Ready or not, the new health insurance requirements are here! Everyone seems to have an opinion as to whether this is a good or bad thing. The fact is, though, it’s required and for many people in our county, it offers free or lower cost health insurance, and coverage will not be denied for pre-existing conditions or dropped when someone gets very sick or chronically ill.
Covered California is the state entity that runs our new health insurance exchange. Those who have health coverage that covers certain “essential health benefits” such as hospital stays, emergency care, maternity care, and pediatric care, prescriptions, and more, and also doesn’t overcharge (the state provides a formula for this) can stay with their current plans.
People who do not have coverage or whose current coverage doesn’t meet the above criteria, now can be insured through Covered California (www.coveredca.com). All Covered California plans cover the same essential health benefits, which are the minimum required by law for all plans, whether through Covered California or your own private insurance.
The Covered California website or a Certified Enrollment Counselor, can help you determine if you qualify for Medi-Cal, “premium assistance,” or other affordable plans through Covered California. Individuals making $15,857 or less per year or are disabled will qualify for Medi-Cal, which is free health insurance. Those who make $15,857 – $45,960 will qualify for “premium assistance,” which means the federal government will pay a portion of your insurance premium each month. Chart I (sidebar) shows the income limits for Medi-Cal and premium assistance for households of 1 – 5 members.
Enrollment is open for all plans now. You must chose a plan (have your own private insurance or choose Covered California or Medi-Cal insurance) by Dec. 15, 2013 for coverage beginning Jan. 1, 2014, or risk paying a penalty. There is, however, a grace period lasting until March 31. After that, you will be charged annually based on every month that you don’t have health coverage. The law requires this coverage or you will face a tax penalty of $95 per person or one percent of your annual income, whichever is greater for 2014, the first year (for the number of months you are without insurance). By 2016, the fine will be $695 per person or 2.5% of annual income, whichever is greater.
Covered California offers four levels of coverage. The more you pay out of pocket, the less your deductible and maximum out of pocket will be. The website allows you to compare plans. See Chart II (sidebar) for a comparison of plans at the “Basic” level for a single person. The website also will let you know if you qualify for Medi-Cal. Plumas County has contracted with two Medi-Cal managed care plans—California Health and Wellness and Anthem Blue Cross. You can choose which one is best for you. If you don’t choose, one will be assigned to you, but you can opt to change to the other one at any time, and the change will take place the following month.
Which coverage you qualify for, as well as what plan is right for you, can seem daunting, and for that reason, Certified Enrollment Entities (CEEs) and Counselors are available to explain the choices to you and to help you complete your application. Mimi Hall Director of Plumas County’s Public Health Dept. said she is currently applying to have her department become a Certified Enrollment Entity, and EPHC is applying, as well. Jeri Nelson, Chief Financial Officer, said that Sarah Skeels, Lisa Terry, and Karina Avila, who is fluent in Spanish, will be trained as Certified Enrollment Counselors to help people to enroll.
Covered California and Medi-Cal Contact Information
To find Covered California online and determine what coverage is right for you, go to www.coveredca.com. You can also phone them at 800.300.1506 or TTY 888.889.4500. Service centers are open weekdays from 8:00 am – 8:00 pm and Saturday from 8:00 am – 6:00 pm. You can get information about Covered California in Plumas County by visiting Plumas County Dept. of Social Services or calling 530.283.6351, Mon. – Fri from 8:00 am – 5:00 pm, or calling Sarah Skeels at EPHC 530.832.6568, Mon., Tues, Thurs., and Fri. from 8:00 am – 5:00 pm.
The Covered California website also will help you determine if you qualify for Medi-Cal. If you do, you can apply for Medi-Cal and other benefits on-line at www.c4yourself.com. You can also call Plumas County Dept. of Social Services at 530.283.6350 with questions or to get a paper application mailed to you. You can also visit Social Services at 270 County Hospital Road, Suite 207, Quincy, CA, Mon. – Fri. from 8:00 am – 5:00 pm. EPHC’s Sarah Skeels can help you fill out your Medi-Cal application, as well. You will still have to go to Social Services in Quincy to show them original copies of your birth certificate and picture ID.
Finally, EPHC will have Covered California and Managed Medi-Cal brochures and information on a dedicated display board in each of their four clinics (Graeagle, Indian Valley, Loyalton, and Portola) and in the Portola hospital lobby.