Affordable Care Act Information
The Affordable Care Act was enacted in 2010 and put in place several mandates effecting Employer-Sponsored Health Plans and individuals’ ability to access care. Most notable:
- Dependent children are eligible to stay on health plans until their 26th birthday, regardless of enrollment in school.
- All preventative services (i.e. annual physical), when preformed with an in-network provider, are at no cost to the patient.
- Eliminated lifetime maximums for health insurance coverage (dental/vision maximums were unaffected).
- Established the Health Insurance Exchange, locally known as Covered California.
Covered California gives individuals and their families the opportunity to purchase health coverage directly from a variety of providers, including Kaiser, Blue Shield, and Anthem. Many individuals will qualify for a subsidy to help cover their monthly premium, but this is not a requirement to enroll in a plan.
To browse available plans, visit www.coveredca.com
Click “get a quote” on the right side of the website. You will be asked for your zip code, annual household income (this information is used to determine if you qualify for a subsidy. If you do not wish to receive a subsidy, you can leave this section blank), the number of people living in your household, their age, and if they are pregnant.
The website will then ask you to rate your average usage of different medical services. This information is used to help tailor the results to plans that may be best suited to fit your needs.
Once you click “submit,” you will be able to browse and compare available plans. Once you find the plan you want, add it to your cart and “check out” to be taken to the formal enrollment application. Once enrolled, you will receive notification from the insurance carrier with information on how to pay for your plan and set up an account.
Things to consider when choosing an insurance plan:
- Check the premium. Your premium is the amount you pay each month for coverage, whether you use the insurance or not.
- Check the deductibles, co-payments, and co-insurance amounts. Usually plans that have a less expensive premium have higher out of pocket costs. A deductible is your financial responsibility before the plan pays benefits. Usually, certain coverages are exempted from the Deductible. A co-payment is a flat dollar amount that you are responsible to pay for services. A co-insurance is the percent of the overall cost of the service that you are responsible to pay. You typically owe a co-insurance once your deductible has been met.
- Check the network. If you would like to keep your same doctor and hospital, you will want to make sure they are in-network with the plan you choose, OR if you choose to enroll in a PPO plan, be aware of the costs of using an out-of-network provider.
- Check the formulary. If you are taking medications, you will want to make sure those medications are covered under the plan’s drug formulary or “drug list.” If they are not covered, check with your doctor to see if there is another option that is covered.
If you need help getting coverage or have additional questions about the Affordable Care act, please contact us.