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Why Do You Need Health Insurance?
Your health affects your quality of life. If you become sick or injured, a short hospital stay could be costly. If you don’t have insurance, you could be responsible for the entire bill, and if you have a major medical incident, a health plan can help protect your finances. Serious diseases or accidents often need surgeries, treatments, and medications that can run into hundreds of thousands of dollars.
Having a health plan makes good sense
When you have a health plan, you’ll also be more likely to get routine checkups and preventive care which helps you stay healthy – and saves money on medical costs in the long run. A health plan can fit your budget because you’re able to choose the coverage you want.
Health insurance is the law
Since January 1, 2014, under the Affordable Care Act (ACA), or Obamacare, everyone is required to have health insurance coverage. Health insurance which meets ACA standards must provide ten essential health benefits. November 1, 2016 through January 31, 2017 is the next Obamacare enrollment period. Documents required for health insurance are to verify U.S. citizenship or immigration status. Additional documentation of your income and confirmation of previous health insurance and termination date may also be requested.
If you don’t have coverage, the penalty for no health insurance that qualifies as minimum essential coverage may result in a yearly tax penalty! If you do not qualify for an exemption from health insurance or you do not receive free health insurance such as Medi-Cal or Medicare, you will be assessed a tax penalty if you have a health insurance gap of more than two months, or more than one gap in a tax year.
What Are My Rights and Protection?*
The Affordable Care Act offers several new protections and puts consumers back in charge of their health care. Under the law, a new “Patient’s Bill of Rights” gives people the stability and flexibility they need to make informed choices about their health. These new protections include:
- Ban on Discriminating Against Kids with Pre-Existing Conditions
- Ban on Insurance Companies Dropping Coverage
- Ban on Insurance Companies Limiting Coverage
- Ban on Insurance Companies Limiting Choice of Doctors
- Ban on Insurance Companies Restricting Emergency Room Care
- Guaranteeing You a Right to Appeal
- Covering Young Adults on Parent’s Plan
- Covering Preventive Care With No Cost
How Do You Get Health Insurance?
Under the Affordable Care Act, California has set up an online Marketplace, called Covered California, where you can buy insurance. You can also buy a plan outside the Marketplace and still be considered covered. However, if you buy outside the Marketplace, you won’t be eligible for premium tax credits or lower out-of-pocket costs based on your income.** Covered California 2017 Open Enrollment is November 1, 2016 through January 31, 2017. Freeway Insurance agents can answer your health insurance questions and help you find the health insurance plan that works best for your health and your budget. Freeway has partnered with Covered California’s health insurance marketplace to help you save money, and guide you to any free or low cost programs you may qualify for. A qualifying life event which has taken place in the past year such as marriage/divorce or the birth/adoption of a child can also affect your insurance premiums and subsidy. Even if you already have health insurance Freeway may be able to find a cheaper plan for you. Call 800-308-7708 or stop by one of our offices where are agents are happy to advise you.
If you’re eligible for job-based insurance, you can consider switching to a Marketplace plan. But you won’t qualify for lower costs based on your income unless the job-based insurance isn’t considered affordable or doesn’t meet minimum requirements.
If you have Medicare, you’re considered covered and don’t have to make any changes. If you have Medicare, you can’t use the Marketplace to buy a supplemental plan or dental plan.
Common Health Insurance Plans
There are four coverage levels of medical expense coverage in Covered California plans also known as health insurance tiers.
- Bronze covers 60%
- Silver covers 70%
- Gold 80%
- Platinum covers 90%
- Enhanced Silver provides the benefits of a Gold or Platinum plan with the costs of a silver plan. Income level is the factor in determining Enhanced Silver eligibility.
Types of Plans
- Managed care or HMO plans have you select a primary care physician within the approved insurance network. Your primary care physician makes referrals if needed.
- EPO means Exclusive Provider Organization. The network of hospitals and doctors is very limited and you must use the care providers in the network, or pay 100% of your bill.
- PPO or Preferred Provider Organization offers the most choices and flexibility. You can get care in or out of the network, but out of network increases out of pocket expenses and some services are not covered.
- A POS or Point of Service plan is a combination of an HMO and a PPO. You will have a primary care physician, that can make referrals to specialists outside of the approved network if needed.
Medicare isn’t part of the Health Insurance Marketplace, so you cannot apply for Medicare through the Marketplace. You can apply for Medi-Cal and CHIP coverage through Covered California, but in some cases the eligibility decision may be made by your county Medi-Cal office or the Social Security Administration. If you’re interested in finding out about free health insurance, you can learn more through the Marketplace.