percent of health care costs, while the plan covers 70 percent.

There is also a catastrophic plan for the individual market only that will cover the essential health benefits plus three primary care visits per year. The catastrophic plan can only be sold to consumers under age 30 and consumers who are exempt from the individual mandate as a result of low income or hardship.

8. Federal Subsidies

Starting in 2014, subsidies will be available for consumers whose annual income is between 134% and 400% of the Federal Poverty Level (FPL) and who meet other applicable guidelines. These cost-sharing reductions and advanced premium tax credits will lower the cost of premiums and out-of-pocket expenses for health coverage purchased through Covered California. Those with an FPL under 134% may be eligible for Medi-Cal.

Tax credits will also continue to be available to small businesses with no more than 25 full-time equivalent employees to help offset the cost of providing coverage. Learn more about the small business tax credit.

9. ACA Taxes

The ACA requires that certain taxes be collected to fund aspects of the law, including Covered California—the statewide healthcare marketplace (aka the Exchange). 

10. Play-or-Pay

Starting on January 1, 2014, the Affordable Care Act (ACA) will require companies over a certain size to offer affordable health plan coverage to full-time employees and their dependents or face a penalty if an employee receives federally-subsidized coverage from Covered California (aka: The Marketplace/Exchange).