Covered California 101

Transcription

1 Covered California 101

2 Do you have auto insurance? Reasons why you should: If your car gets in an accident you won t be able to drive to work. It s the law.

3 Do you have health insurance? Reasons why you should: If you have an accident or get sick, you might not be able to work. It s now the law.

4 Making Care Affordable Number of People in Your Household Annual Household Income Medi-Cal Premium Assistance 1 $ 0 - $ 15,856 $ 15,856 - $ 45,960 2 $ 0 - $ 21,404 $ 21,404 - $ 62,040 3 $ 0 - $ 26,951 $ 26,951 - $ 78,120 4 $ 0 - $ 32,499 $ 32,499 - $ 94,200 5 $ 0 - $ 38,047 $ 38,047 - $ 110,280

5 Why is it important to have health insurance coverage? Uninsured nightmares

6 SCENARIO 1 Soccer Injury: Torn ACL

7 SCENARIO 1 Uninsured Cost: ACL Reconstruction $ 20,000 - $ 50,000 Includes surgeon s fee, facility fee, anesthesia. Physical therapy can add $ 1,000 or more to cost.

8 SCENARIO 2 Home Repair Accident: Broken Leg

9 SCENARIO 2 Uninsured Cost: Non-surgical care: up to $ 2,500 If surgery is required, costs skyrocket to $ 17,000 - $ 35,000 or more

10 What is a premium? The amount that must be paid for your health insurance or plan. You or your employer, or both, usually pay it monthly, quarterly or yearly. What is a deductible? The amount you owe for health care services your health insurance plan covers before your plan begins to pay. For example, if your deductible is $ 1,000, your plan won t pay anything until you have met your deductible for covered health care services. The deductible may not apply to all services. What is a copay? A fixed amount (for example, $ 15) you pay for a covered health care service, usually when you receive the service. The amount can vary by the type of covered health care service.

11 What about Obamacare? The Affordable Care Act (also known as Obamacare) is the federal law that made changes to health care.

12 What does the Affordable Care Act Guarantee? All essential benefits are covered. No denial for pre-existing conditions. Coverage is required; otherwise, pay a penalty.

13 Who is eligible? All legal residents of California. Who is not? Undocumented immigrants. Currently incarcerated individuals.

14 Medi-Cal If you earn $ 15,856 or less, you may be eligible for free/reduced insurance under Medi-Cal. Applying at Covered California will allow you to see if you re eligible for Medi-Cal.

15 How to Shop for Health Insurance Paid by Health Plan Paid by You METAL TIERS BRONZE SILVER GOLD PLATINUM 60 % 40 % 70 % 30 % 80 % 20 % 90 % 10 %

16 What You Get Regardless of the plan selected, the following essential benefits are covered: outpatient services emergency services hospitalization maternity and newborn care mental health and substance abuse disorder services prescription drugs rehabilitative and habilitative services and devices laboratory services preventive and wellnesss services and chronic disease management pediatric services No denial for pre-existing conditions.

17 Insurance Cost Scenario Oscar AGE 25 RESIDENCE Sacramento Long Beach MARITAL STATUS single ANNUAL INCOME $ 22,000 (modified adjusted gross income) Use our Shop and Compare Tool to calculate your cost to purchase health coverage.

18 Insurance Cost Scenario HMO Taylor family HMO AGE 25 AGES John, 42; Maria, 40 RESIDENCE Long Beach 2 kids RESIDENCE Long Beach MARITAL STATUS single MARITAL ANNUAL STATUS INCOME married $ 22,000 (modified adjusted gross income) ANNUAL INCOME $ 65,000 (modified adjusted gross income) HMO PPO EPO Use our Shop and Compare Tool to calculate your cost to purchase health coverage.

19 How to Enroll One application for Covered California or Medi-Cal. ONLINE Service Center (800) (800) (Spanish) PHONE * or 7 MAIL OR FAX IN-PERSON Certified Enrollment Counselor IN-PERSON Local county human or social services office IN-PERSON

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21 What You Need to Enroll f Employee s address and ZIP code 15 State Employer s state ID number 16 State wages, tips, etc. 17 State income tax CA , Form W-2 Wage and Tax Statement 2013 Copy 1 For State, City, or Local Tax Department SOCIAL SECURITY # INCOME INFORMATION INCOME TAX FILING

22 When You Can Enroll Initial open enrollment: Oct. 1, 2013 March 31, Special circumstance : 60 days within a certain life-changing event, such as a divorce or the birth of a child. Subsequent enrollment: October December each year. Medi-Cal applications accepted year-round.

23 Penalty for No Enrollment If not enrolled by March 31, 2014, you will begin paying a penalty of: 2014 $ 95 or 1 % of income, whichever is greater $ 325 or 2 % of income, whichever is greater. Unless special circumstance (life-changing event like divorce or birth of child)

24 CoveredCA.com (800) Covered California