Individual Reforms

The Affordable Care Act (ACA) radically changed the Individual Health Insurance Marketplace. The ACA established the state exchange “health insurance marketplace” (Covered California),  the individual mandate,  the large group “play 0r pay”,  the 10 essential health benefits,  guaranteed health coverage,  eligibility to age 26, $O copays for preventive services,  subsidies for low to moderate income consumers,  tax-credits for qualified small employer groups,  the Minimum Medical Loss Ratio (MLR),  an open enrollment period for individual health plans, age based rates,   standardized level of health coverage,  and expanded Medi-Cal. These reforms caused some degree of confusion and chaos among consumers, providers, and the Insurance Carrier. Health care reform is an enormous challenge to begin with, but the policies under the ACA are sound and the implementation technology is bound to improve.

imagesThe ACA established an Open Enrollment period for all Individual Health Insurance that begin each November 15 and ends January 31st.  Individuals must now wait until the open enrollment period to enroll in or change health plans. Individuals without health coverage could be subject to fine.

The only exception to the open enrollment rule is if an individual has a “qualifying life event,” such as losing employer based coverage, aging out of your parents plan, becoming ineligible for public assistance health coverage (example: Medi-Cal), or moving to an area not covered by your current open enrollment health plan.

If you have a “qualifying life event” that creates eligibility for enrollment in an individual health insurance plan, you can get a quote and enroll online off-exchange by clicking on our EZ QUOTE system, or you can go to Covered California’s SHOP AND COMPARE feature and apply for health coverage all online (if you think you might qualify for “subsidy,” you will most certainly what to check out Covered California). The website will determine whether or not you are eligible for cost share reduction and/or a subsidy (advance premium tax-credit) to help make coverage more affordable. Either way we can help you find the right plan for your needs and budget.

We know first hand the good that the ACA has done for so many health care consumers, many of whom, just one year ago, couldn’t get coverage of any kind, or simply could not afford to purchase health insurance for themselves or their families. We have also observed first hand the challenges of enrolling through the Exchange, the confusion caused by ACA 10 Essential Health Benefits, and the problems created with the new “narrow provider networks.” As Certified Insurance Agents for Covered California we have helped hundreds of consumers get health insurance either through Covered California or Medi-Cal.  We can help you too.

The Affordable Care Act didn’t make health care free, but it did make it available for everyone and more affordable for many and that’s a good thing for all health care consumers.