Health Care Reform Information
Reform Basics
Note: Health Care Reform is extremely complex and implementation is dynamic with new laws and rules being issued constantly.
This page represents a good faith effort to aid in understanding the changes.
This page represents a good faith effort to aid in understanding the changes.
What Are The Exchanges?
The Patient Protection and Affordable Care Act (PPACA) or otherwise known as the "Affordable Care Act" (ACA) or "Obamacare" requires that beginning in 2014 all U.S. Citizens have a certain minimum level of health insurance or else be penalized by the government.
The Federal government mandates that each state set up an 'Exchange' or 'marketplace' where standardized plans be offered for sale to the public. Some states, like California, are setting up their own exchange, other states will accept a Federally run exchange, and some other states will have a hybrid system. Each state will have two separate exchanges: one for individuals and families to buy coverage, and one for qualified small businesses to buy coverage for their employees.
In California, the Exchange is called 'Covered California' with the small business Exchange being known as the 'SHOP', or Small Business Health Options Program.
What Do Plans Look Like?
Plans offered on the Exchanges are standardized into four 'metal levels' or tiers: Bronze, Silver, Gold, and Platinum. These tiers represent 'actuarial values' or theoretical amounts of health expense coverage. So, in other words, Bronze will cover 60% of health expenses, Silver will cover 70% of expenses, Gold 80%, and Platinum 90%. Total calendar year out of pocket expenses will be controlled by a fixed 'Out of Pocket Limit' however.
There will also be a cheaper, higher deductible 'Castastrophic' plans for persons under age 30, and those demonstrating a financial hardship (income is greater than 400% of FPL, but the calculated premiums are greater than 8% of household income).
Those with low incomes may qualify for Enhanced Silver plans with actuarial values ranging from 73 to 92.
What Will The Costs Be?
Costs will be determined by your age, geographic location, your household income, number of people in your household, and the plan you choose. Costs are also calculated to ensure that the oldest person (age 64) doesn't pay more than 3 times what the youngest person (age 18) pays.
One big change is that family rates used to stop rating at two children, so the third child and up was free. Now, ACA rules say that three children must be rated for, with the 4th and up free. The bottom line is that families with three or more children will see their monthly rate go up by $150 to $200 per month, just to cover the cost of the third child.
Covered California Individual Exchange has a Shop and Compare Tool to help estimate your family's costs based on income.
How Do I Sign Up?
Get help and guidance for free with a Covered California certified health insurance agent. Online enrollment, and other community groups assisting with enrollment will also be available.
The Patient Protection and Affordable Care Act (PPACA) or otherwise known as the "Affordable Care Act" (ACA) or "Obamacare" requires that beginning in 2014 all U.S. Citizens have a certain minimum level of health insurance or else be penalized by the government.
The Federal government mandates that each state set up an 'Exchange' or 'marketplace' where standardized plans be offered for sale to the public. Some states, like California, are setting up their own exchange, other states will accept a Federally run exchange, and some other states will have a hybrid system. Each state will have two separate exchanges: one for individuals and families to buy coverage, and one for qualified small businesses to buy coverage for their employees.
In California, the Exchange is called 'Covered California' with the small business Exchange being known as the 'SHOP', or Small Business Health Options Program.
What Do Plans Look Like?
Plans offered on the Exchanges are standardized into four 'metal levels' or tiers: Bronze, Silver, Gold, and Platinum. These tiers represent 'actuarial values' or theoretical amounts of health expense coverage. So, in other words, Bronze will cover 60% of health expenses, Silver will cover 70% of expenses, Gold 80%, and Platinum 90%. Total calendar year out of pocket expenses will be controlled by a fixed 'Out of Pocket Limit' however.
There will also be a cheaper, higher deductible 'Castastrophic' plans for persons under age 30, and those demonstrating a financial hardship (income is greater than 400% of FPL, but the calculated premiums are greater than 8% of household income).
Those with low incomes may qualify for Enhanced Silver plans with actuarial values ranging from 73 to 92.
What Will The Costs Be?
Costs will be determined by your age, geographic location, your household income, number of people in your household, and the plan you choose. Costs are also calculated to ensure that the oldest person (age 64) doesn't pay more than 3 times what the youngest person (age 18) pays.
One big change is that family rates used to stop rating at two children, so the third child and up was free. Now, ACA rules say that three children must be rated for, with the 4th and up free. The bottom line is that families with three or more children will see their monthly rate go up by $150 to $200 per month, just to cover the cost of the third child.
Covered California Individual Exchange has a Shop and Compare Tool to help estimate your family's costs based on income.
How Do I Sign Up?
Get help and guidance for free with a Covered California certified health insurance agent. Online enrollment, and other community groups assisting with enrollment will also be available.