A handful of local residents attended a presentation at the Signal Hill Council Chamber on Saturday, Dec. 7 to get an update on options available through Covered California, the state-run health-benefit exchange that was rolled out this year to help individuals comply with the Affordable Care Act (ACA).
Jasmin Ramirez, a certified health educator for Fresno-based nonprofit California Health Collaborative, gave a Powerpoint presentation and answered questions on the new law that requires all legal citizens obtain health coverage by next year or face a penalty.
Signal Hill Vice Mayor Ed Wilson, a certified public accountant who is running for the 70th State Assembly District next year, said the City organized the event strictly to provide residents with accurate information on the ACA’s new mandates and what is available through Covered California.
“We’re going to give you the real facts,” he said. “It may be modified years later or next year, but we do know this is what it is right now.”
After changes were made earlier this year, all uninsured legal citizens now have until Dec. 23 to enroll in a health plan for coverage starting Jan. 1, when the law, also known as Obamacare, officially goes into effect, Ramirez explained. Those who haven’t enrolled in a plan by that date won’t be penalized until March 31. After that time, however, the fine for being uninsured is $95 and the penalty rises annually thereafter, she said.
“You have a pretty open window in terms of being able to apply and get the ball rolling,” Ramirez said. “You still have time to look at different options if you’re not satisfied yet. We definitely don’t want anybody to just jump the gun and choose something just to have something.”
She said Covered California is considered the “leading” state-operated health-benefit exchange in the country for implementing the new health-care reform law. The exchange provides a “marketplace” for individuals to enroll in a health plan, whether through the State’s website (coveredca.com) or through a local services center.
Ramirez said Covered California also has call centers dedicated to helping individuals who recently had their health insurance dropped because it didn’t comply with the law.
Health-plan enrollment is currently only offered to individuals, as the Small-Business Health Options Program (SHOP), in which businesses with 50 or fewer full-time employees are able to purchase small-group health-insurance plans and may qualify for federal tax credits, has been delayed until November 2014. Large businesses with 50 or more employees will be required to cover employees’ health insurance by 2015.
Ramirez noted that it’s important to log on to the right website when obtaining resources or providing personal information, since there are numerous fraudulent sites that are spreading misinformation and may be identity-theft scams.
According to a Dec. 3 press release from Covered California, a total of 431,756 individuals had enrolled in the state exchange through Nov. 30. Earlier this year, Covered California estimated that more than 5 million individuals in the state were uninsured and 2.6 million individuals, who don’t receive insurance assistance through their employer or the government, were eligible for federal subsidies offered through the exchange.
In Los Angeles County, six health-insurance providers are offered through Covered California. These include Anthem, Blue Shield, Health Net, Kaiser Permanente, L.A. Care and Molina Healthcare.
Under the state exchange, each provider offers five health-plan tiers: bronze, silver, gold, platinum and catastrophic. The tiers are categorized from cheapest (with low monthly co-pays and high premiums) to most expensive (high monthly co-pays and low premiums) based on a person’s health-care needs.
“Every health plan has its own set of co-pays that you’re working with,” Ramirez said. “So it’s up to everybody to take that ownership and really look into the details of what you’re looking for and what you want out of the health plan. Everybody’s going to have a health plan that is different in comparison to everybody else because everybody has different needs.”
A benefit to enrolling in Covered California is being able to receive federal premium assistance, which is based on income, age, residency and household size. However, not everyone is eligible for the federal subsidy offered through the state exchange, she explained.
Eligibility for financial assistance on monthly payments through Covered California ranges from a single person making between $15,860 and $45,960 a year to a household of five with an annual income of $38,050 to $110,280.
Households with incomes less than those thresholds are not eligible for financial assistance and would qualify for Medi-Cal coverage instead, Ramirez said.
“In California, Medi-Cal has expanded,” she said. “A lot of individuals who did not qualify for Medi-Cal now have the opportunity to apply for services.”
Ramirez added that individuals who fall into this category still have the option of enrolling in Covered California but won’t get the monthly financial assistance.
Factors that won’t be determining rates under the new law, however, are a person’s health status, gender, “preexisting conditions” and tobacco use, Ramirez noted. Prior to Obamacare, however, these considerations dictated health-plan rates.
During the presentation it was brought up that, under the new law, the cost ratio between young and old individuals has been condensed in that young people will be paying higher fees to cover the cost of elderly people who often need more expensive care and treatments. One resident pointed out, however, that young individuals would still be paying less than older people.
Under the ACA, all health-insurance providers are required to cover 10 “essential health benefits,” which include doctor visits, hospitalization, emergency care, maternity care, pediatrics, prescriptions drugs, medical tests, mental health care and preventive-care services, such as mammograms and colonoscopies.
Ramirez said Covered California offers certified enrollment counselors who provide individuals with information on all of the options offered under the state exchange, however, she added that individuals also have the option of consulting their own private insurance agents as well.
“Everybody is welcome to call wherever you want,” Ramirez said. “It could even be an agent outside of Covered California, if that’s what you choose. You have the option of choosing any type of health insurance as long as you choose [one that complies with the ACA] you won’t be penalized the $95 next year.”
She said the IRS is expected to monitor each person’s compliance with the new law starting next year after tax season.