Understanding the upcoming changes to healthcare under the Affordable Care Act is important, especially considering that individuals will be required under the law to have insurance by January 1, 2014. Many states including California have set up health insurance exchanges, marketplaces where people can compare standardized, government-regulated plans. Though businesses with more than 50 employees have been given an extension until 2015 to offer insurance to their employees, as of now individuals will still be required to comply with the law.
Who can use the health insurance exchanges? Those who:
- Do not receive employer-sponsored health coverage
- Whose employer-sponsored plan costs more than 9.5% of their income
- Whose employer-sponsored plan does not provide adequate coverage, based on ACA stipulations
Individuals who earn between 138% and 400% of the federal poverty level (which looks at family income and the number of people in the family) may qualify for tax breaks/subsidies to help pay for the cost of coverage. Estimate your costs and savings with this tax credit calculator.
All plans offered through the exchange must include the following 10 Essential Health Benefits, as outlined in the ACA:
- Ambulatory patient services
- Emergency services
- Hospitalization
- 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
Not all states will have a state-based exchange; some will default to the federal exchange. For California residents, the exchange, called Covered California, has been divided into 19 different rating regions. Covered California will begin enrolling individuals in plans on October 1st.
Get Expert Help
Benefit Packages will be an Exchange Certified Agency and can help Californians understand their options both inside and outside the exchange. The company’s founder has been helping individuals, seniors and small businesses obtain affordable coverage for over two decades. Visit benefitpackages.com for more information, or call us toll free at 1-800-356-3615.