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California Healthcare Reform Implementation Breakdown

California Healthcare Reform Implementation Breakdown
Open enrollment on the health insurance exchanges begins Tuesday. Consumers must sign up by Dec. 15 for coverage that starts Jan. 1. Key information for consumers:

CALIFORNIA'S HEALTH BENEFITS EXCHANGE

Covered California is the state-run agency established to oversee the health insurance exchange and enroll people for insurance coverage. Go to www.coveredca.com or call 1-800-300-1506. Under a state law enacted last year, people who sign up for health insurance through Covered California also can register to vote during the enrollment process.

WHO BENEFITS

The exchanges are for the poor who will be eligible for Medicaid, low-income workers who will be eligible for government subsidies and people who buy their own insurance. They generally do not apply if you have existing employer-based coverage. Covered California estimates that by 2014, about 2.6 million Californians will be able to access financial assistance to help pay for their health insurance through the exchange, while an additional 2.7 million will be eligible for coverage that is guaranteed but not subsidized by the government. Another 1.4 million Californians will be newly eligible for Medicaid, or Medi-Cal as it is known in the state. To enroll through Medi-Cal, an individual would have to have an income that tops out $15,400, or about $31,000 for a family of four. Covered California estimates that 2.3 million Californians will be newly enrolled in a health plan through the exchange by 2017.

ESSENTIAL BENEFITS

Benefits required to be covered are: ambulatory patient services; emergency services;
hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative services and devices; laboratory services; management of chronic diseases, and preventive and wellness services; and pediatric services, including dental and vision care.

COLOR-CODED COVERAGE

Bronze, silver, gold and platinum refer to the types of insurance policies available to businesses and individuals under the exchanges. The categories reflect how much premiums will cost each month and the amount you will pay for such things as hospital visits and prescription medications. The percentage covered by the plan increases from bonze to platinum. The lowest-cost plan is bronze, in which the insurance company covers 60 percent of the expenses and the individual will pay 40 percent. The highest-cost tier is platinum, in which the insurer covers 90 percent of the expenses and the individual pays 10 percent.

IMMIGRANTS

Legal immigrants can buy insurance through the health care exchanges and are eligible for the subsidies. Immigrants who are in the country illegally will not be eligible to buy insurance through the exchanges. They also are ineligible for Medicaid.
 

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