In 2010, the federal government approved a law — the Patient Protection and Affordable Care Act (Affordable Care Act) (popularly known as "Obamacare") — to increase the number of Americans with health insurance and cut the cost of health care. The law is important to Californians because it provides financial assistance to help individuals and small businesses pay for health insurance. Those who already have affordable health insurance don’t need to take any action, unless they lose their coverage for certain reasons, such as the loss of a job.
To help those without health insurance get covered, the Affordable Care Act included a requirement that states either set up their own marketplace for people to buy health insurance or have one set up by the federal government. These marketplaces will offer one-stop shops where people can compare health insurance plans and buy the plan that works best for them, their family and their budget. California chose to set up its own marketplace — Covered California™ — as its doorway to health coverage. California also decided to expand its Medi-Cal program, and Covered California is the place to go to find out if you are eligible.
The Individual Mandate
The individual mandate requires that all eligible Americans have at least basic health coverage. If you don't have insurance by January 31st, 2014 or obtain an exemption you get charged a fee for every month you don't have insurance on your year-end taxable income.
There are a few things to know about the individual mandate:
- Insurance must be obtained by January 2014 to avoid the fee.
- The fee is based off of the number of months in a given year an individual is without "minimal essential coverage" or an exemption.
- If buying a "silver plan" on the health insurance marketplace will cost you more than 8% of your family income, after subsidies, you are exempt from the mandate.
- You are allowed a coverage gap of 3 months in a year and will be exempt from the fee for these months.
- Most employer based coverage, Medicare, Medicaid, CHIP, private insurance and all insurance purchased through your State's marketplace count as minimal essential coverage.
- ObamaCare makes insurance more affordable. Americans making under 400% of the federal poverty level may be able to obtain free or low-cost health insurance from their State's Health Insurance Marketplace.
Essential Health Benefits
All health insurance plans purchased through Covered California must cover certain services called essential health benefits. These include
- Ambulatory patient services
- Emergency services
- 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, including oral and vision care
Health insurance plans also must cover preventive care services, like mammograms and colonoscopies, for free.
Covered California--California's Health Insurance Exchange
Californians can get brand-name health insurance under the Patient Protection and Affordable Care Act through Covered California. It’s the only place to get federal premium assistance to help pay for private insurance from companies, or get health insurance through the state’s Medi-Cal program.
There are five plans in San Mateo County that are offering insurance through Covered California. Three are PPOs (Blue Shield of Calfiornia, Anthem Blue Cross, and Health Net) and two are HMOs (Kaiser Permanente Medical Group and Chinese Community Health Plan).
To apply for coverage or simply learn more about Covered California, please visit CoveredCa.com or call 800-300-1506.