You've probably seen the headlines about the new health plans that will be available under the Affordable Care Act. One of the requirements of the act is that virtually everyone in the United States has to have health insurance by Jan. 1, 2014.
If you already have health insurance through your workplace or a family member’s employer, or if you are covered by a government program such as Medicare or Medicaid, you probably won’t need to make any changes. However, if you do not have health insurance, or you have an individual plan that is changing, you will have to purchase it either from a private insurance company directly or through the state-operated “health exchange,” known in this state as Covered California.
“There has been a lot of speculation on how well the exchange system is going to work – about who will sign up and how robust the markets will become,” said Chris Van Gorder, president and CEO of Scripps Health. “But no matter what happens with the exchanges, health care in this country is already changing and must keep evolving, because it’s broken. This crisis presents a challenge and an incredible opportunity for physicians and hospitals to fundamentally reshape the future of health care.”
Visitors to the Covered California website -- www.coveredca.com – will be able to view and compare the various types of health insurance coverage for which you are eligible. Different types of health plans are available from various health insurance companies, but under the Affordable Care Act, all plans offered through the exchange must provide basic health care benefits, along with preventive and wellness services, chronic disease management, prescription drugs, laboratory testing, mental health benefits and other services. Also, your coverage under these and all health insurance plans can’t be canceled or denied because of a pre-existing medical condition or if you get sick.
You have a choice of different benefit levels and premium costs.
The exchange plans are divided into four basic coverage levels: Platinum, Gold, Silver and Bronze. You can compare plans in the same coverage level or across levels. A higher monthly premium means your out-of-pocket cost for your actual care will be lower. Conversely, if you choose to pay a lower monthly premium, you will pay more when you actually receive medical care.
Once you have chosen a plan on the Covered California website, you can enroll online as well. The open enrollment period began Oct. 1, 2013 and ends March 31, 2014. Coverage will become effective on Jan. 1, 2014.
What if you want to keep your physician?
If you want to stay with the physician you have now, call the office and ask which exchange plans he or she will be participating in. For example, if you have a Scripps physician, you can keep your physician and receive care from Scripps hospitals and clinics through exchange plans offered by Blue Shield and by Health Net’s Bronze PPO.
Do you qualify for financial assistance?
The government will offer financial assistance in the form of federal tax credits and cost-share subsidies to help qualified individuals (based on income level) pay their insurance and health care costs. Covered California will help you find out if you are eligible for financial assistance that helps to reduce your health care costs. For more information on the health exchange and its available plans, visit the Covered California website or call Covered California toll-free at 800-300-1506.
“I expect the implementation of the exchange may be a bit messy at first, but that everything will be worked out with time,” Van Gorder said. “But while the ACA and its initiatives may not be perfect, it is the law of the land, and it is a step toward addressing this nation’s health care problems. The fact that health care costs this nation so much – it amounts to some $3 trillion a year – and still 48 million people go without coverage is unacceptable.”