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Health Insurance


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.


1.    Open enrollment

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, 2020. 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.


2.    Health insurance exchanges

Health insurance exchanges are marketplaces where individuals can shop for coverage. California established “Covered California” as the state exchange.


3.    Essential health benefits

All 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 services.


4.    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.


5.    Individual rating structure changes

Rate restrictions 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.

Family size

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 family premium.

Rate guarantee

  Rates for health plans will be guaranteed for a full calendar year or the duration of the calendar year for special enrollment.

  Rate adjustments due to age changes can only occur during open enrollment or special enrollment periods.


6.    Tax credits (subsidies)

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.


7.    ACA taxes

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 the information:

a)  Health 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.

b)  Transitional 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).


8.    Mandated coverage

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.









CA License  #    0H89035
Direct        949-831-8924



Eugene Siffredi

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