The Affordable Care Act (ACA) was passed in March 2010. Its intended purpose was to provide access to health insurance for the entire country by providing subsidies to low-middle class individual and families and removing health underwriting. Effective 1-1-14 no person can be declined for any pre-existing health condition. Additionally, everyone is required to purchase health insurance or pay a fine.

When does Obamacare start? When can people apply?

In California, the ACA is called Covered California. The “exchange” market opens to individual/families to submit applications from October 1 through 12/31. All applications (regardless of submission dates) will have a January 1st effective date.

The president promised (3) things that the ACA would provide to help the American people. You can keep your plan if you like it (2) you can keep your doctor if you like him/her and (3) the price of insurance would go down by $2500 per family per year. Is this true?

Well that is an interesting question. The law states that all plans in 2014 must have a deductible of $2000 or less. If you plan (even if you like your plan) has a deductible greater than $2000 you will be kicked off you plan and forced to a plan with a deductible of $2000 or lower. Thus if you had a $3000 deductible your premium will be going up significantly because you are lowering your deductible by $1000. Additionally, the ACA mandating specific benefits such as unlimited office visits on all plans. Therefore, the basic-catastrophic plans that we sell in 2013, which are in expensive do not comply with the mandated benefits. Therefore, for many people the price is going to increase significantly. Lastly, all plans sold in the Exchange (Covered California) are limited network plans. Meaning limited doctor choices. So, if you purchase a plan in the Exchange your doctor may have chosen not to accept the lower reimbursement rates in the smaller networks. So, the promise of “keep my doctor” may not always be true. So really time will tell is the “affordable care act” does bring down the cost of insurance-it is too early to tell.

We have heard this term call subsidies that are available to help families pay for the higher premiums. What is a subsidy and how does a person find out if they are eligible?

Subsidies are available only in the exchange and are based off income. In other words you cannot keep your plan and get a subsidy-you need to purchase in the exchange. For lower income folks (under $15k) the subsidies are rich and will cover 100% of the premium. From $15k-30k the subsidies decline on a sliding scale. There are subsidies for individuals up to $42k for individuals. However, they are very small over $30k. Subsidies are calculated by your 2012 gross adjusted household income and the number of people in the home.

How do I find out more about the plans and if I am eligible for a subsidy?

We are here to help. That is our role as a certified enrollment agency. You can visit our web site at or call us at 877-840-0554. There is a 2-step process to apply for both subsidy and plans. The first is an IRS application to find out how much you are eligible for and the 2nd is to apply those dollars to a health insurance plan in the Exchange. The nice thing is that if you do get a subsidy you pay only the adjusted premium after the subsidy is applied. In other words if you choose a plan that costs $200 and you are eligible for $125 in subsidy your premium is $75 per month. We can help you over the phone with our subsidy calculator and if you are not eligible we simple submit your health insurance application “off” or out of the exchange.

Are the plans the same in and out of the Covered California Exchange?

Yes, the plans and premiums by carriers are the same. The only reason to submit in the exchange is if you are subsidy eligible.

What carriers are available in California?

There are (4) carriers “In” the exchange to choose from. Anthem Blue Cross, Blue Shield, HealthNet and Kaiser. All offering both PPO and HMO with the exception of Kaiser, which is a HMO carrier that does not offer PPO

Can I drop my coverage with my company plan and go in to the exchange?

Yes. However, if your company offers affordable coverage, which is calculated as the employee premium cost does not exceed 9.5% of; his/her gross income than you cannot leave your group plan and enter the exchange market for a subsidy. Additionally, if you leave your group plan this may affect the groups’ participation requirements. But, in general I would say that many small groups may see some of their employees leave the group plan based off their low income and go to the individual market to capture a subsidy, which is greater than the employer contribution toward their premium.

If you have more questions please call us at the office at 877-840-0554. You can also visit our company “home” web site at Thank you for visiting our site.