Three years after Congress approved it, the federal Affordable Care Act (ACA) began enrolling uninsured Americans into low-cost private insurance plans on October 1, 2013. In California, more than 1 million low-income residents will gain access to Medi-Cal’s low-to-no cost health coverage.
With roughly 7 million Californians uninsured, the implementation of the ACA and enrollment through Covered California – California’s new private health insurance marketplace – aims to close the health coverage gap.
The 2,400-page law is filled with more than a few benefits to Californians who previously avoided doctors and other health care for fear of the high cost.
One benefit of the law is a set of consumer protection measures that restrict health insurance companies from instituting a cap on lifetime or yearly medical expenses, and denying health coverage for patients with preexisting conditions.
For families, the Affordable Care Act also allows adult children to stay on their parents’ health insurance plan until they reach 26 years of age. Prior to the passage of the ACA, children were removed from their parents’ insurance plans at 18-years-old or when they?graduated high school.
The Individual Mandate
An important part of the new law is called the individual mandate. This will require every United States’ citizen or resident to purchase health insurance. The idea behind this mandate is to have everyone participate in the health system. Immigrants who are living and working legally in the United States will be required to participate in the health insurance mandate. Undocumented people are exempted from this mandate. Here is a brief description of how the mandate works:
If you currently have insurance either through your employer or through a plan you purchased outside of work- you do not have to pay a penalty or worry about the mandate because you are already covered. If you do not have health insurance now you will need to get it or face paying a tax penalty beginning in 2014. If you fall into the uninsured group, there will be new ways to make it easier for you to find and pay for health coverage. Lower-income and many middle-class families will be eligible for government run low-to-no cost health programs like Medi-Cal.
New opportunities to access Medi-Cal
For more than 1.4 million Californians, the ACA is opening a new door to Medi-Cal (California’s version of the Medicaid program, a government-funded program that assists low income families and individuals with medically necessary procedures, treatment and services). The health care law expanded requirements to receive low-to-no cost health coverage through Medicaid/ Medi-Cal. You may qualify for Medi-Cal, if you are a single U.S. citizen or permanent resident earning about $15,900 or less per year or $32,500 or less per year for a family of four. Medi-Cal provides complete health coverage – including dental insurance – for those who qualify. From 2009 until this year’s expansion of Medi-Cal, recipients over the age of 21 were unable to receive dental coverage as part of their coverage through the program. While enrollees can begin enrolling now, Medi-Cal coverage will not begin until January 2014. Also, many California counties offer Low Income Health Programs (LIHP) to some Medi-Cal patients – providing benefits earlier than those enrolling for Medi-Cal coverage and automatically transitioning patients from LIHP to Medi-Cal in January 2014. Check with your county’s social services agency (visit http://bit.ly/countyca to find contact information) to see if you qualify for LIHP.
Coverage for Undocumented Workers
The Affordable Care Act will be a blessing for many people who have gone too long without health coverage. But many people will still be left uninsured and unable to pay for medical care, and this includes many of the nation’s farmworkers. The ACA does provide funding to community health centers, and according to the National Association of Community Health Centers, this funding will allow migrant health centers to almost double the number of people they serve by 2015. Currently, fewer than 25% of farmworkers use migrant and community health centers for primary and preventative services.
For those people who will remain uninsured, these health centers will provide a safety net to keep them healthy. Because they do not require insurance to receive services, farmworkers and their families will continue to have access to healthcare even after the provisions of the ACA are implemented. Providing quality care to more than 5 million Californians each year, these community clinics remove barriers to care for farmworkers in a variety of ways:
• Provide health care in the patients’ own language;
• Provide treatment regardless of the patients’ ability to pay;
• Are located in areas near migrant and seasonal farmworkers, often times using mobile vans and;
• Customize services and hours of operation to meet the patients’ needs.
These health centers are required to provide primary, preventative and emergency health services regardless of the patient’s ability to pay. Primary health services include diagnostic laboratory (blood tests, urine tests) and radiology services (X-rays).
Preventive health services include pediatric care, prenatal and postpartum care, immunization, family planning, health education, and preventive dental care. If a health center is not equipped for after-hours care, emergency health services will sometimes be provided by an outside provider, who has a relationship with the health centers. To see if there are any clinics near you, visit California Health+ at http:// bit.ly/esphealth, or call 1 (855) 899- 7587.
Accessing private insurance options
While many Californians qualify for Medi-Cal under the ACA’s expansion of Medicaid, others will have to seek private health insurance coverage.
To help accompany the millions of Americans searching for insurance, the Affordable Care Act created private health insurance marketplaces, known as “exchanges,” in each of the 50 states. California’s marketplace is known as Covered California and sells insurance plans from Anthem Blue Cross, Blue Shield of California, Kaiser Permanente and others. The plans are categorized by the price of monthly premiums and size of out-of-pocket expenses patients will pay when receiving care.
The lowest level plan – bronze – will have low monthly premiums but high out-of-pocket costs when patients receive care. The highest plan –platinum – has high monthly premiums and low out-of-pocket costs when receiving care. Covered California’s website allows Californians to input their city, income level, number of enrollees joining on their plan to find the various plans and health care providers available. The Covered California private insurance enrollment period runs from October 1, 2013 – March 31, 2014. Medi-Cal enrollment is always open. For those enrolling prior to 2014, medical coverage will not begin until January 1, 2014. Check http://coveredca.com to see if you qualify for Medi-Cal or shop and compare private health insurers. Because finding insurance can be confusing and overwhelming, under the Affordable Care Act, States will be given Federal money for Consumer Assistance Programs. If you need help with a health insurance problem or have a question about coverage or benefits, you can contact the California Department of Managed Health Care at 1 (888) 466-2219. Spanish and English options are available.