The Affordable Care Act for California (ACA)

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.

About the Affordable Care Act

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.

U.S. Health Care Reform Timeline

• 1965: Medicare and Medicaid legislation passes
• 1986: Emergency Medical Treatment and Active Labor Act passes
• 1989-2007: Many proposals for Health Care Reform are considered
• 2008: Health Care Reform is a major topic during the general election
• January 20, 2009: Barack Obama is sworn into office as President
• February 2009: President Obama begins work on Health Care Reform
• 2009-2010: Ongoing congressional negotiations
• March 23, 2010: The PPACA is signed into law by President Obama
• 2010-Future: The ACA rolls out in stages, mainly over the first 4 years

Common Terms Used to Refer to the Affordable Care Act

People refer to the Affordable Care Act by many different names:

• Patient Protection and Affordable Care Act, the full legal name
• Affordable Care Act, a shorter version of the legal name
• Obamacare or Obama Health Care, common and informal terms
• Health Care Reform, a common name

Why Did We Need the Affordable Care Act?

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.

Creating the ACA

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 Mandate
• The Health Insurance Penalty
• Universal health care
• Guaranteed Issue
• Individual or Employer Mandate
• Subsidy levels
• Federal funding for birth control/abortion

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:

• Bronze: On average, your plan pays 60% of the health care costs, while you pay 40%.
• Silver: On average, your plan pays 70% of the health care costs, while you pay 30%.
• Gold: On average, your plan pays 80% of the health care costs, while you pay 20%.
• Platinum: On average, your plan pays 90% of the health care costs, while you pay 10%.

Enhanced Silver Plans

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:

• Plan 94%: On average, your plan pays 94%, and you pay 6%.
• Plan 87%: On average, your plan pays 87%, and you pay 13%.
• Plan 73%: On average, your plan pays 73%, and you pay 27%.

Minimum Coverage Plans

This is another coverage option you can qualify for if any of the following is true:

• You are under 30 years of age.
• You can’t afford health coverage.
• You qualify for hardship exemption.

What Benefits Does the Affordable Care Act Cover?

All the health plans sold in the Covered California marketplace must meet the minimum coverage requirements. These requirements include:

• Hospitalization services.
• Ambulatory services.
• Urgent and emergency care.
• Prescription medications.
• Maternity and breastfeeding support.
• Laboratory services.
• Preventative and wellness benefits.
• Mental health and drug abuse services.
• Pediatric services, including dental and vision care for kids.

What Benefits Does the Affordable Care Act Not Cover?

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.

Patients’ Protections in the ACA California

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:

• Everyone in California has access to health insurance.
• Pre-existing health conditions cannot deny anyone health coverage or extra charges.
• Children can be listed on their parent’s health plan until they are 26 years of age.
• Employers or businesses with more than 50 employees have to provide health insurance for their employees that meet the minimum requirements set by the government or risk paying penalties.
• Insurance providers can no longer terminate your coverage because of a new health condition.
• You are free to choose your primary care doctor and out-of-network specialist services.
• You can compare prices through the state-run marketplace Covered California.
• It’s against the law for employers to fire you because you chose an Obamacare plan over the company’s plan.
• Yearly and lifetime dollar limits are no longer applicable for certain health benefits.
• Many types of preventive care are free on all Marketplace plans.
• You can qualify for a tax credit to lower your monthly health insurance premium.
• New measures have been put in place to reduce fraud in Medicaid, Medicare and CHIP.

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.

Affordability of Health Care in California

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:

• Be a U.S citizen or be legally present in the country.
• Enroll for health coverage through Covered California.
• Not be receiving Medicare, Medi-Cal or military health benefits.
• Not have health coverage from your employer.
• Have a household income that ranges between 100%-400% of the Federal Poverty Level.

You’ll also need to present a few documents before enrolling in California’s Obamacare:

• The previous year’s tax information for you and your spouse.
• A list of everyone in your household who will be on your federal tax return for the year you will be receiving coverage.
• Your Social Security number or document numbers.

How Can I Enroll for Health Coverage in California?

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.