Congressman Eric Swalwell

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Affordable Care Act

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law.  Since then, it has been upheld by the Supreme Court, and California has prepared for its full implementation in 2014.

Californians may visit CoveredCA.com or call 1-800-300-1506 for more information on the health plans available through the Covered California marketplace.

As always, my District Office is prepared to answer any questions you many have about what the Affordable Care Act means for you and your family. Please contact us at (925) 460-5100 or (510) 370-3322.


Key Dates to Remember

October 1, 2013: Enrollment begins for individuals in the Covered California Health Insurance Marketplace and for California Small Businesses in the Small Business Health Options Program (SHOP). Learn more about how the health care law impacts small business through this webinar. 

January 1, 2014: Health coverage in the Marketplace begins. This means that millions of uninsured Californians, including low income families and individuals with pre-existing conditions, will be able to purchase affordable, quality health insurance. The deadline to apply for coverage that begins January 1 has been extended to December 23, 2013.

March 31, 2014: Last day to enroll in health coverage through Covered California.  Those who do not sign up for health insurance by March 31, 2014 will have to wait until 2015 to sign up.

 

HHS ACA Infographic

Click image to enlarge

Frequently Asked Questions

What if I already have health insurance? Do I have to enroll in the Marketplace?

If you have employer-provided health insurance, public program insurance such as Medicare, or are a veteran receiving VA health care, you are considered covered and can keep your current plan.

If, however, you are unsatisfied with the coverage you currently have or you purchase coverage on the “individual” market, you will have the option to switch to Marketplace coverage.

But, individuals with employer-provided coverage are also receiving numerous new protections and benefits under the ACA, including:

  • Your insurer must spend at least 80 percent of your premium on health care as opposed to CEO bonuses or overhead.
  • For most people in private plans, you have free coverage of key preventive services.
  • Your insurer must give you the option of having your young adult children stay on or join your employer-provided plan until they turn 26.

Beginning in January 2014, you will receive additional benefits, such as:

  • Your insurer cannot discriminate against you if you have a pre-existing condition or get sick.
  • You are protected by a cap on your out-of-pocket costs.
  • If you are a woman, insurers cannot charge you more than men for the same coverage.


What is the Covered California Marketplace?

Covered California is a new, easy-to-use marketplace where you and your family may get financial assistance to make coverage more affordable, and where you will be able to compare and choose health coverage that best fits your needs and budget. By law, your coverage can’t be dropped or denied even if you have a pre-existing medical condition or get sick.

The Covered California Marketplace will help uninsured Californians gain access to affordable, quality, and accessible health care, including Essential Health Benefits.


What are Essential Health Benefits?

All health plans purchased through the Covered California Marketplace are required to have Essential Health Benefits. These include services like:

  • Doctor visits
  • Hospitalization
  • Emergency care
  • Maternity and newborn care
  • Mental health and substance abuse services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services
  • Ambulatory patient services, including medical care provided without need of admission to a health care facility (i.e. blood tests, X-rays, vaccinations, and monthly well-baby checkups)


How do I choose a health plan through Covered California?

Starting in 2014, all new health insurance sold to individuals and small businesses must be classified as one of the four levels of coverage – bronze, silver, gold or platinum.  The Marketplace will make it simple for you to compare the available plans and learn if you qualify for financial assistance to purchase insurance.

You may choose to pay a higher monthly premium for the gold or platinum level, so that you pay less when you need medical coverage.  Alternatively, you can choose a lower monthly premium, but when you need medical coverage, you pay more.

The Covered California Marketplace will open on October 1, 2013. You will be able to select health coverage online or by calling 1-888-975-1142.  You will also be able to sit down with a certified enrollment assistant in your community.  Enrollment assistants are currently getting certified and trained, so more information will be available soon.


How much does health insurance cost?

Covered California will offer a range of health plans so you can choose the one that best meets your financial and health needs. You can use the cost-estimate calculator to estimate about how much you will pay per year for a health plan under the different coverage levels.

Many individuals seeking health coverage will qualify for financial assistance to help cover the cost of the health plans. Starting in 2014, individuals seeking health coverage will be helped to afford it in three ways:

  1. Tax credits: Tax credits are available to help lower the cost of health coverage for individuals and families who meet certain income requirements and do not currently have affordable health  insurance.  To find out more about tax credits and what it means based on your income, visit here.
  2. Cost-sharing subsidies: Cost-sharing subsidies reduce the out-of-pocket amount of health care expenses an individual or family has to pay, including copayments and other costs you pay when you receive medical services.  Learn more about cost-sharing subsidies here.
  3. Medi-Cal assistance: Starting in 2014, California will expand Medicaid (also known as Medi-Cal) to cover people under age 65, including people with disabilities, or with income of less than $15,856 for a single individual and $32,499 for a family of four.  The coverage is part of the Affordable Care Act and is free for those who qualify.


Helpful Links and Resources

Covered California

This is the go-to website for understanding and enrolling in the Marketplace.  It includes information about health insurance options for Californians and the financial assistance that may be available to you to purchase coverage: http://www.coveredca.com.

You can also call Covered California toll-free with any questions: 1-888-975-1142


Health Plan Cost-Estimate Calculator

Estimate how much insurance may cost you in 2014 and find out if you qualify for tax credits by inputting simple information such as the number of people in your household and your household income: http://www.coveredca.com/fieldcalc/#calculator.


HealthCare.gov

This interactive, easy-to-use website provides quick information in multiple languages as well as contact information for helpful representatives: https://www.healthcare.gov/

Learn more about the ACA and how it benefits you: