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Kern Valley Sun 10-16-2013: Affordable Care Act demystified - 2013/10/18 09:38 SOURCE:http://www.kernvalleysun.com/news/article_5989b306-3670-11e3-a5ee-0019bb2963f4.html
Affordable Care Act demystified
By Kathe Malouf/ Special to the Sun | Posted: Wednesday, October 16, 2013 7:36 am

The Affordable Care Act has been the focus of media attention and round-table discussions for much of 2013. While it is a sweeping change regarding how we shop for insurance, there are many residents who won’t be affected by the new law.

Open enrollment for Covered California, the state’s exchange for the Affordable Care Act (ACA) started Oct. 1. Sharon Rooney, one of the valley’s insurance agents who has applied for certification with Covered California, said she is fielding calls from Kern Valley residents who have questions about how to enroll, and if enrollment is even required.

“People have a lot of questions,” Rooney said. “But the most important thing to remember is that if a person is on Medicare, the Affordable Care Act does not affect them for 2014.” What, if any changes will occur after 2014, is unknown at this time.

Additionally, those who currently have insurance through an employer or purchase health insurance through the open market are not required to enroll in Covered California.

The ACA requires that every US citizen have minimal health insurance. While that sounds simple, Rooney admits that there are a number of different scenarios that are possible under the Act. “I’ve heard that this Act will cover 50 million people in the United States, and I predict that there will be at least 48 million different scenarios for calculating what coverage is the best fit for a particular person or family,” she said.

In a nutshell, Covered California guarantees coverage for an individual who does not currently have insurance. A person cannot be denied for a pre-existing condition, nor are rates based on a person’s health status. Some of the essential health benefits provided under Covered California include: emergency services, hospitalization, prescription drugs, maternity and newborn care, lab services, rehabilitative services and devices and pediatric services.

“The Affordable Care Act is designed to make insurance affordable for everyone,” Rooney said. “Under Covered California, premiums are based on the adjusted gross income as reported on the person’s tax form, there is zero deductible with some plans, and with affordable copays, it means lower out-of-pocket expenses.”

Coverage is available to all legal California residents, while undocumented immigrants and incarcerated individuals are not eligible. Rooney noted that when an individual applies for coverage, they must show proof of citizenship.

For the purpose of Covered California, the state is divided into separate Regions. In Kern County, there are four health care providers:

• Anthem Blue Cross

• Blue Shield of California

• Health Net

• Kaiser Permanente

Covered California provides four different insurance plan tier levels:

• Bronze, which is the least expensive, but carries the highest deductible

• Silver

• Gold

• Platinum, which is the most expensive, but has the lowest deductible

Each of the four tiers determines how much the person pays compared to the health plan. The premium rate is determined by a number of factors, including age, number of persons in the household, and the adjusted gross income. The range of options is a personal choice and should be made based on what an individual can afford when reviewing the amount of the monthly premium, co-pay and deductible. Rooney said some individuals will qualify for financial assistance that is available on a sliding scale, meaning those who earn less will qualify for more financial support, since the so-called Premium Assistance, or tax credit, is based on the individuals’ income.

Gene Parks, a Farmers Insurance agent in Mt. Mesa, is awaiting his final paperwork to certify him as an agent. “This is a very good thing for some people and the coverage is good,” Parks said, noting that younger people will be paying higher premiums than the older pre-65 year-olds. “But the down side is that there will be a narrow network of doctors participating in the program.”

Covered California has set up a website where individuals can compare and choose the health care coverage that best fits their needs and budget. Online enrollment is also available from the website. The online applications got off to a rocky start on Oct. 1 – the first day of the program, and a number of glitches continue to hinder enrollment. Rooney says that once the web-site is functioning, it will help individuals by calculating their premium rates and help them to make the right choice for their insurance.

Open enrollment will continue until March 31, 2014. In order to ensure that health care coverage begins on Jan. 1, 2014, a person must sign up before Dec. 15 of this year. Those who do not sign up by the March 31, 2014 deadline will face a penalty of $95, and that penalty fee will increase with each year that a person does not apply for coverage.

To apply for Covered California, residents can call 1-800-300-1506, or go to the website at: www.coveredca.com.
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