Effective January 1, 2014 most people will be required to have health care coverage!
Today, you can have a fabulous expendable income and not even be able to buy private health insurance if you have what the insurance company considers a “pre-existing condition”. If you get sick and need extensive treatment, your insurance company can stop paying your expenses because you have reached your annual limit. You can be charged more for your coverage because you are woman. All these disastrous scenarios’ will change dramatically on January 1, 2014!
The Affordable Care Act (ACA) often referred to as “Obamacare” has already produced tremendous benefits for people, although the political rhetoric in the media has many people confused. A recent Kaiser Family Foundation Health Study indicated 42% of people are unaware the ACA is actually the law, including 12% who believe Congress repealed it and 7% who think the Supreme Court overturned it.
Mendocino County residents are particularly vulnerable, given the Healthy Mendocino Community Dashboard which indicates that only 54% of adults, ages 18-64, have health insurance through their employment or privately purchased. Twenty two percent of people in this age range are totally without access to health insurance at all. These statistics were from 2009; before the recession blasted our region, so current circumstances may be worse.
Benefits already realized include:
- 19-26 year olds have insurance!
- Health plans cannot drop members due to illness!
- Children with chronic conditions cannot be denied coverage!
- The Medicare donut hole, where prescriptions are not covered, is shrinking now & will be gone in 2020!
- “Preventive care” out of pocket costs are eliminated for Medicare & Medicaid!
- Lifetime limits on health coverage are gone!
- Small business tax credits
Effective January 1, 2014 most people will be required to have health care coverage, either with their employer, public benefit programs or purchased through the state health benefit exchange, Covered California. More people will be eligible for Medi-Cal as it limits will increase to 138% of federal Poverty Levels (FPL). Uninsured individuals and families with incomes up to 400% FPL, purchasing through Covered California, are eligible for their premiums to be partially subsidized by the federal government. There is a fine associated for not having insurance, although there are exceptions including if coverage costs are greater than 8% of your income.
Enrollment in Covered California begins October 1, 2013, although coverage is not effective until January 1, 2014. There are many avenues for securing information and assistance including community health centers and family resource centers throughout the county. People can apply through staff at the centers, via computer, by telephone or the mail with a 3 page application.
There are 10 Essential Health Benefits that all new policies must cover including:
- Ambulatory patient services (office visits)
- Emergency services & hospitalization
- Maternity & newborn care
- Mental health & substance use services
- Prescription drugs
- Laboratory services
- Prevention, wellness & chronic disease management
- Rehabilitative services & devices
- Pediatric services + oral & vision care
While there are some differences in plans, generally, many preventive services will be available with fewer out of pocket costs and your medical expenses cannot exceed 9.5% of your annual income. Other protections include insurance companies must spend 80% of their income on your health care, you cannot be denied coverage from pre-existing conditions, no gender discrimination and no dollar limits on coverage.
While the insurance requirements for businesses with over 100 full time equivalent employees have been postponed until January 1, 2015, there are benefits for smaller businesses with the Small Business Options Program (SHOP) through Covered California. Qualifying small businesses with less than 50 employees may be eligible for better rates, coverage and tax credits. . Small businesses are not required by the ACA to provide insurance for their employees, so are not subject to fines. If a small business does not offer employee’s insurance, they can acquire it themselves through Covered California.
The two companies providing insurance through Covered California in Mendocino County are Anthem Blue Cross and Blue Shield of California. There will be four different levels of coverage available, depending on your health care needs. They range from paying 60% -90% of costs and have varying co-pay’s and options’. There is an additional less expensive catastrophic coverage option for young people under 30 years of age. Geographical region, age and the level of coverage you want determines your rates.
There are many emerging details on the intricacies of the ACA implementation. Two clear sources for more information, in addition to your community health center, are the websites www.healthcare.gov and www.coveredca.com. There are videos, fact sheets and brochures available in a variety of languages. Spanish speakers may also want to visit www.asegurate.com. Let us celebrate the goal of building a Healthy Mendocino!