How “Covered California”, The California Health Benefits Exchange, Works

The California Health Insurance Exchange or California Health Insurance Marketplace, called “Covered California”, is an online website for health insurance. Once at the Covered California health insurance marketplace customers will fill out a form including basic information about their family and taxable income. Customers will then be able to use a cost calculator to determine costs of insurance after subsides and compare prices and benefits of health plans. Most individuals and families will have a wide range of plans to choose from.

• ObamaCare’s open enrollment period for 2015 starts on November 15th, 2014 and continues until February 15th, 2015.

• During open enrollment you can apply for cost assistance, enroll in a plan, and change plans.

• If you don’t obtain coverage during open enrollment you won’t be able to use the marketplace again without qualifying for a special enrollment period.

• Not everyone who doesn’t have insurance will be charged a fee or will get cost assistance. How much you pay depends on what you make.

• All health insurance sold on official ObamaCare websites must include all the new benefits, rights and protections of the Affordable Care Act.

• www.coveredca.com is your State’s official ObamaCare website for California.

• Learn more about Covered California from CA.gov.

California Health Insurance PlansCalifornia Insurance Exchange Subsides and Tax Credits

ObamaCare subsidizes those with incomes ranging from 139% to 400% of the FLP (federal poverty level) and helps to make Medicaid and CHIP available for those below the 139% mark. in 2013 400% FPL is $45,960 for single person, $62,040 for a family of two, and $78,120 for a family of three. Subsidies are given as refundable tax credits. Subsidies are given as refundable tax credits.

Applying for Subsidies, Tax Credits and Cost Assistance on the California Health Insurance Exchange

In order to get subsidies all you need to do is sign up with the insurance exchange. Once you input your families information and your tax information the system will automatically calculate your subsidies. Since subsidies are reflected as tax credits your cost assistance will not be set in stone until the end of the year. Keep this in mind as you may lose or gain cost assistance as your income fluctuates throughout the year.

Applying for ObamaCare in California

Make sure you have the following information about your and your family before visiting Covered California, your State’s official Health Insurance Marketplace.

• Last years tax information for you and your family.

• Projected incomes for this year.

• Medical history – ObamaCare does away with pre-existing conditions and gender discrimination so these factors will no longer affect the cost of your insurance. Smoking, family size and age may still affect your affect cost.

• Social Security Numbers (or document numbers for legal immigrants).

• Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements).

• Policy numbers for any current health insurance plans covering members of your household.

• A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)

• Any other important information that could affect your health insurance premium or coverage options. Better safe than sorry!

Here is an example of the health insurance exchange application form for individuals.

Here is an example of the health insurance exchange application form for families.

Qualifying for Medicaid Expansion

If you make under 139% of the Federal Poverty Level you may qualify for Medicaid under California’s Medicaid expansion under ObamaCare. You can apply for Medicaid using the California Health Insurance Exchange.

California Health Insurance Exchange Facts

Some of the latest facts on the Health Insurance Exchange in California.

California has announced that insurance companies have submitted premiums for its state-based ObamaCare exchange, and the rates will come in lower than forecast.

Atnea has pulled out of offering insurance on the health care exchange in California.

Choosing the Right Health Insurance Plan

There are a number of different tiers of plans available on the California Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the California insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

California health insurers don’t have to offer every tier of plan, but within the California health insurance Exchanges, all health insurance companies must offer at least one silver plan and one gold plan to consumers.

California Insurance Exchange: Factors that Affect Rates

ObamaCare does away with pre-existing conditions and gender discrimination so these factors will no longer affect the cost of your insurance. Please be aware location, income, smoking status, family size and age all affect the cost of your health insurance premium. So the cost of any their of plan will fluctuate from person to person and from family to family. Please keep this in mind when shopping for insurance on the California health insurance exchange.

Choosing a Health Care Plan: How to Calculated the Cost of Health Insurance

To get started you’ll want to figure out what your budget is for health care this year. Affordable health insurance is defined as 8% of your income. Take your income for last year and find out if you can afford to pay 8%, if not find a number that you feel you can pay. Now that you have an idea of what you can afford it’s time to take a look at the official cost calculator from the Covered California health insurance exchange. This will give you an estimate of what you and your family will pay. Keep in mind that health, age and other factors can increase or decrease the cost of your insurance.

How to Get Started Using the Insurance Exchanges

If you live in California, Covered California is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Covered California website to apply for coverage, compare plans, change plans, and enroll. You can apply at any time during open enrollment or if you qualify for a special enrollment periodVisit Covered California now to learn more.

The California health insurance marketplace is only open during open enrollment. You can use the marketplace during each years annual open enrollment period.  Make sure to sign up for our newsletter for updates. The second the exchanges open up we will have detailed directions on how to use the exchanges as well as reviews of plans.

 

California Health Insurance Exchange Guide
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