ACA

The Affordable Care Act (ACA), or Obamacare, introduces health reforms that will affect every American's coverage, costs, and care.

Starting January 1, 2014 almost everyone will be required to have health insurance or pay a tax penalty. Some business owners will be required to provide health insurance for employees.

 

In short, the ACA will:

    • Expand coverage,
    • Hold insurance companies accountable,
    • Lower health care costs,
    • Guarantee more choice, and
    • Enhance the quality of care for all Americans.

Coverage

New Coverage Options

In 2014, there will be two new coverage options - Covered California and an expanded version of Medi-Cal.

Medi-Cal (also known as Medicaid)

This program provides free or low-cost health coverage for kids and adults with limited resources. In 2014, more adults will be eligible because:

      • Adults without children can now qualify for Medi-Cal,
      • Cut-off income requirements for adults will increase, and
      • Enrolling will be simpler.

Covered California

This is an online marketplace where you can compare, apply for, and buy health insurance. Those not eligible for Medi-Cal may qualify for coverage through Covered California.

To receive coverage for year 2018, you can enroll in Covered California from November 1, 2017  through December 15, 2017. Outside of the enrollment period, you can only enroll into Covered California if you have a qualifying life-changing event (e.g. loss of job, death of a spouse, or birth of a child).

 

 

 

Guarantees your Right to Appeal

When an insurance plan denies payment for a treatment or service,  you now have the right to request an appeal.

If you don’t speak English, you may be entitled to request appeals information in your native language.

When you request an appeal, your plan must give you its decision in a timely manner.

No More Arbitrary Withdrawals of Coverage

Insurers can no longer cancel your coverage just because you or your employer made an honest mistake on your application.

Your health plan can still stop coverage if you intentionally put false or incomplete information on your insurance application, and it can cancel your coverage if you fail to pay your premiums on time.

However, your health plan must give you at least 30 days’ notice before it can stop your coverage, giving you time to appeal the decision or find new coverage.

Pre-Existing Conditions Can't Disqualify Kids

Health plans can no longer limit or deny benefits to children under 19 due to a pre-existing health condition.

This rule applies whether or not your child’s health problem was discovered before you applied for coverage.

Starting in 2014, these protections will be extended to Americans of all ages.

Young Adults Keep Coverage

If you are under 26, you may be eligible to be covered under your parent’s health plan. You can join or remain on your parents' plan even if you are:

    • married
    • not living with your parents
    • attending school
    • not financially dependent on your parents
    • eligible to enroll in your employer’s plan

Costs

Care

Free Preventative Care

Many insurers must offer recommended preventive health services at no cost to you.

This includes immunization, cholesterol screening, and diet counseling. See the list of benefits for adults, pregnant women, and children.

You Choose Your Doctors

You have the right to choose your primary care doctor from your plan’s network.

You can also see an OB-GYN without a referral from another doctor.