Congressman Scott Peters

Representing the 52nd District of California

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Health Care & the Affordable Care Act (ACA)

Most San Diegans will be able to keep the coverage they currently have either through their individual or employer based policies. There will also be tax credits and federal subsidies available for many Americans to offset the cost of insurance. For general questions visit healthcare.gov, 1-800-318-2596, or coveredca.com or call our San Diego office at 858-455-5550.

SOME OF THE NEW HEALTH CARE LAW BENEFITS

  • Most people in the new Health Insurance Marketplaces will pay the same or less than they do for their coverage now. This is because more than 80% of those buying coverage in the Marketplaces will qualify for premium tax credits, which will cut what an individual actually pays in premiums in many cases.
  • Your insurer cannot drop you when you get sick.
  • Your insurer can no longer impose a lifetime limit on your coverage.
  • Your insurer must give you the option of having your young children stay on or join your employer provided plan until they turn 26.
  • You have free coverage of key preventative services such as mammograms and colonoscopies.
  • Your insurer cannot discriminate against you if you have or develop a pre-existing condition (Jan. 2014)
  • You are protected by a cap on your out-of-pocket costs.
  • You have free preventative services for all plans in the marketplace.
  • Medicaid will expand to include adults up to 138% of the Federal Poverty Level, covering over 21 million new Americans

 

IF YOU DO NOT HAVE INSURANCE CURRENTLY:

Visit Covered California at coveredca.com now to see what information you will need to get insurance and what your premiums might be. You might be eligible for Medi-Cal or subsidies in the marketplace.

The California Healthcare Marketplaces will open on October 1st throughout our state. Health care coverage begins on January 1, 2014. Millions of Americans will have the opportunity to purchase affordable, comprehensive health care that will allow them to get preventative checkups for free, to keep them healthy. It will cover pre-existing conditions to make certain that a simple medical problem doesn't become a serious one. Finally, it will do all this through private insurance policies with subsidies for those who cannot afford to pay their entire premium.

If you do not have health coverage by January 1, 2014, you will be required to purchase coverage (unless you fall into certain limited exceptions). For those who do not purchase coverage, there will be a tax penalty.

The charts below shows what the penalties will be for those choosing not to purchase insurance:

Year per adult per child Family max   % of taxable income
2014 $ 95 $ 47.50 $ 285 or 1 percent
2015 $ 325 $ 162.50 $ 975 or 2 percent
2016 $ 695 $ 347.50 $ 2085 or 2.5 percent

 

MEDI-CAL

Medi-Cal is California's Medicaid health care program. This program pays for a variety of medical services for children and adults with limited income and resources. Medi-Cal is supported by federal and state taxes. This program is for people under the age of 65, including persons with disabilities, with income less than $15,856 for a single individual and $32,499 for a family of four. Coverage is free for those who qualify. If you qualify, you can easily apply for Medi-Cal right now.

The chart below shows who might qualify for Medi-Cal or other programs to reduce the cost of insurance.

IF YOU ARE…

THEN YOU QUALIFY FOR…

An Individual making less than $15,415*

Medi-Cal, a free government program.

An individual making $15,415 to $27,935*

You qualify for help in paying out-of-pocket costs like deductibles and co-pays.  You also qualify for a tax credit that will lower the amount of your monthly premium.**

An individual making $27,936 to $44,680*

You qualify for a tax credit that will lower the amount of your monthly premium.**

An individual making over $44,680

You do not qualify for government assistance but you are still eligible to buy health insurance through Covered California.

A family of four making less than $31,810*

Medi-Cal, a free government program.

A family of four making $31,810 to $57,635*

You qualify for help in paying out-of-pocket costs like deductibles and co-pays.  You also qualify for a tax credit that will lower the amount of your monthly premium.**

A family of four making $57,636 to $92,200*

You qualify for a tax credit that will lower the amount of your monthly premium.**

A family of four making over $92,200*

You do not qualify for government assistance but you are still eligible to buy health insurance

*Income levels are based on the year 2012
**You must enroll through Covered California to be eligible for your tax credit

If you want to get a sense of your eligibility, visit the "Covered California Shop and Compare Tool"

HEALTHY FAMILIES

The Healthy Families Program is low cost insurance that provides health, dental and vision coverage to children who do not have insurance today and do not qualify for no-cost Medi-Cal. To learn more and check your eligibility, please visit the Healthy Families website.

SUBSIDIES AND MARKETPLACE

For individuals and families, signing up for health care will be quick and easy. Starting on October 1, 2013, individuals and families who qualify, who do not have health insurance, can sign up for insurance and premium payment assistance through the Health Insurance Marketplaces. Let's look at how the Marketplaces will function:

Covered California is the official Marketplace created by the State of California, to help you and your familiy get health care coverage to protect yourself and your loved ones. To learn more, visit Covered California's website: www.coveredca.com. You can also call 1-800-318-2596 to reach the HHS Helpline, with any questions you have about the new law, or the marketplaces.

 

PAYING FOR HEALTH INSURANCE

The Kaiser Family Foundation has developed a calculator that people can use to get a rough estimate of the level of premium tax credits they could be eligible for, to use in the new Health Insurance Marketplaces. Simply input the requested information and a new window will pop up with information on subsidies.

See the cost calculator here: kff.org/interactive/subsidy-calculator/

The chart below also has potential scenarios and what the costs might look like:

Kaiser FF Flow Chart

 

SMALL BUSINESS OWNER?

The SHOP Marketplace will be opening in CA on October 1st to give small businesses the opportunity to provide insurance, though if you have fewer than 50 full-time employees you are NOT required to provide it. Information on the SHOP Marketplace is available at business.usa.gov/healthcare or by calling 1-800-706-7893.

Starting in 2010, up to 4 million small businesses that offer healthcare coverage to their employees may be eligible for a tax credit.

To see an estimate of your tax credit visit: http://www.smallbusinessmajority.org/tax-credit-calculator/index.php

  • To qualify, a small business must:
  • Have fewer than 25 full-time equivalent employees
  • Pay average annual wages below $50,000 per FTE
  • Contribute at least 50% of each employee's premium

Notes:

  • Owners are excluded, and should not be counted in number of employees, wages, or premium contribution amount.
  • Tax credits can't be larger than actual income tax liability.

The tax credit is currently worth up to 35 percent of premium costs for a small business. That amount will rise to 50 percent in 2014. More than 300,000 small businesses have already used the tax credit to provide health insurance to more than two million workers.

For more information about the impact of the Affordable Care Act on your small businesses, visit the SHOP! The Small Business Health Options Program (SHOP) is a new program that simplifies the process of buying health insurance for your small business.

 

SENIORS

AARP has launched two sites to answer questions you might have - healthlawanswers.org & healthlawfacts.org

 

VETERANS

If you already have care through the VA Health Care System you do NOT need to enroll in an exchange; and you will not see any change in costs or deterioration of benefits. However if you do not have insurance, or your family members aren't covered visit www.va.gov/aca to see what the ACA means for you or call 1-877-222-VETS (8387).

Any further questions should be referred to coveredca.com or my San Diego office at 858-455-5550.

 

HIPAA (Health Insurance Portability & Accountability Act)

For a quick visual overview of your rights surrounding your health care records, click here. Or visit the link below.

http://youtu.be/3-wV23_E4eQ

Issues: