Health Insurance Policy

I Have Health Insurance 

AT A GLANCE

If you already have health insurance from your employer, you don't have to do anything. The new health law does not require employers to change the insurance they provide. Medicare is largely unchanged by the Affordable Care Act, although the law improves coverage of prescription drugs. If you're already receiving Medical, you will continue to do so. If you buy insurance for yourself or your family, you will have access to a new marketplace called Covered California. You may also qualify for tax credits to help you pay for health insurance. Anyone who does not have health insurance can buy it through Covered California.

Employer-based Health Insurance

 If you receive health insurance at work, you are likely to continue to do so. But even after the health law takes effect Jan. 

1, employers may change plans, premiums, deductibles or other elements of the insurance they offer, just as they can now. The Affordable Care Act mandated several changes that benefit people with health insurance. No waiting until 2014 for these changes — they're already in effect: 

Children can stay on a parent's plan until age 26 
Your insurance company cannot drop you if you get sick 
You get free preventive care with no co-pay and no deductible, including many cancer screening tests (although some plans already in effect may be exempt from providing this benefit)
Lifetime caps on coverage are banned That's it. If you have employer-based health insurance, the health law's most significant changes are already in place.


I Am Covered Through the Low Income Health Program. What Do I Do? 

The Low Income Health Program (LIHP) was built as a "bridge to reform." On Jan. 1, you will transition to Medi-Cal. You can read more about Medi-Cal in this guide. I Buy My Own Health Insurance. 


What Does the New Health Law Mean to Me? 
Right now, people who buy insurance for themselves or for their families have no leverage with insurance companies. If you're buying your own insurance, you probably pay a much higher premium than a large company would pay for similar coverage. If you are sick, the insurance company might also charge you a higher premium or refuse to cover you.


I Do Not Have Health Insurance

 AT A GLANCE 

7 million people are uninsured in California. 
Under the health law, most people must have insurance starting Jan. 1, 2014, or pay a fine. 
People who are uninsured may get insurance in one of two ways: an expanded Medi-Cal program or a new online health insurance marketplace. 
People who buy insurance in the marketplace may be eligible for federal tax credits to help them afford health insurance. 

In California, 7 million people do not have health insurance. Many say they cannot afford it. Others say insurance companies refuse to issue them a policy because they are sick. Most uninsured people have jobs, or are the children of working parents, but their employers do not offer health insurance.

The New Marketplace — Covered California In the new marketplace,
insurers will no longer be able to deny you coverage because of a current or past health condition. In addition, many people will qualify for government subsidies — in the form of tax credits — to help them purchase health insurance.


Expanded Medi-Cal program

Medi-Cal is the government health insurance program for people who are poor or disabled. Under the new federal law, California is expanding the income limits for the Medi-Cal program. Many more poor people will qualify.



What the Health Law Changes for Small Business Owners

 Under the Affordable Care Act, small business owners will be able to purchase health insurance for their employees on a special marketplace called "SHOP," the Small Business Health Options Program. SHOP is run by Covered California, which also runs the new marketplace for individuals and families. The SHOP marketplace is expected to launch this summer. In SHOP, you will be part of an insurance pool made up of small businesses across California. This is new under the health law. The goal is to give small businesses access to more plans and more buying power, just as large businesses have traditionally had. If you currently offer health insurance and have a broker you work with, your broker can help you pick a plan on SHOP. If you don't have a broker, you may seek help navigating SHOP from Covered California, if you wish.




Does the Health Law Require That Small Businesses Provide Health Insurance?
No. The Affordable Care Act does not require that businesses with fewer than 50 full-time equivalent employees (defined as 30 hours per week) provide health insurance. But if your business has 50 or more FTEs, you could be subject to penalties if you do not provide insurance. 



What Businesses Are Eligible for This Tax Credit I Keep Hearing About?

First, the tax credit is available now. If you currently offer health insurance, you can claim the credit on your income tax return, if you are eligible. The major qualifying factor is the size of your business. Only companies with 25 or fewer full-time equivalent employees are eligible. Eligibility is further determined by several other factors including: Your average annual wages are less than $50,000 per full-time equivalent employee You pay at least 50 percent of the health insurance premium for your employees Both businesses and nonprofits are eligible. The tax credits are available on a sliding scale: up to 35 percent of premiums in tax year 2013 and up to 50 percent of premiums in tax year 2014. Covered California can help you determine your own eligibility. Tax credits are available for a total of two consecutive years.