CA Health Benefit Exchange

California was the first state to create a health insurance exchange after the passage of the Affordable Care Act (ACA). After January 1, 2014 nearly all Americans will be required to carry health insurance under the new law.

The California health benefit exchange is designed to help individuals, families and small businesses get access to comprehensive and affordable benefit plans. The exchange will help individuals:

  • Who do not receive employer-sponsored health coverage
  • Whose employer-sponsored plan costs more than 9.5% of their income, or
  • Whose employer-sponsored plan does not provide adequate coverage, based on ACA standards

Some of the state’s leading health insurance companies, including Kaiser Permanente, Anthem Blue Cross of California, Blue Shield of California and Health Net will be offering plans through the health insurance exchange. is Your Resource for Health Insurance Insurance Agency is an Exchange Certified agency that works with carriers both inside and outside the exchange. We provide objective advice to help you determine the best options for affordable, comprehensive coverage for you, your family or your small business employees. Our step-by-step application form makes it easy to apply for coverage.

Benefits Included in the California Health Benefit Exchange

All plans offered through the exchange must include the following 10 Essential Health Benefits, as outlined in the ACA:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services

Tiered-Plan System

In addition to covering the Essential Health Benefits, plans in the exchange must follow a standard design, as outlined by the ACA. Plans will be offered in a tiered system that includes the following levels:

  • Bronze
  • Silver
  • Gold
  • Platinum

The plans with a higher value metal designation have a higher premium, but they also cover more, while the lower value metals have a lower premium but cover less. A Platinum-level plan has a higher premium but covers 90% of expenses, for example, while a Bronze-level plan has a lower premium but covers just 60% of expenses.

Subsidies/Tax Breaks to Help Pay for Coverage

Individuals and Families

  • If you’re purchasing a policy through the Ca health insurance exchange your income can qualify you for both Advanced Premium Tax Credits (APTC) to lower your premium but also provide you with Cost Sharing Reductions (CSR’s) which apply only to the Silver Plan. The Silver 70 is the Standard Silver Plan and has a deductible of $2,250. The Silver 73 has a $1,900 deductible The Silver 87 has a $550 deductible and the Silver 94 has a $75 deductible.

Individuals who earn between 133% and 400% of the federal poverty level (FPL) may qualify for a subsidy to help pay for coverage. Tax credits can be paid directly to the qualified health plan, so you can receive immediate savings.

Small Businesses

Small businesses with fewer than 100 full-time employees as of January 2016 are eligible for health insurance through Covered California. Health insurance plans through Covered California offer standardized health benefit’s at four defined levels of coverage: Bronze, Silver, Gold and Platinum. Employers can choose one or two plan levels of coverage to offer employees.  All health insurance plans available through Covered California cover the same Essential Health Benefits such as doctor visits, hospital care, emergency care, care for pregnant women and prescription drugs.  Unlike small business plans off exchange, if an employer doesn’t offer coverage for employees’ dependents, coverage for them may be available through Covered California’s Individual Marketplace.

Small Business Tax Credits

Unlike employer health insurance off exchange insurance purchased through the exchange may qualify for Tax Credits which is significantly better than a deductible expense! Employers must have fewer than 25 full-time equivalent employees, pay employees an average annual salary of less than $50,000, and contribute at least 50 percent towards qualified employee premium costs. Employers with fewer than 10 fulltime equivalent employees with wages averaging less than $25,000 per year will be eligible for the maximum tax credit amount. The maximum credit is 50 percent of premium expenses or 35 percent for tax-exempt organizations. Nonprofit or tax-exempt employers must meet the same criteria as detailed above. The tax credits are available for a total of two consecutive years