Communities like Boyle Heights will benefit greatly from the full implementation of the Affordable Care Act (ObamaCare), which promises to provide insurance for millions of Americans.
But before signing up, many seek answers to questions and concerns about how this new law will impact their lives. What does it mean for senior citizens, for business owners, or the uninsured? This is the first article in a comprehensive series that will aim to break down how this law will impact specific groups of people.
The full implementation of the Affordable Care Act is nearing, with all major provisions in effect in January 2014.
Most Californians will not need to do anything once the Affordable Care Act goes into effect because they already get health insurance through their employers.
But people without insurance and small businesses can benefit from the new law. They can shop for a health plan on October 1””when they are able to sign up for insurance through an online marketplace or exchange called “Covered California.” Covered California will provide information to help consumers choose between a variety of health plans. It is important to select one that fits your needs.
The Uninsured
Reports by the California Healthcare Foundation show that there are over 7 million residents of California without health insurance, with about 60% of those uninsured being Latino. Many of these uninsured Californian go to their local emergency room when they get sick, at hospitals such as LA County + USC in Boyle Heights. But getting treated there is far more expensive for taxpayers than visits to a local clinic for routine care.
Exchanges will help to address this problem by providing individuals and small businesses with the information they need to purchase an affordable health plan. Insurance companies who participate in the state’s exchange have to offer health plans that offer the same kinds of benefits so that consumers can compare them more easily. In California, consumers will have 13 health plans to choose from.
The new law does not benefit people who are undocumented or who have lived in the U.S. as legal residents for less than five years. They are not eligible for health insurance under the Affordable Care Act.
Details of the healthcare marketplace in California:
Ӣ There will be four basic levels of coverage: Platinum, Gold, Silver and Bronze. This ranking system will make it easy to compare different health plans. The more expensive plans provide more comprehensive coverage so that you pay a lower co-payment, or percent of medical expenses, each time you visit the doctor.
Ӣ Covered California is designed to make coverage more affordable for the uninsured and for low-income families. About 2.6 million Californians will qualify for federal subsidies based on their income. Those subsidies help make insurance more affordable.
Ӣ Another 2.7 million uninsured Californians do not qualify for assistance, but will benefit from a guarantee that they can get insurance even if they have serious illnesses. In the past, some insurance companies would refuse to insure people who were ill. Under the new law your coverage cannot be dropped or denied if you already have a pre-existing condition like diabetes or heart disease.
”¢ All health plans available through Covered California will cover the same range of services — such as doctor visits, hospitalizations, medications, emergency care, and preventive care exams like mammograms without out-of-pocket costs to you.
Ӣ Individuals can also use tax credits or cost-sharing subsidies provided by the government to help pay for a health plan.
Ӣ Starting in 2014, the State of California is planning to expand the Medicaid program (called Medi-Cal in California) to cover people under age 65, including people with disabilities, with income of less than $15,000 for a single individual and $31,180 for a family of four. The coverage is free for those who qualify.
It is very important to become familiar with this website if you are currently uninsured. The Covered California website is very interactive and gives you the ability to estimate how much it will cost you to purchase a health plan. Enrollment begins October 1, 2013 and runs through March 31, 2014.
For more information visit www.coveredca.com
Victor M. Peña is a native and resident of Boyle Heights. He has more than eight years working with healthcare organizations in Santa Barbara and Los Angeles counties. He has a Master’s in Business Administration and is a Director of Healthcare Corporate Initiatives with the American Cancer Society. He is also a member of the American College of Healthcare Executives.
