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 Affordable Care Act, also called 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 Affordable Care Act marketplace, also known as Covered California.
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 smaller/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 cost 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 (Obamacare) Cover?
In California, 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)
Patients’ Protections in the ACA California
You’ll find the following protections for patients in the ACA California:
- Pre-existing health conditions cannot deny anyone health coverage. No matter your medical history, you can sign up for health insurance and be guaranteed coverage without any extra charges.
- Children can be listed on their parent’s health plan until they are 26 years of age.
- Insurance providers can no longer terminate your coverage because of a new health condition.
- You are free to choose your primary care doctor as well as out-of-network specialist services.
- 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.
- New measures have been put in place to reduce fraud in Medicaid, Medicare and CHIP.
Affordability of Health Care in California
California residents with low-income 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. Keep in mind 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
How Can I Enroll for Health Coverage in California?
If you are looking for health insurance in California, visit the state health insurance marketplace — Covered California. 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. Just fill out our confidential form to get started. No contact information is needed, and you’re under no obligation to buy.