Exploring health care options under Obamacare

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The California Health Exchange ­at www.coveredca.com opened Oct. 1, allowing millions of Californians the opportunity to shop for affordable health care under the Affordable Care Act.

Despite rumors of high premiums, on Sept. 25, the U.S. Department of Health and Human Services released a report and press release announcing “lower than expected premiums available in the new Health Insurance Marketplace.”

The report promises about a choice of two or more health insurance issuers for 95 percent of consumers.

California was the first state to implement the ACA in 2010 and establish its health insurance exchange. But with 2.1 million uninsured and eligible for coverage, it will be a challenge to make the coveredca.com site easy to understand and navigate for the millions that will use it, even given that the site provides information in 13 languages.

One of the biggest misconceptions about ACA is that it creates a government-run health plan; it does not. Another persistent misconception is that undocumented immigrants will be allowed to enroll, which they will not.

To further clarify the key reforms of the ACA, on Sept. 25, the White House released a statement that includes stronger consumer rights and protections to effectively put an end to coverage denial based on pre-existing condition(s), an end to lifetime caps on the amount of care received based on a maximum dollar limitation and coverage cannot be canceled due to illness.

Coverage is also more affordable in that it requires insurance companies to adhere to the 80/20 rule, meaning that if insurance companies do not spend at least 80 percent of the premium on medical care and health care improvements, they will be required to give the insured a rebate.

Further, insurance companies in every state are required to publicly justify any rate increases of 10 percent or higher. Small businesses will also benefit by receiving a tax credit. And under the ACA, the level of care received is improved because insurers are now required to pay for several recommended preventive services without an increase in costs via copays or deductibles. Parents can breathe a sigh of relief because under the new law children can remain on the family insurance plan until age 26.

To understand the process and identify the participating insurance companies and health plan options, visit coveredca.com.

Plans are divided into four “metal” categories — bronze, silver, gold and platinum. The bronze and silver plans offer a lower premium but higher out-of-pocket costs; the gold and platinum plans require a higher premium, but lower out-of-pocket costs.

At the website, select “Resources,” from the menu, then “Shop and Compare.” Click on “Get Started” and begin filling in the information requested, such as number in household, household income, zip code, age(s) and number of dependents. At this stage, it is not necessary to provide any personal information. A variety of scenarios may be explored based on each person’s unique set of circumstances. After entering the information requested, click on “See My Options” for a list of plans/insurers offering coverage. Under each plan offered select “View Details” for a cost breakdown, detailed plan benefits and information about the insurer.

For example, a family of three with two adults aged 55 and 45 and a son or daughter age 20, based on an annual income of $30,000, may consider Enhanced Silver 87 and the Bronze 60.

Here are the plans/insurers under Enhanced Silver 87:

Monthly Premium Monthly
Insurer Premium Assistance Payment
Health Net $838 $779 $59
Molina Health care $883 $779 $104
Blue Shield of CA $899 $779 $120
Anthem Blue Cross $902 $779 $123

For a complete list of coverage offered under each plan, click “View Plan Benefits.” For information about the company, click “About [name of insurer].”

It is important to note that “Premium Assistance” is available from the government to lower the cost of insurance. After applying, the assistance may be immediately applied to the total monthly premium to lower the monthly pay out.

An insured will not need to pay the entire premium up front each month and then wait for reimbursement on their tax return. But, they can elect to use the Premium Assistance all at once, use some of the assistance available, or none at all depending on their income and their accountant’s advice. They can claim the unused portion of the subsidy on their income tax.

Anyone may shop and purchase a plan beginning Oct. 1 but coverage will not take effect until Jan. 1, 2014.

Anyone with coverage through their employer may not qualify for a tax credit unless the employer’s plan covers less than 60 percent of medical costs. In this instance, the employee may qualify for subsidized coverage.

A list of “Frequently Asked Questions” and downloadable fact sheets are available for both individuals and small businesses. For families, the California School Health Centers Association provides a list of the “Top 10 Things You and Your Family Need to Know About the Affordable Care Act.” Visit www.schoolhealthcenters.org.

The Washington Post Wonkblog features the column “You’ve got 42 Obamacare questions. Wonkblog has 42 answers” at www.washingtonpost.com/blogs/wonkblog/wp/2013/09/25/youve-got-42-obamacare-questions-wonkblog-has-42-answers.

Coveredca.com has also established a toll-free call center to provide answers to health care questions at 888-975-1142.

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