AKA The Affordable Care Act, California Style
The very first question seniors have about Covered California is: “Will my Medicare coverage change because of Covered California (The Affordable Care Act)?” Answer: No, not at all. People who have Medicare coverage are not affected by Covered California. Medicare is not a part of Covered California’s Health Insurance Marketplace. If you are a Medicare beneficiary, your Medicare benefits are not changing. You do not need to replace your Medicare coverage with Marketplace coverage. For more information about the Marketplace, visit www.coveredca.com/.For more information about Medicare Parts A, B, C, and D, visit www.medicare.gov. Or read the publication on Medicare at www.socialsecurity.gov/pubs.
Covered California is a State Program
Covered California is not run by the federal government, it’s administered by a state board. When President Obama allowed insurers to offer canceled plans for an extra year, the Covered California board unanimously disagreed with the president. This means Californians’ plans not compliant with the federal health care law will not be extended through 2014. Also, the 24-hour extension to sign up for healthcare to start Jan 1 did not apply in California.
When you apply for Covered California insurance, the information you provide also determines whether you are entitled to low-cost or no-cost health coverage through Medi-Cal.
Your financial and family situation is also used by Covered California to determine if you are eligible for federal subsidies and tax credits to help pay your insurance premiums.
Besides income and size of family, the cost of a Covered California insurance policy is determined by location. Currently there are 19 different “Pricing Regions” in California, all with different insurance premiums.
Covered California enrollment from Oct. 1, 2013, to Dec. 23 was for coverage that takes effect Jan. 1, 2014. The open-enrollment period for coverage during 2014 runs to March 31, 2014. If you are eligible for Medi-Cal, the open enrollment period does not matter.
You can enroll through the Covered California Website, through a licensed insurance agent or by a certified counselor – all at no charge.
Covered California Insurance Programs
There are four levels of coverage which determine the cost of the policy, the cost of the benefits provided and the co-pays and deductibles levied. The four levels are Bronze, Silver, Gold and Platinum. The Bronze coverage pays for 60 percent of the medical costs provided leaving 40 percent for the insured to pay, the Silver 70 percent and the insured paying 30 percent, Gold 80 percent and the insured paying 20 percent, and Platinum 90 percent with 10 percent remaining for the insured to pay. In addition to these categories, Covered California offers a “minimum coverage plan,” for those under 30 years old which helps protect a person from financial disaster in the event of a serious and expensive medical emergency.
Premium assistance: Premium assistance is available to reduce the cost of health coverage for individuals and families who meet certain income requirements.
Cost-sharing subsidies: Cost-sharing subsidies reduce the amount of out-of-pocket health care expenses an individual or family has to pay. These expenses might include the copayments for health care services or other costs.
Covered California’s Health Coverage
All health insurance plans offered through Covered California’s individual and small-group markets cover a comprehensive set of benefits known as “essential health benefits.” They include the following 10 categories:
- Ambulatory patient services
- 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
- Laboratory services
- Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
Who can buy health insurance through Covered California?
Everyone up to the age of 65 can apply for Covered California. Legal California residents, except for currently incarcerated individuals and legal minors, are eligible to buy insurance through Covered California. However, if an enrollee has access to affordable health insurance through another source such as an employer or government program, the enrollee may not qualify for financial assistance through Covered California.
If your income at the end of the year does not match the estimate you provided when applying there are consequences. If your income is less, you may be eligible for a refund on your insurance premium. If your income is more, you may have to pay the difference to make up what you should have paid.
For more information about available health care options, you can visit www.CoveredCA.com or call (800) 300-1506 (interpretation into languages other than English is available). To learn more about the organization that runs Covered California, please visit www.hbex.ca.gov.
Medi-Cal Coverage
Medi-Cal is California’s health care program for individuals who make $15,856 or less per year. This program pays for a variety of medical services for children and adults with limited income and resources. Beginning Jan. 1, 2014, California will expand Medi-Cal eligibility for some low-income adults. When you complete a Covered California application, your eligibility for Medi-Cal will automatically be determined. You can apply for Medi-Cal benefits regardless of your sex, race, religion, color, national origin, sexual orientation, marital status, age, disability or veteran status. To find out more about Medi-Cal, please contact Medi-Cal directly at (800) 541-5555 or visit www.dhcs.ca.gov/services/medi-cal/Pages/Medi-CalFAQs1.aspx.
Medi-Cal Immigrant Care/Coverage
For Medi-Cal, immigration status only affects the scope of service. The services that Medi-Cal provides to undocumented immigrants include, but are not limited to, emergency medical services, prenatal care, pregnancy-related services, nursing home care, and limited breast and cervical cancer treatment.