What is the Affordable Care Act?
The Patient Protection and Affordable Care Act, also known as the Affordable Care Act, or ACA, was passed by Congress and signed into law by President Obama on March 23, 2010. The ACA was put in place to increase access to quality health coverage, lower healthcare costs, enhance the quality of care for all Americans and insure the 30-70 million Americans who are currently uninsured. In June 2012, the Supreme Court upheld the ACA after considering a series of challenges to several of the law’s key provisions. The major reforms in the ACA took effect in 2014.
Is my plan affected by ACA provisions?
If you were enrolled in a plan prior to March 23, 2010, then you have a "grandfathered plan." Any plan purchased or changed after March 2010, would be considered a "non-grandfathered plan." Grandfathered plans are exempt from certain healthcare reform provisions whereas non-grandfathered plans must comply with all healthcare reform mandates.
If I don't have health insurance will I have to pay a penalty?
Most people will be required to have health insurance or pay a penalty if they don't. (Applies to plan/tax years 2015-2018) Coverage may include insurance through your job, coverage you buy yourself, or insurance from the government like Medicare or Medicaid.
Will I be able to get health insurance even if I have a pre-existing condition?
Yes. As of January 1, 2014, health insurance companies must accept consumers who apply for coverage regardless of health, age, gender or other factors (including pre-existing conditions).
What are health insurance exchanges?
Health insurance exchanges are state-run marketplaces where individuals and small businesses can buy health insurance for coverage. The health insurance marketplace for California is called Covered California.
Individuals may get financial assistance to make coverage more affordable and be able to compare and choose health coverage that best fits their needs and budget. Subsidies will only be available via Covered California to individual consumers who qualify.
Who will be eligible for subsides on Covered California?
People with annual incomes between 134% and 400% of the Federal Poverty Level (FPL) are eligible for subsidies from Covered California. Those with incomes under 134% FPL would be eligible for Medicaid.
Do I have to buy health insurance from Covered California?
No. In addition to buying coverage through Covered California, individuals and small businesses can purchase health care the way they do today through brokers and directly through insurance carriers like Blue Shield.
What kind of health insurance plans are offered?
Under the Affordable Care Act, all non-grandfathered health plans offered in the individual and small business markets will be required to provide coverage at a metal level – Platinum, Gold, Silver and Bronze. This applies to plans purchased via the Covered California marketplace and plans purchased outside of Covered California. The metal levels are based on the actuarial value (AV): Bronze (60% AV), Silver (70% AV), Gold (80% AV) or Platinum (90% AV). What this means is that someone who buys a silver plan would have to pay 30% of healthcare costs, while the plan covers 70%.
There is also a catastrophic plan for the individual market that will cover the essential health benefits plus three primary care visits per year. The catastrophic plan can only be sold to consumers under age 30 and who are exempt from the individual mandate as a result of low income or hardship.
When will I be able to purchase health insurance
Open enrollment runs from November 1 to January 31. Individuals will only be able to purchase health insurance during this open enrollment period in order to obtain coverage. If you have a life-changing event such as the loss of a job, death of a spouse or birth of a child, you are eligible for special enrollment within 60 days of the event.
Are there health reform taxes I need to be aware of?
The ACA requires that certain taxes be collected to fund aspects of the law. Beginning January 1, 2014, two taxes took effect: the health insurer tax and the transitional reinsurance tax. Health insurers, including Blue Shield, employers, and individuals will be responsible for paying these taxes. In addition, Covered California will assess its own fee on health insurance plans to fund its operations. For an overview of both taxes download our ACA tax fact sheet.