Sound familiar? These are the questions everyone has regarding the Affordable Care Act and Covered California.

1-Should I Shop the Insurance Exchange?

Yes. Why not take a look? Covered California will offer the “Metal” plans; Bronze, Silver, Gold and Platinum, where consumers can compare the benefits available at each level to (1) shop and acquire health insurance for the 1st time or (2) buy new or replacement coverage. You must be a US Citizen to shop in the Insurance Exchange. If you are not insured as of January 1, 2014, you will pay a penalty.

Additionally, if you have an Individual or Family plan you may be forced off your plan and on to a plan that meets the government’s level of benefits. This is referred to as a “Qualified Plan”.

If you purchased your plan before the Affordable Care Act was signed (March 2010) in to law your plan becomes “Grandfathered” and you are not forced to purchase a qualified plan.

If you are currently insured these are your options for purchasing coverage in 2014.

  • Enroll in the expanded Medicaid/Medi-Cal program.
  • Apply for a government subsidized Exchange plan. Click here to “GET A QUOTE”
  • Purchase a standard health plan outside the Exchange. Click here to “GET A QUOTE”
  • Join a group health plan if offered by your employer.

2-Am I Eligible for a Federal Subsidy?

This is probably the biggest question every Californian will have in 2014. Due to the increases in premiums over the last several years, medical insurance has become un-affordable for some people and families. The Federal Gov’t will determine if you are eligible for a subsidy based off you income level and household size. You are not required to shop in the Exchange. The private insurance market will not go away. However, in order to receive a subsidy you must acquire coverage in the Covered California Exchange.

Following is a reference guide to help you determine the health insurance option(s) that may work best for you.

Find Your Household Size and Gross Family Income
Household Size Column A: 100% FPL (1) Column B: 133% FPL Column C: 400% FPL Column D: Over 400% FPL
1 Up to $11,490 $14,856 $45,960 + $45,960
2 Up to $15,510 $20,628 $62,040 + $62,040
3 Up to $19,530 $25,975 $78,120 + $78,120
4 Up to $23,550 $31,322 $94,200 + $94,200
5 Up to $27,570 $36,668 $110,280 + $110,280
6 Up to $31,590 $42,015 $126,360 + $126,360
7 Up to $35,610 $47,361 $142,440 + $142,440
8 Up to $39,630 $52,708 $158,520 + $158,520
For each additional person, add: Up to $4,020 $5,347 $16,080 + $16,080
Apply for: Medi-Cal Exchange Plans Private Plan, Group Plan or Medi-Cal (2) {if eligible}

Note:
(1) Based on 2013 Federal Poverty Levels from the U.S. Department of Health & Human Services. The poverty guidelines are for contiguous states, including the District of Columbia.

(2) You could have a high income and still qualify for Medi-Cal. Click Medi-Cal Eligibility for more information.

If you’re gross (before taxes) family income is:

  • Below 100% of the federal poverty level (less than Column A above), you will want to contact Medi-Cal to apply for the expanded Medicaid Program.
  • Between 133% and 400% of the federal poverty level (not less than Column B but no more than Column C), you will qualify for a federal subsidy. You more than likely will want to apply for an Exchange plan. Remember though that the higher the income, the lower the subsidy will be. So if group insurance or other coverage options are available, don’t automatically disregard them. Compare the costs and consider the one that is best-suited for your situation.
  • Over 400% of the federal poverty level (more than Column C), you won’t qualify for a government subsidy. You can still apply through the California Exchange, but since a subsidy advantage is unlikely, consider shopping for insurance outside the Exchange. Going through an agent, broker, or directly to the carrier may be better because some carriers are planning to offer additional health plans outside the Exchange and you could find a better option.

3-How much are the ‘Covered California’ Exchange Plans?

Below you will find a direct link to “Get A Quote”. Purchasing Health Insurance via the Exchange does not cost you a penny more. We have a wholesale relationship and have the same plans and prices as going direct. The difference is you have an insurance agent as your advocate. If you have any experience attempting to call or go in person to a government agency to have your questions answered, you know that it’s like standing in line at the DMV, which is not something to look forward to! We answer the phone and will take any and all of your questions. We are here to help. Click on the “Testimonials” link to view our clients’ comments about our service.

4- How do I Choose a Plan? What are the Benefits?

The government is saying it should be easier to choose a plan. However, like most people insurance is overwhelming and confusing. Starting in 2014 there will be four basis levels of coverage: bronze, silver, gold or platinum. In addition, a “catastrophic” plan will be available to those who are under 30 years old or can provide a certification that they are without affordable coverage or are experiencing hardship. If you need help with purchasing or understanding coverage, www.CaliforniaExchangePlans.com is our California Exchange site licensed through CIF Insurance Agency Inc. (CA Insurance License 27-0861009). We can be reached at 877-840-0554. Click here to “GET A QUOTE”.

5-I’m insured now. What should I do now?

The best thing you can do is stay in touch with your insurance broker and watch and listen for important ongoing changes. The news coverage as we approach 2014 will be extensive. If you do not currently have someone who can help you, give us a call at 877-840-0554 and we would be happy to walk through your options with you. Additionally, see our company Facebook page at https://www.facebook.com/CaliforniaInsuranceFinder?ref=hl for current industry news as well as other health related topics. Please click on our Facebook page and “LIKE IT” to stay up to date.

Some consumers who are currently insured will be required to switch to a qualified health plan, and they will be notified as such by their insurance carrier. Should this happen to you, you’ll need to dis-enroll from your current plan (to be effective at the end of 2013) and re-enroll in a qualified health plan for a start date of January 1, 2014. An exception to this is people who are on grandfathered plans, which would be health policies that were effective prior to March 23, 2010, the date Health Care Reform went into effect.

Apply During Open Enrollment: October 2013 – March 2014

Starting October 1, 2013, you can begin shopping for Health Care Reform plans through the California Exchange. You may apply between October 1st and December 15th for an effective date of January 1, 2014. After that, you must apply by the 15th of the month in order to begin coverage on the 1st of the next month. The last day of open enrollment is March 31, 2014. If you apply between March 16th and March 31st, you will be enrolled for a June 1, 2014 effective date.

Once the first open enrollment period is over, you must wait until the next open enrollment period to sign up for a plan. An exception to this rule would be qualifying events such as the birth of a child, an adoption, or loss of coverage.

In October of 2013, you’ll be able to obtain Health Reform Plans. At that time, CaliforniaExchangePlans.com will be available to offer assistance by providing free quotes, explaining benefits and the application process and answering all of your questions.

We are here to help. If you have questions please call us direct at 877-840-0554.