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The California Health Insurance Exchange or Marketplace, which is also known as “Covered California”, is an online website for health insurance. It is mandated under President Obama’s signature universal health care law, which is also known as the Affordable Care Act (ACA) or Obamacare, that all 50 states provide access to insurance marketplaces or exchanges where uninsured and/or underinsured residents can purchase insurance coverage.
Once at the Covered California health insurance exchange, customers will complete a form including basic information about taxable income and family history. Next, consumers will be directed to a cost calculator to determine the costs of insurance after subsidies and/or vouchers are applied, as well as compare benefits and prices of health plan options available. In most cases, individuals and families will have a wide variety of plans to choose from depending on needs, desires, and other perimeters.
Here are some vital facts regarding the ACA or Obamacare structure and insurance protocols for Covered California in 2015:
–The ACA or Obamacare open enrollment period for 2015 commenced on Nov. 15, 2014, and it ended on Feb. 15, 2015.
–During open enrollment, consumers can enroll in a plan, change plans, and/or apply for cost assistance.
–If a customer does not or is unable to obtain insurance coverage during open enrollment, consumers will not be able to use the marketplace again without qualifying for a special enrollment period.
–Not all uninsured or underinsured consumers will be charged a fee or qualify for cost assistance. The structure of the program is income-dependent, so how much one makes will help determine the premiums paid for coverage.
–All health insurance plan options offered on official Obamacare websites must include all the new rights, benefits, and protections of the Affordable Care Act (ACA).
–www.coveredca.com is the official Obamacare website for the State of California.
Under the ACA, Obamacare subsidizes coverage for customers with incomes ranging from 100 to 400 percent of the Federal Poverty Level (FPL), as well as assists with Medicaid and Children’s Health Insurance Program (CHIP) supplemental coverage availability for those individuals below the 138 percent income threshold. For calculating cost assistance for 2015, 400 percent of FPL is $46,680 per annum for a single person, $62,920/yr. combined for a family of two, $79,160/yr. for a family of three, and $95,400 per annum combined for a family of four. The subsidies are issued as refundable tax credits. Additional assistance is also available in the form of Cost Sharing Reduction (CSR) subsidies, which are available on certain health insurance plan options for individuals ranging between 100 to 250 percent of the FPL.
In order to obtain information on subsidies, consumers only need to sign up at the marketplace. Once the customer’s and/or families’ information, along with tax data, is inducted into the system, it will automatically calculate the qualifying subsidies and reflect them when comparing health insurance plan options. Since subsidies are based on expected income, the cost assistance subsidies are subject to change until the end of the year. This is an important aspect to note as people may gain or lose cost assistance as their income fluctuates throughout the year. Individuals in seasonal and/or commission-based jobs can be greatly affected by this aspect of the structure. If an individual’s income does change, make sure to report it to the marketplace so that the subsidies can be promptly adjusted.
Here is a rundown of the information needed to begin the enrollment process. It should be gathered prior to visiting Covered California, which is the state’s official health insurance marketplace. This documentation will help aid the enrollment process as well as provide consumers with a realistic projection of health insurance premiums and plan options. In order to enroll in Covered California for 2015, consumers will need the following items:
–Tax Information for 2014
–Projected Income(s) for 2015
–Medical History–ACA or Obamacare has excluded gender discrimination and pre-existing conditions. Therefore, these factors will no longer affect the cost of insurance premiums. However, factors such as family size, age, and smoking can affect the insurance premiums.
–Social Security Numbers (or naturalization documentation for immigrants)
–Employer and Income Information for every household member applying for coverage (e.g. W-2 forms and/or pay stubs).
–Policy Information for any current health insurance plans covering members of the applying household.
–Completed Employer Coverage Tool for every job-based plan for which members of the household are deemed eligible. The completion of this form is mandatory even for coverage that individuals are deemed eligible for but do not enroll in.
–Any other vital or related information that could affect health insurance premiums or coverage plan options.
Under the ACA or Obamacare, if a person is a California resident, does not have access to reasonably priced health insurance coverage, and qualifies under income requirements, they can use the health insurance marketplace and seek subsidies for coverage at the exchange. Obamacare is particularly desirable for individuals with pre-existing conditions, who might have been considered uninsurable or subjected to outrageous premium costs prior to the passage of this landmark legislation. Even if they do not qualify for tax credits, consumers might find it easier to deal directly with insurance companies than other entities for their coverage needs.
Written and Edited by Leigh Haugh
Obamacare Facts–California Health Insurance Exchange
Covered California–Frequently Asked Questions
Covered California–Tax Penalty Details and Exemptions
Affordable Health California–Health Insurance Q&A