Affordable Care Act
One major change in the delivery of health care brought about by the ACA is the development of health care exchanges, also referred to as marketplaces, which allow individuals to purchase health insurance from a list of competing plans that qualify based upon a set of minimum essential benefits.
California was one of the first states in the nation to open a health care exchange, called Covered California, which allows California residents to calculate what health care plans are available to them based on their income, the number of people in their families, and age. Covered California has contracted with 12 insurance companies that represent a mix of major insurers and smaller companies, regional and statewide doctor and hospital networks, and both for profit and nonprofit plans. Of the 12 plans, only two are available in Tuolumne County: Anthem Blue Cross and Blue Shield of California.
The ACA requires that:
• Almost all Americans be insured in some form; each person who is required, but doesn’t purchase health care coverage, will face increasing annual penalties.
• Americans with an income of up to 400% of the Federal Poverty Level (FPL) who don’t receive employer-sponsored benefits (or Medicaid, Medicare or military coverage) will qualify for government subsidies, a break on health insurance premiums in the form of tax credits. Although individuals can purchase insurance directly from brokers, only those who purchase through the exchange are eligible for the subsidies.
• People with a household income at or below 138% of the FPL (which in 2013 is about $16,000 for a single person and $32,000 for a family of four), will qualify for Medi-Cal.
• Insurance companies will be required to cover all applicants, and offer the same rates regardless of pre-existing conditions, age, or gender.
Resources for Individuals:
- Covered California Health Care Exchange: www.coveredca.com
- National Health Care Exchange: www.healthcare.gov
- Consumer Reports Health Law Helper: www.healthlawhelper.org
- Health Reform Beyond the Basics: www.healthreformbeyondthebasics.org
- California Health Benefit Exchange: www.healthexchange.ca.gov
- Families USA: www.familiesusa.org