Many of the Affordable Care Act (ACA) rules remain in force. These include regulations around benefits, eligibility, Open Enrollment, rating areas and policies, and more. California has adopted new changes for 2020.
Beginning in 2020, the State of California will require residents to maintain minimum essential coverage (MEC) for themselves and their dependents throughout the year. Those who don’t maintain minimum essential coverage will pay a tax penalty. The tax penalty is fairly complicated and is tied to several factors, including the cost of a bronze plan in your area, your household size and income. In addition, the State has created a new tax subsidy to help middle income earners with the cost of health insurance.
C.A.R. members and consumers should remember that you can only enroll in a medical plan during a medical open enrollment period or generally within 30-60 days of a Qualifying Event. For questions about eligibility or qualifying events, contact RealCare at (800) 939-8088, Option 2
Open Enrollment for 2020 ends January 31st, 2020
The Affordable Care Act (ACA) changed the health insurance landscape. Here are some fundamental ways health insurance has changed.
The federal ACA mandate has ended, but the State of California mandate takes effect January 1, 2020. This requires individuals to maintain Minimum Essential Coverage (MEC) throughout the year or pay a state tax penalty.
The ACA mandated benefits by establishing a list of key benefits that must be covered in a health plan (minimum essential coverage.) To help define benefit plans, the government adopted Metallic plan descriptions – Bronze, Silver, Gold, and Platinum. These levels represent the average percentage of cost a plan will pay for services from 60% (Bronze) to 90% (Platinum).
NO MEDICAL QUESTIONS – Health insurers no longer ask medical questions when evaluating an application for coverage. No one can be turned down for insurance regardless of their health history.
NO PRE-EXISTING CONDITION LIMITATIONS – Every insured is covered from the effective date of the policy for all covered services.
NO ONGOING ENROLLMENT – Individuals must enroll during Open Enrollment or within 30 or 60 days of a qualifying event (Special Enrollment).
New pricing – Plans now rate each family member based on his/her own age
Advanced Premium Tax Credit and California State Tax Credit – federal and state assistance to reduce the cost of premiums and potentially lower deductibles and copays are available to those who qualify based on income and household size.
Open Enrollment for individual health plans ends January 31st. If you want to enroll for 2020, or need to make plan changes, you must do so during the Open Enrollment period.
Does the ACA change how or when I can get medical insurance?
All plans are guaranteed to be issued to residents of California. No medical questions are asked and no one can be turned down due to pre-existing medical conditions.
Enrollment periods are now LIMITED. Consumers can only apply for coverage during specified periods.
Consumers can ONLY enroll for individual health insurance during an Open Enrollment period or within 30-60 days of a qualifying event. If you don’t enroll during that time you will have to wait until the next Open Enrollment to apply for coverage from any carrier or source, including Covered California.
The only exception for enrolling outside of Open Enrollment is for someone who experiences a qualifying event such as the loss of other coverage, marriage, adoption, birth, etc.
What is Covered California and do I have to enroll in it?
Covered California is a program that offers health insurance programs for individuals and small groups. As a marketplace, Covered California offers coverage from several insurance carriers all within one program. All plans offered within Covered California are ACA compliant and fall within one of the four metal tiers – Bronze, Silver, Gold and Platinum. You can choose to enroll with any plan offered in Covered California.
Covered California is the only program that allows you to apply for the federal or state tax subsidies or cost sharing reductions to help offset your costs.
As a consumer you can purchase coverage inside or outside of Covered California. There are more plans available outside of Covered California which may offer you additional choices or larger provider networks. However, the only way to take advantage of the tax credits or cost sharing reductions is to enroll through Covered California.
What if I cannot afford insurance?
If your income is too low to qualify for a tax credit, you may enroll in Medi-Cal. Those who don’t wish to enroll in Medi-Cal may be eligible to purchase lower cost catastrophic coverage. If you choose not to enroll in a qualifying health plan, you will likely pay a penalty on your 2020 state income tax.
What is happening with premiums?
Covered California plans increased by a fairly small amount in 2020. Rate increases for certain plans were higher – especially for Silver level plans. The average statewide increase in Covered CA was .8% for 2020. However, keep in mind that some areas/plans may have increased by more than 10%. And, your premiums will increase due to your age change as well. Your rates are based on your age on January 1st so each year your age category moves up.
Some people will be eligible for premium credits through Covered California (see below) which will lower their rates.
Can I get help to pay for insurance?
Some people qualify for a substantial subsidy of their insurance premium. The subsidy is available only for those who buy a policy in the Covered California. The federal subsidy is based upon the cost of the “Silver Plan.” People whose household incomes are under 400% of the federal poverty level (FPL) will qualify. The state subsidy will apply to those making between 400% and 600% of the FPL. For assistance in determining your eligibility, call us at (800) 939-8088.
This is confusing. How can I get help?
RealCare is the ONE-STOP-SHOP for members looking for health and related insurance. We offer:
Over 25 years helping REALTORS® with health insurance
Exclusive representative of the C.A.R. Group Health Insurance options
Experience in group, individual, and Covered California plans, including subsidized plans
Licensed professionals who understand your options
Ongoing support and communication about the changes in the health insurance landscape