Covered California: What You Need To Know About The New Healthcare Marketplace

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According to the California Healthcare Foundation’s 2012 annual report entitled “California’s Uninsured: Treading Water,” in 2011 nearly 7.1 million people under the age of 65 were not covered by health insurance. The report also states that the percentage of Californians who were receiving employer-based coverage was only 52%. Now that the Patient Protection and Affordable Care Act, commonly referred to as “Obamacare,” has gone into effect, those statistics should be greatly altered. The Affordable Care Act, which was signed into law in March 2010, established a healthcare marketplace where individuals, families and small businesses can shop for and purchase affordable health insurance. In California, this new marketplace is called Covered California.

What is the process for enrolling in a health plan through Covered California?

Individuals can enroll in a health insurance plan online at Covered California’s website at http://www.coveredca.com  or by calling (800) 300-1506. Covered California’s Facebook page provides up-to-date information where people can ask questions, and offers a convenient Shop and Compare Facebook App. The deadline for enrolling in a healthcare plan is December 15, 2013 for coverage to take effect on January 1, 2014. Open enrollment for 2014 will continue through March 31, 2014. People enrolling in a plan will need to provide their adjusted gross income, age, family size and zip code. For employers who own small businesses with 50 employees or less, insurance plans can be purchased for their employees through the Covered California Small Business Health Options Program (SHOP), a small business health insurance marketplace. Covered California’s website explains that for those small businesses seeking an insurance plan for their employees, SHOP is an easy way to “shop” for insurance and that some businesses may qualify for federal tax credits. Individuals and small businesses can also enroll in a plan by contacting a certified health insurance agent who will discuss the available plans that are offered through the marketplace, as well as other plans outside of it, and can recommend one that will best fit the needs for their families or businesses. “Every case will be a little bit different,” states Elizabeth Mitchell-Collord, CEO of Community Health Plan of the Siskiyous. “I recommend everyone seek guidance regarding their options so they can learn about the new law and make a good initial choice.”

What types of health insurance options are available through Covered California?

Covered California offers four levels of health coverage to choose from: bronze, silver, gold or platinum. “The four metal tiers reflect the percentage of expected health care services costs the plans cover. For example, the lowest cost “bronze” plans will pay about 60% whereas the “gold” plan will cover approximately 80%,” explains Mitchell-Collord. An individual who purchases a bronze plan will pay a lower monthly premium but will need to pay a higher share of costs for care. For a gold plan, an individual will pay a higher monthly premium, but then the plan will pay more of the medical costs if a person requires a lot of medical care. Families and individuals who enroll in a health plan may qualify for tax credits, but they also need to understand how the penalties work for not maintaining qualified coverage. In 2014, the penalty is $95 per person or 1% of modified household income, whichever is greater (children under 19 are considered half of an adult when calculating the amount of the flat rate penalty). Mitchell-Collord also emphasizes that families with special medical considerations should really study the provider networks of the plans they are considering to ensure access to any specialty providers and facilities that are important to them.

What are some benefits of Covered California’s new healthcare marketplace?

Covered California provides many new benefits for Californians. Under the law, insurance policies must cover 10 essential health benefits in order to be offered in the marketplace. These basic benefits include ambulatory patient services, maternity and newborn care, prescription drugs, hospitalization, pediatric care, lab services, preventive and wellness services, and emergency services. In addition to these basic benefits, the law will help individuals with pre-existing medical conditions as they will no longer be excluded from obtaining health insurance. Families may find additional benefits under the new healthcare law. The plans offered in the marketplace will provide coverage for dental and vision care for children under 19. Parents also have the option of keeping their children covered under their health insurance plan until they reach the age of 26. Middle-income women who are pregnant will also be interested in learning about the Access for Infants and Mothers (AIM) program. It is available to those who are less than 30 weeks pregnant with no health insurance or who have limited maternity benefits. Covered California provides individuals, families and small businesses the opportunity to shop for and compare insurance plans on a level playing field. As President Barack Obama stated when he signed the health care bill into law in 2010, this landmark legislation preserves “the core principle that everybody should have some basic security when it comes to their health care.” 

Darla Greb Mazariegos
About Darla Mazariegos

Writer Darla Greb Mazariegos is a mother of three and part of the North State Parent staff.

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