Terms like "Exchange" and "Marketplace" are just different names for Covered California. In other States, there will be other "Exchanges" or "Marketplaces" with different names. If you live in California don't worry about them; you only need to understand Covered California and how it works. So how does it work?
Think of Covered California like Orbitz or Travelocity for Health Insurance. Instead of comparing airline fares you are comparing health insurance plans. When you find the plan that makes the most sense for you, just enroll in the plan. You can enroll directly with the insurance company or through Covered California, BUT if you are eligible for premium assistance (where the government helps cover some of the cost of your plan) you must enroll through Covered California to get that assistance.
Plan premiums are the same whether your enroll by yourself or use an agent. Why not work with an expert? Call (916) 600-1663 today!
One of the most important changes to health insurance is the fact that insurance companies can no longer deny coverage because of your health. Starting in 2014 there are no more pre-existing conditions. BUT, there are limitations on WHEN you can enroll for health insurance.
Unless you have a special “qualifying” event, such as losing employer coverage or moving to another part of the country, you must wait until the annual open enrollment period to sign up for coverage. Getting sick is not considered a qualifying event.
Open enrollment begins November 1st and continues through January 31st. If you don't enroll during open enrollment, you won’t be able to enroll in health insurance until the next open enrollment period unless you have a qualifying event. When enrolling during open enrollment the earliest date coverage will start is January 1st.
If your household income falls below 400% of the federal poverty guideline, AND you have not been offered employer sponsored health insurance, you may be eligible for premium assistance IF you purchase your health insurance through Covered California. It is important to estimate your income as closely as possible. It may be helpful to work with an Agent who can assist you in this process and remains available for future questions.
Premium assistance is actually an advance tax credit from the IRS. Based on the information you provide about your expected annual income and your number of dependents, the IRS will pay (directly to the insurance company) a portion of your health insurance premium each month. When you file your taxes the IRS will adjust your tax credit based on your actual income. If you make more than estimated you will owe money to the IRS. Be careful when estimating your income!
If your household income is 138% or less than the federal poverty guideline you are eligible for Medi-Cal. Should you decide not to accept Medi-Cal and instead purchase health insurance, you will NOT be eligible for Premium Assistance. Children are eligible for Medi-Cal up to 266% of the federal poverty guideline. This means you may get regular insurance while your kids get Medi-Cal.
The Individual Mandate & Tax Penalty
Each U.S. citizen or legal resident is required to have "Qualified Health Insurance" OR pay a tax penalty. The penalty for 2014 is the higher of $95 per person (up to 3 people, or $285) OR 1.0% of taxable income. The penalty increases in 2015 to the higher of $325 per person (up to 3 people, or $975) OR 2.0% of taxable income. It increases again in 2016 to the higher of $695 per person (up to 3 people, or $2,085) OR 2.5% of taxable income. After 2016 the amounts will adjust annually for cost of living increases.
To learn more about your health insurance options click the read more button.