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Covered California is coming, the basics you need to know

By Garrett Viggers
Published On: Dec 24 2013 07:55:46 AM CST
Updated On: Sep 30 2013 04:14:10 PM CDT

Just around the corner on October 1, open enrollment for California's Health Insurance Marketplace Exchange (A.K.A. Covered California) begins. On January 1, the "Individual Mandate" rolls out. This will require citizens to be covered on a health plan or pay a small penalty.

Well, what is a Health Insurance Marketplace? This will be a new way for individuals and families to shop for health insurance in the new world of guarantee-issue coverage.

This means, effective January 1, you can no longer be denied coverage due to medical conditions. Much like shopping at a grocery store, you will now be able to look at plans and prices that best fits your needs without being declined or rated up 50 percent based on your health.

This is a huge shift from only employer group plans offering guarantee issue. Covered California also has options for small businesses as well, but let's take a look at 10 things individuals and families need to know:

  1. Open enrollment begins October 1 through March 31 and coverage takes effect January 1 as long as you complete an application by December 15.
  2. Covered California is a marketplace for individuals and families to shop for a private individual health plan (Anthem, Blue Shield) with the option of a tax credit (A.K.A. premium assistance) to help cover the monthly premium.
  3. Eligibility to receive premium assistance is based on annual household income and family size.
  4. A single earning between $15,857 and $45,960 would be eligible for premium assistance (incomes below will be eligible for Medi-Cal).
  5. A family of 4 earning between $32,500 and $94,200 would be eligible for premium assistance (incomes below will be eligible for Medi-Cal).
  6. Premium assistance through Covered California is only available if you don't already have access to an affordable health plan through your employer or on Medicare (Note: If you are currently covered on an individual policy you would be eligible to apply for premium assistance).
  7. There are four standard categories of health plans, otherwise known as "metal tiers." Bronze, Silver, Gold, Platinum. Anthem and Blue Shield will have options available in each metal tier. (NOTE: Under 30 adults are eligible to enroll in a "Catastrophic" Plan that is less expensive than the Bronze Plan).
  8. All health plans offered through Covered California include these Essential Health Benefits: ambulatory patient services (i.e. X-rays, blood tests, immunizations), hospitalization, emergency services, maternity and newborn care, mental health, prescription drugs, rehabilitative services, laboratory services, preventive and wellness services and chronic disease management, and pediatric dental and vision care.
  9. If you are looking for a health plan through Covered California, make sure you see if your doctor is a part of the network. In our area, Anthem and Blue Shield will have smaller networks than the current networks in place.
  10. Licensed insurance agents that are certified with Covered California will be able to serve you with the ability to shop and compare plans available in Covered California as well as outside the marketplace. Shasta County also has local community based "assisters" available to help with enrollment and checking eligibility for premium assistance.