What Obamacare in California entails: A Comprehensive Guide

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Obamacare california
Obamacare california

Earlier this month, in our previous article, we discussed Obamacare’s health insurance plan and all that it entails, so if you missed it, make sure you read it right here – Obamacare Health Insurance.

Today, we’ll have an in-depth discussion about Obamacare in California.

As we all know, the Affordable Care Act 2010, or Obamacare as it is also known, is a healthcare reform law whose primary goal is to make health insurance more affordable and widely accessible to all Americans. 

In addition to the health insurance exchanges, the Affordable Care Act also created health insurance marketplaces, which are government-run websites that you can access if you don’t have health insurance for yourself or your family.

Obamacare California

Depending on which state you live in, there are two types of Marketplaces.

Some states have the federal health insurance exchange (also known as Healthcare.gov) while other states run their own state-run health insurance exchanges.

As part of the California Health Insurance Exchange, also known as Covered California, the state has its own health exchange set up.

You may not have to make any changes to your current health insurance coverage if you already have it.

Under Obamacare, there could be a tax penalty imposed on you if you do not have health insurance and do not qualify for an exemption.

Covered California serves as the state’s health insurance exchange, however, it is not the only choice you have if you choose to purchase a health plan on the individual and family marketplaces.

There are many ways you can find health coverage, including directly through insurance companies and licensed brokers such as eHealth.

The Centers for Medicare and Medicaid Services (CMS) has made an enrollment agreement with eHealth.com that allows you to enroll in an eligible health plan and receive advanced premium credits without leaving the site.

Find out how California’s Obamacare program works and what options you have for health coverage by reading on.

Am I eligible for Obamacare health coverage?

In order to be considered eligible for health insurance coverage under the Affordable Care Act (ACA), most U.S. citizens, U.S. nationals, and permanent residents of California must meet minimum requirements for coverage.

When you do not have health coverage for two consecutive months or more, you may have to pay a premium tax penalty unless you qualify for an exemption.

A person who is illegally in the United States is not required to carry health insurance.

The Covered California exchange will not allow you to enroll in a health plan, but you may still be able to enroll in private health insurance outside of the exchange.

Even if you do not have legal status in the country, you can still apply for Covered California health insurance coverage through your family member who is legally in the country.

Types of health plans on the California health insurance exchange

Obamacare california
Obamacare california

Covered California offers four metal levels of health insurance plans.

You’ll pay different amounts for health plans according to the metal level you choose, and it has nothing whatsoever to do with the quality of care you receive.

The four metal levels of plans offered on the California health exchange are:

  • Bronze level: 60% of healthcare costs are covered by your plan, 40% by you.
  • Silver level: You pay 30% of covered health care costs; your plan pays 70%.
  • Gold level: 80% of covered healthcare expenses are covered by your plan, with 20% paid by you.
  • Platinum level: 90% of your health care costs are covered by your plan; the remaining 10% is your responsibility.

Enhanced Silver plans

For those with a modest income who qualify for lower out-of-pocket payments, the California health exchange provides an Enhanced Silver plan.

When qualified individuals purchase an enhanced Silver plan, it offers the lower cost-sharing benefits of a Gold or Platinum plan, but at the cost of a Silver plan.

Minimum coverage plans

You might consider minimum coverage plans if either of these applies to you:

  • You’re younger than 30.
  • You aren’t able to afford health coverage, or you don’t qualify for hardship exemptions.

A minimum coverage plan, which can also be referred to as catastrophic coverage, is another type of health insurance that is designed to provide you with the same essential benefits as the other Marketplace plans.

Most of these plans are less expensive than other health plans, but most of the costs are not covered until you meet the high deductible.

Plans with minimum coverage are designed to protect you in case of the worst situation that might occur.

A minimum coverage plan in California covers some benefits before a deductible is met.

Following services are typically covered without copayments or coinsurance

  • Three doctor visits
  • Urgent care visits
  • Outpatient mental health or substance abuse care
  • Free preventive benefits

How Do I Qualify for Obamacare?

The following requirements must be met to become eligible for California Obamacare plans:

  • A household income of 138 percent up to 400 percent above the poverty level
  • Ineligible for Medi-Cal coverage; not eligible for Medicare coverage; or not eligible for military health coverage
  • Your employer does not offer you access to affordable health coverage
  • Ensure tax returns are filed for the benefit year

Costs

State California
Average Lowest Cost Bronze Plan $323
Average Lowest Cost Silver Plan $400
Average Benchmark Plan $426
Average Lowest Cost Gold Plan $444

What benefits are covered by Obamacare health plans?

In California, health insurance plans are required to meet minimum coverage requirements, or “essential health benefits,” before they are sold on the individual or family Marketplace.”

Among these benefits are:

  • Ambulatory services
  • Emergency or urgent care
  • Hospitalization services
  • Maternity and newborn care
  • Mental health and substance abuse services, including counseling
  • Prescription medications
  • Rehabilitative services and equipment
  • Laboratory services
  • Preventive and wellness care, including chronic-condition management
  • Pediatric services (which must include dental and vision care for children)

Obamacare California phone number

Call 1-877-752-4737 or visit the Covered California website for information about Obama Care California quotes and applications.

You can call 1-800-318-2596 if your address is outside of California.