What Is ObamaCare California?
The 2014 Affordable Care Act (ACA) increases the quality, accessibility, and affordability of health insurance. In California it is known as “Covered California”. It is also referred to as “ObamaCare California”.
The law eliminates pre-existing conditions, stops insurance companies from dropping you when you are sick, protects against gender discrimination, expands free preventative services and health benefits, expands Medicaid (Medi-Cal) and CHIP, improves Medicare, requires larger employers to insure their employees, creates a marketplace for subsidized insurance providing tens of millions individuals, families, and small businesses with free or low-cost health insurance, and decreases healthcare spending and the deficit.
The law doesn’t create health insurance – it regulates the health insurance industry and helps to increase the quality, affordability, and availability of Private Insurance.
Covered California (ObamaCare California) is the place where Californians can get brand-name health insurance under the Patient Protection and Affordable Care Act. It’s the only place in California to get federal and state premium assistance to help you buy private insurance from companies like the ones listed on the right. That means you may qualify for a discount on private insurance, or get health insurance through the state’s Medi-Cal program. Either way, you’ll get great health coverage, providing that you meet the guidelines of each program.
Up to 82% of nearly 16 million uninsured U.S. young adults will qualify for federal subsidies or Medicaid (Medi-Cal in California) through the marketplace.
All new plans sold on or off the marketplace must include a wide range of new benefits. These include wellness visits and preventative tests and treatments at no additional out-of-pocket cost.
All full-time workers who work for companies with more than 50 employees must be offered job-based health coverage by 2015. Employers who do not offer coverage will pay a per-employee fee.
Small businesses with under 50 full-time employees can use a part of the marketplace called the SHOP (small business health options program) to purchase group health plans for their employees.
Small businesses with fewer than 25 full-time employees can use the marketplace to purchase subsidized insurance for their employees.
Seniors on Medicare can just ignore ObamaCare California. You’re covered.
Types Of Health Plans With Covered California (ObamaCare California)
Like in the rest of the United States, the health plans available on Covered California fall into four metal levels. The metal levels reflect the costs you can expect to pay for health plans in each category; they don’t have to do with the quality of care.
Health plans sold on the California health exchange fit into the following four metal levels:
- Bronze level: On average, your plan pays 60% of covered health-care costs; you pay the remaining 40%.
- Silver level: On average, your plan pays 70% of covered health-care costs; you pay the remaining 30%.
- Gold level: On average, your plan pays 80% of covered health-care costs; you pay the remaining 20%.
- Platinum level: On average, your plan pays 90% of covered health-care costs; you pay the remaining 10%.
Enhanced Silver plans
Covered California (ObamaCare California) also offers an Enhanced Silver plan for certain individuals with limited income who qualify for lower out-of-pocket costs. With an Enhanced Silver plan, eligible individuals who purchase a Silver plan will have the lower cost-sharing benefits of a Gold or Platinum plan — but for the cost of a Silver level plan. There are three types of Enhanced Silver plans available, and each type has a different level of cost sharing:
- Plan pays 94%: On average, your health plan pays 94% of health-care costs; you pay the remaining 6%.
- Plan pays 87%: On average, your health plan pays 87% of health-care costs; you pay the remaining 13%.
- Plan pays 73%: On average, your health plan pays 73% of health-care costs; you pay the remaining 27%.
Minimum Coverage Plans
Minimum coverage plans may be another coverage option if either of the following is true for you:
- You’re under 30 years old.
- You cannot afford health coverage or otherwise qualify for a hardship exemption.
Also known as “catastrophic” coverage in some states, minimum coverage plans are another class of health insurance and cover the same minimum essential benefits as other Marketplace plans. These plans typically have lower premiums than other health plans, but you’ll need to meet a high deductible before the plan begins to pay for most medical costs. Minimum coverage plans are designed to protect you in a “worst case scenario.”
In California, minimum coverage plans do cover some benefits before you reach the deductible. You generally won’t have to pay copayments or coinsurance for the following benefits (even if you haven’t met your deductible yet):
- Three doctor visits
- Urgent care visits
- Outpatient mental health or substance abuse care
- Free preventive benefits
With the exception of the above benefits, you’ll pay 100% for all other health-care services until you meet the plan deductible. In California, those enrolled in a minimum coverage plan pay a negotiated in-network cost for health-care services. After your out-of-pocket spending has reached the deductible, the plan pays for 100% of covered health-care benefits.
What benefits do Covered California (ObamaCare California) health plans cover?
In California, as in the rest of the United States, all health plans sold on the individual and family Marketplace must meet minimum coverage requirements, or “essential health benefits.” These required benefits include:
- Ambulatory services
- Emergency or urgent care
- Hospitalization services
- Maternity and newborn care
- Mental health and substance abuse services, including counseling
- Prescription medications
- Rehabilitative services and equipment
- Laboratory services
- Preventive and wellness care, including chronic-condition management
- Pediatric services (which must include dental and vision care for children)
Dental coverage and Covered California
All health plans sold on the California health insurance exchange include pediatric dental care as a covered benefit. Dental coverage for children under 19 is an essential health benefit, and pediatric dental services are “embedded” into the health plan.
Adult dental services are not a minimum health coverage requirement, and health plans are not required to cover dental care. Dental coverage is optional, so there isn’t a penalty if you don’t get dental insurance. If you do want adult dental coverage, you’ll need to purchase this coverage through a stand-alone dental plan and pay a monthly premium for it. A good dental plan that may be of benefit to you and your family can be found on this website www.Denti-Cal.net
Starting with the 2016 plan year, you’ll have the option to enroll in a stand-alone dental plan on Covered California. If you have children, they’re automatically covered for dental services by any health plan sold through the California health exchange. However, if you like, you can purchase a separate family dental plan that may offer additional pediatric dental benefits. Or, alternatively, you can find a wide selection of dental plans through a licensed insurance broker, such as Healthy Families Insurance Services and www.Denti-Cal.net
Getting help with health-care costs
California residents with limited income may qualify for help with health-care costs. Depending on your income level and eligibility, you may qualify for lower premiums, also known as premium tax credits or other subsidies. In some cases, in addition to lower premiums, you may also be eligible for help with cost-sharing expenses like copayments, coinsurance, deductibles, and out-of-pocket maximums.
If you think you may qualify for lower premiums or out-of-pocket costs, you can apply for a subsidy at the same time that you enroll in a health plan. You can enroll in a plan through Covered California to get these savings. Important note: Those who qualify for lower cost sharing must enroll in an Enhanced Silver plan; these plans automatically include lower copayments, coinsurance, deductibles, and out-of-pocket maximum limits.
To be eligible for financial assistance, you must:
- Be a U.S. citizen, U.S. national, or legally present in the United States.
- Purchase a health plan through Covered California.
- Not be receiving Medi-Cal, military health benefits, or premium-free Medicare Part A.
- Not have access to affordable coverage through your work.
- Have a household income between 100% and 400% of the Federal Poverty Level. For a family of four in 2015, this would be a household income between $23, 850 and $95,400.
Some individuals with limited income may qualify for Medi-Cal, California’s state Medicaid program. If you’re eligible for Medicaid, you’ll get your health coverage through the program. If you get Medicaid, you’ve met the requirement to have health coverage and won’t face a tax penalty. You won’t need to enroll in a separate health plan. To find out if you’re eligible for Medicaid and to apply, contact the California Medicaid department.