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Health Reform FAQ

  • What is health reform?
    Health Reform, a.k.a. Obama Care; the term “health care reform” refers to the Affordable Care Act; a federal law that was passed in March 2010. The goal of these laws are to help citizens get affordable health insurance coverage and to receive better health care.
  • Does everyone need to buy health insurance?
    The Affordable Care Act requires most U.S. citizens and legal immigrants to have a basic amount of coverage beginning January 1, 2014. Insurance companies may no longer deny coverage to those who have a medical condition, and may no longer require you to pass a medical exam to qualify for coverage.Some people won’t have to buy insurance. This includes people with certain religious beliefs, undocumented immigrants, members of Native American tribes and those in prison. Those whose income is below a certain level are also not required to buy insurance.
  • What do I need to do right now?
     If you already have health coverage, you may simply keep your current plan. For 2014, insurance companies will have to update many of their health plans to include all of the changes from the health care law. That means there might be some big changes to come. There is nothing to do now: BUT you may need to change your plan in the fall of 2013. If you complete the “Keep me informed” section, we will let you know about plan changes coming for 2014 in the next few months as the government is still making changes that may affect you.

    Looking ahead, keep in mind that there will be several well known companies inside and outside of the exchange to choose from — including the care and providers you know and trust. Beginning in October, you’ll have the opportunity to enroll in new plans that will begin on January 1, 2014.

  • Do Children need to be covered now?
    Yes. Children need to be covered and if they have no maintained credible coverage, there will be a 10% penalty added to the premium. We have some great low cost plans that will enable you to get your children covered now.
  • What if I can’t afford the premiums for health care?
    The government may provide financial assistance to you– called subsidies – this will help people to pay for health coverage or care if they can’t afford it themselves. Subsidies are usually determined by a person’s income level and family size. You will be able to find out if you qualify for financial assistance when the Marketplaces opens in October. The following are general income guidelines that might be used by the government to determine if you qualify and how much help you might receive. Check out our Health Reform Subsidy Calculator in the side bar to the right.If you’re single, the range of income qualifying for assistance could be between $15,282 and $45,960.
    For couples, the range of combined income qualifying for assistance could be between $20,628 and $62,040.
    For a family of four, the range of combined income qualifying for assistance could be between $31,322 and $94,200. 
  • How will I know if I can get help through Federal Subsidies?

    Beginning in October, 2013, we will be here to assist you in applying for financial assistance (subsidies) from the federal government to help pay for your coverage and health care in 2014. We have placed a subsidy calculator on our site to help you determine what you might expect come October.

    We will help you determine if you qualify for federal financial assistance (subsidies) and will assist you in obtaining your coverage through the exchange.

    Subsidies will help with premiums and out-of-pocket expenses in the Health Insurance Exchange.
    Financial Assistance will be on a sliding scale, based on income and family size. The Federal Government just announced that disclosure of income for subsidies will be based on the honor system.

  • What are the Different Levels of Coverage
    All plans in the Marketplaces will be grouped into four levels of coverage – Bronze, Silver, Gold, and Platinum, these are known as Metal plans. These categories of coverage were set up to make it easier for you to compare plans offered by the various insurance companies. To illustrate how they work, Bronze plans, generally would have lower premiums but higher co-pays, co-insurance, and deductibles than plans in the other levels. Platinum plans, will more than likely have higher premiums but lower out-of-pocket costs for deductibles, co-insurance, and co-pays.
    The Marketplaces will have various levels of coverage offered by different insurers, which will allow you to tailor the coverage to meet your own needs at a rate you may afford.
    All plans will offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
    Those who qualify, will have the additional option of a high-deductible plan with low premiums.
  • What are the Health Insurance Marketplaces?
    Marketplace, also known as the “Exchange”, in California, you may purchase your health care coverage through the Insurance Companies via Agents like myself, who will be certified to write health insurance through the exchange or by contacting the State. There are no difference in rates by going through an Insurance Agent vs. going through the State. Coverage will be available to people who are uninsured or who have purchased insurance on their own. The California Exchange (Marketplace) will also operate a Small Business Health Options Program, also know as the SHOP. This allows Insurance Agents, like myself to assist small employers shop the various Insurance Companies in their purchase from a variety of plans; they may allow their employees to choose from a plan they select or they may choose from all the plans. We will begin writing coverage when the Marketplace opens in October 2013, coverage purchased will be effective January 1, 2014, or later.
  • Do I have to buy from the Exchange | Marketplace?
    Not necessarily. The Marketplace is just one of the ways people can shop for health coverage. People can still get coverage through their employer or directly from an insurance company. You will have to buy coverage through the Marketplace to apply for subsidized coverage, however.
  • What if I don’t buy health care coverage?
    If you don’t buy coverage and go without it for three months or longer, you’ll be charged a tax penalty by the government. If you lack coverage for a period of fewer than three months, you will not be charged a penalty for that period of time.
  • If I am a Small Business, will I have to provide coverage for my employees?
    No, You do not have to provide coverage for your employees and there will be no penalties for Small Businesses. A small business is one that has less than 50 full time employees. HOWEVER, we will come to your business establishment and present health care coverages and enroll your employees. It might be to your benefit to offer a defined contribution plan and contribute a portion of the employee’s premium. Talk with your tax preparer to see if you would qualify for tax credits. As your Insurance Agent, we give a high level of service to our small business clients, to include assistance with defined contribution plans, Employee Handbooks and other resources. Call us today 559-492-6680.
  • How do I determine a full time employee?
    A full time employee is an employee that works 30 or more hours per week.
  • f my spouse is covered under an employer plan, can I go into the Exchange | Marketplace?
    Yes, if your spouses coverage is paid by the employer but the employer does NOT pay for dependents, then you MAY go into the exchange and possibly obtain subsidies for the dependents not covered under the employer plan.