California’s Brand New Health Insurance Exchange: Your Questions Answered

October 11th, 2013 by Navid J. Leave a reply »

In honor of the fact that open enrollment for California’s health insurance exchanges went live on October 1st – leaving California citizens, of course, with many questions – it’s decidedly worth reviewing what this means for the state.

Covered California is a new by the state, for the state agency that was put in place in order to supervise the buying and selling of health insurance and to help enroll eligible candidates for coverage.

Who does it benefit?

There are three main demographic groups who will benefit from the new healthcare exchanges: the poor, the low-income working class, and anyone who buys their own insurance. Essentially, anyone with an income below $15,400 per year will be qualified to take advantage of Medicaid – or Medi-Cal, as it is known in California. It is projected that this will help some 2.3 million uninsured Californians enroll in an individual California health insurance plan within the next 3 years.

What about immigrants?

Under this new plan, legal immigrants are eligible to purchase insurance plans through Covered California. They are also available for the government subsidies if they are qualified in terms of their income. However, illegal immigrants cannot buy insurance and are not eligible for Medicaid.

What will it offer?

Essential benefits are required under the new act, which include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation services and equipment, laboratory services, chronic disease management services, preventative and wellness services, and pediatric services.

What are the bronze, silver, gold, and platinum color codes?

There are three different types of coverage policies available, and they are color-coded to match their offerings. The color codes reflect what percentage of health care costs will be covered by the insurance plan, as well as how much the monthly premiums and copays will cost for doctor visits and prescription drugs. Bronze is the lowest-cost plan, and on this plan the insurance company will cover 60% of expenses, leaving 40% to be billed to the patient. A Silver coverage plan will offer an average of 70% of expenses paid by the insurance company, and Gold will have an average of 80% paid by the insurance company. Platinum, on the other hand, offers the most coverage – up to 90% to be paid by the insurance company – but is also the most expensive on a month-to-month basis. According to Forbes, “Your share of costs might come in the form of a large deductible with low coinsurance once you’ve met your deductible. Another plan might offer a low deductible with higher coinsurance.”

As the result of these changes, it’s estimated that 2.6 million people will now be qualified to take advantage of financial assistance in paying for health insurance. Another 2.7 million will be newly eligible for guaranteed coverage. Emergency services will no longer be denied to those who can’t outright afford it in the state of California.


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