Affordable Health Insurance is Within Reach
The Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010 with the goal of making health care more affordable and accessible. The law has several different provisions that have allowed millions of Americans to gain vital health care services. California has been a leader in ACA implementation.
Californians can enroll in coverage through Covered California, the state’s health insurance marketplace. Open enrollment will begin on November 1, 2015 and ended on January 31, 2016. The first date for 2016 coverage to begin is January 1, 2016. If you experience a life-changing event, such as the loss of a job, death of a spouse, or birth of a child, you are eligible for a special enrollment period within 60 days of the event. If you are eligible for Medi-Cal, you can enroll anytime throughout the year through the Covered California website.
Covered California has made it easy to find and compare health insurance options through its website, www.coveredca.com. This online marketplace allows consumers to shop and compare health insurance choices, and learn about the options available in California. Through the Covered California website, the cost-estimate calculator allows you to determine your eligibility for low-to-no-cost health insurance through Medi-Cal or whether you qualify for federal financial assistance to purchase private insurance; then you can go ahead and purchase coverage online. If English is not your first language, Covered California has fact sheets and paper applications in many other languages.
FOR SMALL BUSINESS OWNERS AND THEIR EMPLOYEES:
Covered California has options for small business owners and their employees, too! The small business marketplace has increased the affordability of coverage while simplifying choices, expanding employee options, and providing small business owners with more control over how they can purchase health insurance for their employees. Find out more information on how Covered California makes it easier to compare a variety of qualified, competing health plans from private insurance companies.
How Could the Affordable Care Act Change My Insurance?
These provisions of the ACA have made it easier for people with families to get health insurance and medical care:
- Essential Health Benefits – all health plans must provide a comprehensive package of items and services, known as Essential Health Benefits. These benefits fit into 10 categories:
- 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 dental and vision care
- Insurance Protections for Pre-existing Conditions – insurance companies must cover the consumer even if he or she has a pre-existing condition, regardless of age.
- Young Adult Coverage Until Age 26 – young adults can stay on their parents’ health insurance plans until they are 26 years old. It does not matter if young adults are married, living outside of the home, in school, or financially independent.
- Free Preventative Care – If you have a health insurance policy that began on or after March 23, 2010, many preventative services are covered for free.
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- Some of these preventative services include:
- Autism screenings
- Breast and Cervical cancer screenings
- Diabetes and Cancer screening
- Folic Acid supplements and Breast Feeding supplies
- Screenings and Counseling (including obesity, tobacco/alcohol use, and depression)
- Sexually Transmitted Disease Counseling and Screenings
- Vision and Hearing screenings for youth
- For a complete list of free preventative services, visit https://www.healthcare.gov/what-are-my-preventive-care-benefits/
- Insurance Companies Cannot Refuse Coverage – Insurance companies cannot deny you access to health coverage because of a small error or technical mistake on your insurance application.
- Appealing Health Plan Decisions – If your insurance provider will not pay for a service or treatment that should be covered, you have the right to ask your health insurance provider to reconsider the decision not to pay. Insurance companies must follow this rule for policies or plans created on or after March 23, 2010.
- No More Lifetime Limited Coverage – Insurance companies cannot limit the amount of money they will pay over the course of your lifetime (lifetime dollar limits) for most health benefits. Plans created on or after September 23, 2010 must follow this rule.
- Closing the “Doughnut Hole” – Medicare is the government’s health insurance plan for people over age 65. Before 2011, many people who had Medicare’s Prescription Drug Plan (Medicare Part D) would experience a gap in coverage each year. For example, Medicare might pay for a person’s medicines for January through March and September through December, but the person had to pay full price for his or her drugs during April, May, June, July, and August. The period of time during which a person had to pay for his or her own drugs is called “the doughnut hole.” The ACA gradually closes the doughnut hole: If you reach the coverage gap in your Medicare (Part D) coverage in 2014, you automatically received a 52.5 percent discount on covered brand-name drugs and a 28 percent discount on generic drugs, instead of paying full price for them. The amount of the discount for generic and name brand drugs will continue to increase through 2020, when the doughnut hole will be eliminated.
- No More Denials of Coverage – Insurance companies cannot refuse to cover you because you have a pre-existing condition. Individuals who were enrolled in a Pre-existing Condition Insurance Plan will be able to use Health Benefit Exchanges to shop for and buy health insurance.
- No More Discrimination – Insurance companies cannot refuse to cover you or charge you a higher rate because of your gender or current health status.
- No More Annual Dollar Limits – It is illegal for insurance companies to limit the amount of money they will pay for each year for services covered by your health plan.