Obama Care California Plans

President Obama’s health care reform created a new way of shopping for health plans and, with it, comes many questions…   

Is there such a thing as an “Obama Care California Plan”?

Yes! “Obamacare plans” refer to the health insurance plans that qualify for a subsidy. The subsidies, or tax credits, help to make your medical coverage more affordable by lowering your monthly bill. These plans are also called “marketplace” or “on-exchange” plans because they must be purchased on either a  state-based health insurance exchange or the federal marketplace.

How do you qualify for an Obama Care Plan?

Below are some of the requirements that are needed to qualify for an Obama Care plan:

  • Be a U.S. citizen, U.S. national or lawfully present immigrant.
  • Not be eligible for public health coverage such as full-scope Medi-Cal, premium-free Medicare Part A or military health insurance. Please note that some exceptions will apply.
  • Not be offered or have access to affordable, minimum value health coverage through an employer.
  • Agree to file your taxes for the benefit year.
  • If married, file your taxes as “Married Filing Jointly.”**

What do Obama Care plans cover?

All Obamacare plans are ACA (Affordable Care Act) compatible. ACA compatibility is required for all new plans both on and off the exchange in the individual and small group market.  The added benefit of enrolling in an Obamacare plan is that you may be able to receive a tax credit.

  • The Benefits:  ACA compatible plans provide  essential health benefits, like hospitalization, emergency services and preventative services
  • The Law: ACA compatible plans meet the mandate to have health insurance, so you don’t have to pay the Shared Responsibility Payment (tax penalty)

Be Aware of Non-ACA Compatible Plans

There are some non ACA compatible plans available outside of the Marketplace that only offer limited medical coverage, and do not cover the 10 essential health benefits. Although these plans can meet certain needs, you will be subject to a tax penalty if this type of health insurance is all that you carry. Some examples of non ACA compatible plans are:

  • Short Term Medical Insurance
  • Accident Insurance
  • Critical Illness Insurance
  • Travel Insurance
  • Fixed Benefit Insurance
  • Vision and Dental Insurance

What kinds of plans are available?

There are many plans to choose from on the Marketplace.  Obama Care California plans are organized into 4 metal tier levels called the Bronze, Silver, Gold or Platinum plans. The Bronze plans have the lowest premiums with the highest out-of-pocket costs, while the Platinum plans have the highest premiums with the lowest out-of-pocket costs. Each level also has a selection of private insurance carriers in your area that you can choose from.  In addition, most areas offer network types like an HMO, EPO, or PPO.

When and where do you apply?

Apply online during Open Enrollment on an Obamacare website. The state that you live in will determine what website you will use. Californians can submit an application to their state-based exchange, Covered California here.

*In states that have expanded Medicaid, the lower income limit may be higher, and different qualifiers may apply.

**There are a few exceptions to the “Married Filing Jointly” rule – Consult a tax professional on how you may be able to apply.