Health Care Reform. Here are the changes in a nutshell.

Posted by Phil Dougherty
July 25, 2013

The major changes to our health care system are coming soon, but there has already been meaningful change such as mandated preventive care, removal of caps on annual and lifetime coverage, extended dependent coverage to age 26, and requirements for carriers to spend more on claims and less on admin costs. California also mandated some changes; most significant was guaranteeing coverage to children under age 19.

The new health care exchange or marketplace (called Covered California) will open for business October 1, 2013. This will be the start of the first open enrollment period when individuals can enroll in a health plan regardless of their pre-existing conditions with plans starting January 1, 2014.  The health care bill requires everyone to enroll in “affordable” coverage, either through an employer group plan, Covered California, a private exchange, Medi-Cal or Medicare.  Penalties for not enrolling, when eligible, could result in a fine.

The most notable carriers who have bid successfully to participate in the new health care marketplace are Anthem Blue Cross, Kaiser, Blue Shield of CA, HealthNet and Western Health Advantage.  Plans will be standardized and grouped into metallic levels (Bronze, Silver, Gold and Platinum) by how much they will cover “essential benefits”.  In addition to hospitalization, emergency and ambulatory services, plans must also cover maternity, prescriptions, therapies, loads of preventive care, pediatric dental and vision services, and more.

With these mandated benefits and new taxes on insurers, expect premiums to be higher. Bronze plans will be your higher deductible lower cost plans with Platinum being the richest coverage with no deductibles. Enter the subsidy. For those who qualify, the federal government will provide two forms of subsidies: a tax credit to lower premiums and assistance with out-of-pocket costs. Tax credits will be determined on a sliding scale based on income and will be realized as an immediate reduction of premium.

Plan specifics, rates, and the process of transitioning to new plans are due out in the coming months. More to follow.

Phil Dougherty

When the time comes let OnlyHealthInsurance guide you through the transition and help you identify a plan to best suit your needs.