Federal Changes

Thanks to the Affordable Care Act, millions of Americans have already taken advantage of numerous new benefits available to those who are uninsured. Even for those who already have health insurance, coverage has improved markedly.

Beginning January 1, 2014, all Americans are required to have health insurance under the individual mandate. If you do not sign up for health coverage by March 31, 2014, you will be penalized. Under the ACA’s individual mandate, all residents of the United States are required to have health insurance. If you do not have health coverage, you will be penalized $95 for adults and $47.50 for children in 2014. Penalties for subsequent years increase.

Thanks to the Affordable Care Act, under current law:

  • Insurance companies cannot deny anyone for pre-existing conditions like asthma or pregnancy.
  • Young adults can remain on their parent’s health plan till the age of 26.
  • Insurance companies are subject to Rate Reviews which bar them from raising your monthly premium over 10% without justifying it to the state.
  • Insurance companies are required to spend 80% of your premium on your health care services and quality improvement activities under the Medical Loss Ratio, also known as the 80/20 rule.
  • All health plans offered under state exchanges, like Covered California, are required to cover 10 Essential Health Services. These services include:
    1. Ambulatory Patient Services
    2. Emergency Services
    3. Hospitalization
    4. Maternity and newborn care
    5. Mental health and substance use disorder services, including behavioral health
    6. Prescription drugs
    7. Rehabilitative and habilitative services and devices
    8. Laboratory services
    9. Preventative and wellness services and chronic disease management
    10. Pediatric services, including oral and vision care

 

Medi-Cal enrollment is on-going meaning you can apply at any time. Click here to apply for Medi-Cal today!