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Health Care Reform:

Health Insurance & Affordable Care Act

Covered California

Who Is the Marketplace for?

Covered California is the health insurance Marketplace is where eligible residents can shop for and buy insurance in person, online, or by phone. The Marketplace in California is run by the state. The Marketplace, also called an Exchange, is mainly for people who:

  • Don’t have insurance
  • Aren’t insured by their employer
  • Aren’t included in their spouse’s employer insurance 
  • Have pre-existing conditions and may have had trouble getting insurance before
  • Have private insurance but want something less expensive
  • Own a small business

The Affordable Care Act requires that most Americans have health insurance starting in 2014. Generally, you don't need to buy insurance through the Marketplace if you are currently covered by Medicaid, Medicare, TRICARE, or an employer-sponsored plan.

When You Can Enroll: The next open enrollment period will be from Oct. 1, 2014, to Dec. 31, 2015.

If you have a life-changing event -- such as the birth of a child, losing your job, or moving to a new state -- you don't have to wait for the next enrollment period. You can sign up or change coverage within 60 days of the event.

Plans and Costs

Types of plans: All the insurance plans on the Marketplace are sold by private companies or co-ops. They can offer four types of coverage: bronze, silver, gold and platinum. These “metal level” plans all cover the same kinds of benefits in California. What differs is how much they pay on average toward the costs of healthcare services. Here’s how it works:

  • Bronze Plan: You pay 40% and the plan pays 60%.
  • Silver Plan: You pay 30% and the plan pays 70%.
  • Gold Plan: You pay 20% and the plan pays 80%.
  • Platinum Plan: You pay 10% and the plan pays 90%.

Low cost – or catastrophic – plans are available, especially for people who are under 30 and are healthy.  These plans cost less up front, but they don’t give you as much coverage. They generally require you to pay more out-of-pocket costs.

Costs:  California is divided into 19 regions. Rates vary by region, plan level, and age. For example, bronze-level plans for a 25-year-old nonsmoker in the Napa, Sonoma, Solano, and Marin counties will range from $202 a month to $273 a month. Silver-level plans for a 40-year-old in Los Angeles range from $222 to $325. Silver-level plans for a family of four in the Fresno region range from $849 to $997. California’s Cost Calculator and Health Plans Booklet offer more details about premiums and costs.

Who Will Sell Insurance in the California Marketplace? California has selected 12 health insurance plans to offer individual policies: Alameda Alliance for Health, Anthem Blue Cross of California, Blue Shield of California, Chinese Community Health Plan, Contra Costa Health Plan, Health Net, Kaiser Permanente, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, and Western Health Advantage.  Not all of them will be available in all 19 regions of the state; check Covered California’s web site and its Health Plans Booklet to find out which plans will be offering policies where you live.

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