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In this introductory blog post I will teach you about Covered California, the state’s new health insurance exchange and marketplace where individuals, visual and performing artists, and entertainment professionals will be able to purchase health insurance for 2014.
In a following blog post I will discuss Medi-Cal and how it can help obtain affordable health insurance and health care in California for those who qualify.
The final post in the series will cover the state’s Small Business Health Options Program (SHOP). The information provided here is applicable to all California small businesses and what the law requires for these employers.
If you get nothing more out of this series at least take this with you: you maybe able to find the exact same health insurance coverage (for those of you who are already insured) but what’s more: you may qualify for tax credits or assistance with your premiums ONLY if you go through Covered California.
If you are currently insured or choose to purchase coverage directly through an insurer, you may not know about these tax credits or premium assistance as your current insurer is under no obligation to inform you and that could cost you money.
Affordable Care Act and Covered California
Earlier this month the Affordable Care Act (ACA) rolled out. It is the most significant regulatory overhaul of the nation’s healthcare system since the passage of Medicare and Medicaid in 1965 by LBJ and Congress.
Now my mother once told me some sage advice that applies to social situations but it also ostensibly makes sense in social media: to avoid arguments and bad feelings never discuss politics, religion and money.
Being a good daughter (and having learned from experience that my mother is right), I won’t be commenting about the politics of the ACA but I do want to share some information I learned from the Actors Fund. If you want to learn more than what I can provide in this blog post, call the Actors Fund Covered California Information Hotline at 855-491-3357.
OK. I’ll start with the facts as it pertains to me as a U.S. citizen and a California resident.
Under the ACA, all American citizens are required by law to have health insurance in 2014 or pay an annual penalty of $95.00 per adult and $47.50 per child. These penalties will increase significantly in 2015 and beyond.
How can health insurance be obtained for Californians such as myself? The answer is: either through an employer, a government program or privately.
Covered California is the state’s implementation of the American Health Benefit Exchange provisions of the ACA. On the Covered California website (https://www.coveredca.com) California residents can explore health insurance options and enroll in a plan.
Only legal residents of California who do not have health insurance from their employer or government program can obtain health insurance through Covered California.
Assuming you are a resident, you will be able to purchase the same quality health insurance from Covered California that is available on the private market.
Here’s some things you should also know:
- Under Covered California you cannot be denied coverage for a pre-existing condition.
- Premium Assistance is available to those how purchase insurance with an income of 400% of the Federal Poverty Level which is $45,960 for individuals and $94,200 for a family of four.
- The initial enrollment period is from October 1, 2013 through March 31, 2014
- If your enrollment date is on or before December 15 your coverage begins on January 1, 2014.
- The annual enrollment period is October 15, 2014 through December 7, 2014 and every year thereafter.
What Health Insurance Covers
All health plans offered in the individual and small-group markets must provide a comprehensive package of items and services, known as essential health benefits. These benefits fit into the following categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder 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, including dental and vision care
Premium Assistance and Covered California
Premium Assistance is a tax credit to help reduce your monthly insurance premium and are immediately applied when you enroll to pay for health insurance but only if you do so through Covered California. You will not obtain these credits if you go directly through an insurance provider
Times are tough for several of my friends and colleagues who have lost their jobs and livelihoods, I realize that. Many of you may be paying for health insurance privately while you search for a new job. Or if maybe you’re like one single mom that I know who is struggling to get medical care for one of her two sons who has a pre-existing condition.
So what I want to emphasize to those who are undergoing financial stress is that the only way to receive Premium Assistance is to purchase a Covered California Health Plan through their website. As I understand it, Premium Assistance cannot be grandfathered in with your current health plan or COBRA plan. It is necessary to switch to a Covered California plan.
Again: the only way to receive Premium Assistance is to purchase a Covered California Health Plan through their website.
While there, you will find a calculator to determine your eligibility for Premium Assistance. You will also be able to compare plans, select a plan and enroll. Enrollment can be accomplished on-line, over the phone, in person or by mail.
How To Obtain Health Insurance through Covered California
Now determining what the best plan is for you and your family can be confusing, so Certified Enrollment Specialists are vetted by the state to help.
Another great resource is Artists Health Insurance Resource Center (AHIRC).
I’ve found them to be completely unbiased. They do not accept advertising or commercial endorsements.
The only thing they promote is the healthy artists with full access to health care. Their mission is insure every artist in the United States by 2014.
For more information, call 323-933-9244 ext. 32 or visit their Covered California e-learning center here: https://ahirc.org/categories/CA/view
This series of blog posts including Finding Affordable Health Insurance Through Covered California, The Basics of Medi-Cal and Covered California for 2014 and Facts About Covered California’s Small Business Health Options Program (SHOP) is dedicated in loving memory to Martin Bosworth.