With the implementation of the Affordable Care Act, residents in the United States have greater access to health insurance coverage.  Many states opted to develop their own marketplace for residents looking for health insurance through the Affordable Care Act.  In California, individuals and families who do not have access to private health insurance through a group plan can now have access through Covered California.

Through the Affordable Care Act, all newly purchased insurance plans are required to cover the essentials of healthcare such as doctor visits, hospitalization, emergency care, maternity care, pediatric care, and prescriptions.  Additionally, policies are sold on a sliding scale, which means that the monthly premium is less for those who make less money even though it is the same policy.  

Understanding the Basics of Covered California

Eligibility

All residents of California are eligible for an insurance plan through Covered California.  Many residents have access to health insurance through a private group plan, such as those offered by employers.  However, for those who are not eligible for such a group plan, Covered California has many options.  Additionally, children and adults with limited income may be eligible for Medi-Cal, a free or low-cost health coverage option offered through Covered California.

 

Plan Options

While all health insurance plans now offer essential health benefit coverage, plans are now organized into four categories, based upon the level of coverage.  In basic terms, the less expensive monthly plans require the insured to pay more in co-payments and deductibles when they receive medical treatment, and the more expensive monthly plans offer more financial coverage that results in lower payments for medical treatment.

Bronze

On average, your health plan pays 60 percent and you pay 40 percent.

Silver

On average, your health plan pays 70 percent and you pay 30 percent.

Gold

On average, your health plan pays 80 percent and you pay 20 percent.

Platinum

On average, your health plan pays 90 percent and you pay 10 percent.

Additionally, in some cases, individuals may qualify for low- or no-cost plans that have specific criteria for enrollment.

Minimum Coverage Plan

Designed specifically for generally healthy individuals under the age of 30, this plan offers minimal coverage for worst-case scenarios.  Your Phoenix Star insurance professional can discuss whether this plan is right for you.

Medi-Cal

This free or low-cost health insurance coverage is designed specifically for adults, children, seniors, people with disabilities, children in foster care, and former foster youth who have access to limited income and resources.