If you’ve landed on this page, you may be wondering how the Affordable Care Act works in California. The 2010 Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA) or Obamacare, is a health care reform meant to make health insurance accessible and affordable to all. It provides Californians with better health security by setting up modifications that expand coverage and lower health care costs. It also ensures more choice and enhances the quality of care for all.
The law has created marketplaces, popularly known as exchanges, where consumers can compare plans in an easier format. There are two kinds of marketplaces and the type you access will depend on the state where you live. There is the federal health insurance exchange (also known as Healthcare.gov), and then there are state-run marketplaces. California has its own state-run ACA marketplace, also known as Covered California.
The ACA overhauled America’s health care system, reducing national health care costs for individuals, families and the government. It addressed patients’ rights and protections and created new rules for the insurance industry.
The ACA’s goals are to minimize the number of uninsured by making health care more affordable and improving the quality of available care. Now all U.S. citizens, including legal immigrants, have access to health insurance.
People refer to the Affordable Care Act by many different names:
Historically, the U.S has spent considerably more on its health care compared to other high-income countries in the world. Before the ACA, the Medicare and Medicaid Act of 1965 was the last extensive U.S. health care reform legislation.
Some say that attempts to bring about reform go back to 1989 when the Heritage Foundation proposed an individual mandate and a market-based approach for health care. This proposal addressed the issues created by the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1986, which required nearly all hospitals to provide emergency care to all who needed it, regardless of their ability to pay.
The cost of treatment for those unable to pay was often passed to the government and individuals through higher insurance premiums and higher taxes. From 1989 through 2008, legislators proposed many attempts at health care reform. However, these attempts to effect any significant health care legislation failed.
President Obama made a big push in 2009 to have Congress construct the PPACA, a new health care reform law modeled in part on the Massachusetts Health Connector and the Healthy Americans ACT (HEART). The following topics were controversial subjects as the new law was being formed:
The U.S. House and the Senate debated these health care reform issues until the ACA was finally signed into law on March 23, 2010.
Types of Health Plans on the California Health Exchange
The health plans offered on Covered California are divided into four metal tiers. The metal tiers reflect the costs you’re expected to pay in each category. They don’t have anything to do with the quality of care you will receive.
The metal tiers are as follows:
Covered California also offers Enhanced Silver Plans for individuals with limited income who qualify for lower out-of-pocket costs. With Enhance Silver Plans, eligible individuals who enroll in the Silver plan get the benefits of Gold and Platinum plans but at the price of a silver plan.
Enhanced Silver Plans are divided into three categories:
This is another coverage option you can qualify for if any of the following is true:
All the health plans sold in the Covered California marketplace must meet the minimum coverage requirements. These requirements include:
The Affordable Care Act does leave two forms of insurance for adults out of its provisions — vision insurance and dental coverage. Although both of these services are considered essential benefits for children under the ACA, they are not included for adults.
Still, vision insurance is important coverage that you may consider adding to your plan. Supplemental dental coverage is also beneficial. Adults in California can purchase dental and vision coverage as health insurance supplements or stand-alone plans.
Obamacare in California came when many people found that the costs of medical care kept them from accessing it. Obamacare in California put policies in place that made medical coverage more accessible to everyone. You’ll find the following protections for patients in the ACA California:
Because of the new law, people need to be aware of important factors such as income, tax filing status and where and when to apply.
Health insurance is mandatory for everyone in California and you might be subject to a penalty if you don’t have it. However, low-income California residents qualify for help with their health care costs. Depending on your income and eligibility, you may qualify for lower premiums. In addition to premiums, you may also be eligible for cost-sharing reductions, including coinsurance, copayments, deductibles and out-of-pocket maximums.
To get these savings, you should enroll through Covered California. Remember that those who qualify for cost-sharing reductions must enroll in Enhanced Silver Plans. These plans automatically enable you to pay lower coinsurance, copayments, deductibles and out-of-pocket costs.
To qualify for financial assistance, you must:
You’ll also need to present a few documents before enrolling in California’s Obamacare:
If you are looking for health insurance in California, visit Covered California, the state health insurance marketplace. Alternatively, you can use our online services at Health for California to get free, instant quotes for health insurance plans from top insurance providers in California.
It’s best to take advantage of the Open Enrollment Period for Obamacare in California so that you are not shut out. At Health for California, we offer guidance and insurance plans so you can get the coverage that best fits your needs. You can also find supplemental dental and vision insurance plans for your entire family through Health for California. Just fill out our confidential form to get started. No contact information is needed, and you’re under no obligation to buy.
