9 Things You Should Know About
The Affordable Care Act
The Affordable Care Act (ACA)
was signed into law on March 23, 2010, with the intention of decreasing
the barriers for obtaining health coverage. This list, while not
inclusive of all the changes required by law, provides a snapshot of the
important mandates that may impact you in 2018.
Note: if you start to get
confused go directly to #9.
An open enrollment
period has been established as an opportunity for individuals
and families to explore their health plan options and enroll in coverage
that best suit their needs. The
open enrollment period for purchasing coverage
ended on January 31, 2019.
However, special enrollment periods will be available for those who need
to purchase plans (through the Exchange or the traditional market)
outside of open enrollment due to special circumstances.
Health insurance exchanges
exchanges are marketplaces where individuals can shop for coverage. California established “Covered California” as
the state exchange.
Essential health benefits
health plans in the individual market must offer the 10 “essential health
benefits” categories that include services such as emergency services,
hospitalization, prescription drugs, and preventive and wellness
Standardized levels of coverage
In 2018, all
non-grandfathered individual health plans will fall into four levels of
coverage: bronze, silver, gold and platinum. The levels represent
the ”actuarial values” the plans must meet: 60%, 70%, 80% and 90%,
respectively. The actuarial value represents the anticipated share
of costs a plan will cover on. By grouping plans in these levels,
you can more easily compare plans with similar levels of coverage.
In addition to the four levels of coverage, a “catastrophic” plan is
offered. This plan is for individuals younger than 30 years old or those
who can provide a certification that they are without affordable
coverage or are experiencing hardship.
Individual rating structure changes
were implemented to limit how much premiums charged to individuals can
vary. In California, the only rating factors that will be allowed
to be used in determining rates are geography, age and family size.
Basing premiums on health status, medical conditions, genetic
information or evidence of insurability is prohibited.
• Rating will
be based on the cost of care in a particular geographic area.
• There will
be 19 geographic areas, to improve access and affordability.
Rates based on age
will differ by no more than a 3:1 ratio, where the cost for the highest
age may be no more than three times the cost for a young adult.
In determining a
family’s total cost, all adults age 21 and above (subscriber, spouse,
adult children) are rated separately under family coverage, and only the
three oldest children who are under age 21 will be rated in the total
• Rates for
health plans will be guaranteed for a full calendar year or the duration
of the calendar year for special enrollment.
adjustments due to age changes can only occur during open enrollment or
special enrollment periods.
Subsidies, in the
form of tax credits and help with out-of-pocket health expenses for
certain lower-income individuals, are available to U.S. citizens and
legal immigrants who purchase coverage through Covered California, and
who have income up to 400% of the federal poverty level (FPL). To
be eligible, individuals must:
• Not be
eligible for public coverage, including Medi-Cal, the Children’s Health
Insurance Program, Medicare or military coverage, and
• Not have
access to health insurance through an employer, unless the employer does
not cover at least 60% of covered benefits on average or the employee
share of the premium exceeds 9.5% of the employee’s income.
While the ACA
provides tax credits for qualifying individuals, it also taxes plans, to
pay for subsidies and to finance high-risk individuals. This is
insurer tax: Beginning in 2014, this tax paid for a portion of the
expenses related to providing premium subsidies and tax credits.
This tax was estimated to be approximately 2.3% of dues and/or premiums.
reinsurance tax: From 2014 through 2016, this tax funded programs to
finance the cost of high-risk individuals and was estimated to be $5.25
per member per month ($63/year).
Also, starting in
January 2014, most people were required to have health insurance or
pay a penalty if they didn't. Coverage can include
employer-provided insurance, coverage purchased in the individual
market, and certain government-sponsored plans such as Medicare or Medi-Cal.
9. I am your local Covered California Certified Agent and ready
to help you!
Whether you decide
to purchase plans through Covered California or through the traditional
market, depend on me as your trusted advisor to help you find the plans
that best fits your needs and budget.
I can provide you with information on the
plans, help you determine if you qualify for a discount and/or complete
the application process.
Don’t wait… Many Californians will have to make changes to
their current coverage;
the earlier you get yours done, the more
likely you will get personalized assistance.
Call me to reserve
your time slot. We can meet in person or online.