Affordable Care Act
On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law, and California fully implemented it 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. Thanks to the recently passed American Rescue Plan, Covered California soon will be offering more money to help pay for your coverage. Most people who currently have a plan will see a much lower bill, and people who may have earned too much to get financial help in the past will now be eligible for the first time.
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 (510) 370-3322.
Key Dates to Remember
Covered California’s special-enrollment period, in response to the ongoing pandemic, runs through May 15, 2021. Sign up before that date to get coverage for this year.
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.
As of January 2014, you 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
- 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 had to be classified as one of the four levels of coverage – bronze, silver, gold or platinum. The marketplace makes 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.
How much does health insurance cost?
Covered California offers 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. Since 2014, individuals seeking health coverage are helped to afford it in three ways:
- 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.
- 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.
- Medi-Cal assistance: Starting in 2014, California expanded Medicaid (also known as Medi-Cal) to cover people under age 65, including people with disabilities or with low income. The coverage is part of the Affordable Care Act and is free for those who qualify.
Helpful Links and Resources
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: https://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 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: https://apply.coveredca.com/lw-shopandcompare/
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:
- How the Health Care Law Benefits Women
- How the Health Care Law Benefits Seniors & Improves Medicare
- How the Health Care Law Benefits Young Adults
- How the Health Care Law Benefits Children
- For Small Businesses: What You Need to Know About ACA
- How does California benefit from the health law?