Affordable Care Act
The Patient Protection and Affordable Care Act of 2010 is now in full effect, as of January 1, 2014, bringing accessible and affordable healthcare to millions of Americans, including many who live right here in our community.
Now everyone has the right to obtain reasonably-priced health insurance even if they have been denied it in the past due to a pre-existing condition. It also expanded the eligibility for Medi-Cal coverage to more low-income persons.
The initial open enrollment period ended in March, but will be open again from November 15, 2014 through February 15, 2015. Individuals may also qualify for Special Enrollment Periods outside of Open Enrollment if they experience certain events, such as the loss of a job and employer-paid insurance, marriage or the birth of a child.
Depending on your financial circumstances, you may be eligible for tax credits, cost-sharing subsidies or Medi-Cal coverage, which has been expanded to greater numbers of Californians. If you are an individual between the ages of 19 and 64 earning less than $ 15,860 per year, you would be eligible for free health services under Medi-Cal and will be referred to your County for enrollment. If you earn between $ 15,860 and $ 32,500, you would be eligible for assistance with your insurance premiums, if you purchase your plan through Covered California.
A helpful calculator from the Kaiser Family Foundation can help you determine if you are eligible for assistance and estimate how much you would actually pay for insurance offered through the exchange. Click here to visit their website.
Click here to visit the official Covered California website to learn more about the program and your options. You also can call their toll-free number, 1-800-300-1506, to speak with someone in your preferred language, who can guide you through the information and the enrollment process.
The wide-ranging benefits of the Affordable Care Act for you and your family include:
- Standardized health plans that must include certain benefits, regardless of who the insurance carrier is, making it easier to compare prices
- Insurance companies may no longer deny coverage to anyone because of pre-existing conditions.
- Insurance companies may no longer impose annual dollar limits on benefits.
- Expanded list of drugs available at a discount for seniors reaching the “donut hole” in their prescription coverage
- Insurance companies may no longer deny coverage to children under 19 because of pre-existing conditions.
- Young adults are allowed to remain on their parents’ plan until they turn 26.
- Insurance companies may no longer deny payments due to a technical mistake or error on a patient’s application.
- Insurance companies may no longer impose lifetime limits on coverage for essential benefits, such as hospital stays.
- Tax credits for small businesses (fewer than 25 employees) and non-profits to help them provide coverage for their staff. (At least 90% of all Yuba-Sutter businesses are small enough to qualify.)
- Tax-free rebate checks of $250 to seniors as they reach the “donut hole” in prescription coverage, and 50% discount on certain brand-name drugs.
- Free wellness visits and preventive care for seniors on Medicare.
- All new health plans must cover preventive services such as colonoscopies and mammograms, with no deductible or co-pay.
- Insurance companies must spend at least 80% of premiums on benefits and quality improvement or give rebates to policyholders, and must justify premium increases.
For details about these benefits, visit the links below:
- The official U.S. website for information about the Affordable Care Act: www.healthcare.gov
- Wellness and Prevention – this site guides you to resources to help you keep healthy, including free preventive services provided under the ACA: www.healthfinder.gov
- For Seniors and those about to turn 65: www.medicare.gov