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Are you covered for 2014?

The new law requires everyone to have health insurance starting April 1st.



Even those who are healthy today know that they need health insurance just in case. No one can predict when he or she will get sick or have an accident. With the average cost of a three-day hospital stay priced at $30,000, it doesn’t make sense to take the gamble of going without health insurance, particularly if you can find it at an affordable price. Covered California will offer a range of health plans so you can choose the one that best meets your financial and health needs.

What does health insurance cover?

Today, there is a wide range of health insurance policies offering different benefits and access to different doctors, hospitals or other providers. Starting in 2014, all health insurance plans will share some common characteristics. The federal Affordable Care Act now requires that all health plans offered in the individual and small group markets must provide a comprehensive package of items and services, known as Essential Health Benefits. These benefits fit into the following 10 categories:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • 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

The requirement for insurance plans to offer Essential Health Benefits is just one of many changes coming in 2014.

How do I choose a health plan?

It can be overwhelming to find the right health plan for you and your family. Before you get started, it is important to understand another big change happening in health insurance. Starting in 2014, all health insurance newly sold to individuals and small businesses must be classified as one of the four 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.

This system will make it easier for you to compare plans. You can choose to pay a higher monthly premium for a platinum or gold plan so that when you need medical coverage, you pay less. Or you can choose to pay a lower monthly premium for a silver or bronze plan, but when you need medical coverage, you pay more. It’s up to you.

If you need help understanding the levels of coverage and making a choice that works for you and your family, Covered California will have help available in person, online or by phone starting later in the year for coverage that begins on January 1, 2014.

How much does health insurance cost?

Many people who want health insurance are concerned about the cost. Starting in 2014, individuals seeking health coverage will be helped to afford it in three ways:

  1. Tax credits: Tax credits are available to help lower the cost of health coverage for individuals and families who meet certain income requirements and do not have affordable health insurance from an employer or a government program that meets minimum coverage requirements. When you enroll in a health plan through Covered California, tax credits can be immediately applied to the insurance premium, which reduces the amount you pay each month. To find out more about tax credits and how the sliding scale works based on your income, visit here.
  2. Cost-sharing subsidies: Cost-sharing subsidies reduce the out-of-pocket amount of health care expenses an individual or family has to pay. These expenses might includecopayments for health care services or other costs you pay when you get services. To find out more about cost-sharing subsidies, visit here.
  3. Medi-Cal assistance: Starting in 2014, the State of California is planning to expand the Medicaid program (called Medi-Cal in California) to cover people under age 65, including people with disabilities, with income of less than $15,856 for a single individual and $32,499 for a family of four. The coverage is free for those who qualify and part of the provisions of the Affordable Care Act.

Covered California will offer assistance in numerous languages to help you enroll and to provide information about assistance programs and a health plan that best meets your needs.