What’s in the Affordable Health Care Act for You?

Regardless of the Federal shutdown, the Affordable Care Act rolled into effect on Tuesday, October 1, allowing eligible Californians to purchase affordable healthcare called Covered California.

At a Thursday luncheon hosted by the Pasadena Area Women’s League of Voters, UCLA Professor Gerald Kominski spoke about who the Affordable Care Act impacts and what it will provide, addressing “What’s in it for You?”

So who is eligible? The governmental mandate will give affordable health care based on income for individuals and families up to 400% of the Federal Poverty Level (FPL). An idea of 400% FPL would be a single person making $45,960 or a family of four with an income of $94,200 or less.

The second part of the eligibility is the insurance is for those who currently purchase insurance on their own and not through an employer. That makes for 6.5 million Californians under the age of 65 eligible to purchase Covered California insurance.

If you already have affordable health insurance through your employer than no action is required and the Affordable Care Act will not affect you.

Anyone who currently receives insurance with MediCal will not be effected and will keep the same health insurance plan with only slight modifications including eliminating the “doughnut hole” eventually and a small expansion of MediCal Part C.

However, extended MediCal coverage plays a large role in the Affordable Health Care roll-out. Starting January 1, 2014 the only eligibility requirement to enroll in Medicare is to be under the poverty line, paving the way for even the homeless to have insurance coverage with the free plan.

“The homeless can be insured on MediCal, that’s what I think is a big deal,” member Jackie Knowles said.

The only people who will continue without health insurance are undocumented residents, as proof of residence and a photo id is required to purchase the new affordable healthcare. Kominiski estimated there to be about 1 million undocumented and uninsured residents in California.

Under the new law that went into effect, everyone is required to purchase insurance, whether through employer or Covered California, and report it on federal taxes. Those who are not compliant will have to pay a penalty. In 2014 the penalty will be $95 added to taxes submitted without health insurance. In 2016 the penalty spikes up to $695 per person in a household who does not have health insurance.

“The government is hoping that will be enough incentive for everyone to have health insurance. Either you pay the penalty and get nothing, or pay a little more and receive insurance,” Kominski said.

What is the cost? Kominiski gave an example for a 40-year old man what the example costs look like, however, the costs are based on a sliding scale on income, age and geographical location. The sliding scale cost will start at 2 percent of a low-income household and increase to 9.5% for the higher income households who are still under the 400% FPL.

The Covered California healthcare will be available in a range of four levels starting with the bronze level which has a low monthly payment but high co-pay and high deductible up to the platinum which will have no deductible, low co-pay, but a higher monthly payment.

However, each policy plan, whether bronze, silver, gold or platinum must provide exactly the same services. The only difference is the price. The prices will also vary on which provider is chosen.

For an example, a 40-year-old man living in Region 16, or the ‘South Los Angeles County’ which includes everything except Palm Desert area, could choose Kaiser Permanente as his provider at the bronze level and have a premium of $245 before subsidies, one of the more expensive bronze level options. Or he could boost up to the platinum option by choosing Health Net and pay only $311 for much smaller co-pays.

Remember that age, regional area, and income will affect the prices, however, it is now illegal to base the price on a person’s health history.

What should I know about when I start looking for a plan? An important question to ask is “What doctors and hospitals are offered in my plan?” The trend, according to Kominski is that insurance companies are narrowing their networks to limited hospitals and doctors, much like how Kaiser Permanente works. Thus, the insurance you choose in the new plan will determine which doctor you can visit, so if you have a preference of doctor than you need to look closely at the insurance plan.

What benefits are included? All policies must include essential health benefits, limits on annual out-of-pocket spending, no-cost coverage for preventative services, no annual or lifetime dollar caps on benefits, and cannot charge for pre-existing conditions.

“It’s a very generous benefit package, very similar to the type of insurance you would receive if you were working for a big business like UCLA and even better in some regards,” Kominski said.

Essential Health benefits include: Ambulatory patient care, Emergency Services, Hospitalization, Maternity, Mental Health, Prescriptions, Rehabilitation, Lab tests, Preventative Services, and Pediatric dental and optometry.

Companies like Whole Foods and Home Depot are taking away insurance benefits for part time employees to make them eligible for Covered California.

“Last week we already heard that Home Depot and Whole Foods will stop providing health insurance benefits to their part time workers in order for them to qualify for subsidies in the exchange,” Kominski said.

As director of the Center for Health Policy Research, Kominski said studies show that 25 percent of people who currently purchase insurance on their own will be negatively impacted.

“This is the best we can do in our current political situation. The new plan will not necessarily benefit everyone and some will not be better off, but worse off than before,” Kominski said.

A woman in the audience raised questions about her daughter’s family who is in so much debt they cannot currently afford healthcare for their family. Now they will be forced to pay money they do not have to buy health insurance or be forced to pay a penalty. Kominiski was very sad to hear about the real situation of someone who will be worse-off.

With more that 20,000 assisters hired across the state to find and enroll eligible individuals and families, the state hopes to enroll everyone quickly. To find out your eligibility you can go in person, make a phone call, check their website, or use mail correspondence.

The destination for affordable healthcare is coveredca.com.

The League of Women voters welcomes all ages and stages to join their lively luncheons once a month on Thursdays. The league is not limited to women and seeks to educate their members about the issues at stake rather than dabble in political sides. They care about helping the common good and so host luncheons to either advocate a cause or educate about important issues like the Affordable Care Act. Find more about the League on their website http://lwv-pa.org/.