FAQ´s

Our Top 12 most Frequently Asked Questions

What is "health care reform", also referred to as "Obamacare"?
These terms refer to the March 2010 Affordable Care Act, a federal law and its related state laws intended to help more people obtain affordable health care coverage.

What do I need to do now?

If you already have insurance through an employer, your employer should update you on any changes at your next enrollment.  If you already have insurance purchased on your own, you can keep your plan and your carrier may update you with any changes. If you do not currently have coverage, refer to "what are my options" below.

What are my options?
Option 1) purchase insurance through an employer, Option 2) purchase one of the 4 "metal" (Bronze, Silver, Gold, Platinum) plans available through the California insurance exchange (available through this website) in order to receive a subsidy, which will be offered on a sliding scale based on income, Option 3) purchase a plan outside of the exchange and do not receive a subsidy, Option 4) do not obtain any health coverage and pay the tax penalties

What is a health exchange also known as a marketplace?
Federal or state-run markets where you can shop, compare, and buy healthcare coverage, such plans are offered on this site by clicking Apply Now.

Do I have to buy a plan on the "health exchange"?
If a person would like to apply for subsidized coverage, then yes they must apply for a one of the "metal plans" available on the "exchange", click on Apply Now to get started. If subsidized coverage is not needed or desired then a person is not limited to the "metal plans" and can apply for any plan, click on Apply Now to get started to purchase coverage without a subsidy. If a person applies for an exchange or not an exchange plan, they will not be denied based on pre-existing conditions either way under the new laws.

What are the tax penalties for not purchasing health coverage?
The tax penalties will increase over the next several years as follows:

2014: Greater of $95 or 1% of taxable income; 2015: Greater of $325 or 2% of taxable income; 2016: Greater of $695 or 2.5% of taxable income; 2017 and beyond: Annual adjustments based on the cost of living

Is anyone exempt from the tax penalty?
Individuals may be exempt from the tax penalty for any of the following reasons:  a) those who are uninsured for less than three months, b) those who would have to pay more than 8% of their household incomes for premiums, c) those who are part of a religion opposed to acceptance of benefits from a health insurance policy, d) you are an undocumented immigrant, e) you are incarcerated, f) you are a member of an Indian tribe g) your family income is below the threshold requiring you to file a tax return ($9,350 for an individual, $18,700 for a family in 2010), or  h) you have to pay more than 8% of your income for health insurance, after taking into account any employer contributions or tax credits.

When do the tax penalties begin?

Under the Affordable Care Act, individuals, who are US Citizens, must purchase minimum essential coverage beginning January 2014 to avoid tax penalties.

What time of year can I enroll?

The first enrollment period will be 10/13 through 3/31/14. After this first enrollment period is over, open enrollment will be January-March of every year. However, if someone has a "qualifying event" they can enroll any time of year as a "special enrollment" within 60 days of the event (such as loss of job, death of a spouse, birth of a child). Medi-Cal enrollees can apply any time of the year.

How do the subsidy programs work?

Individuals who qualify for a subsidy, based on income, can sign up for one of the PPO "metal" health plans (bronze, silver, gold, platinum) that is approved by the California Health Exchange. The Exchange works with the government and insurance companies to ensure the money for the subsidy is paid to the insurance carrier.

How is a subsidy determined?
The amount of government subsidy an individual or family is provided is based on the Adjusted Gross Income (AGI) on the most recent tax return. The AGI is then compared to the Federal Poverty Level and the amount of subsidy is determined from there.

What if I have a pre-existing condition?
Applicants to the health exchange plans will receive health coverage through the exchange regardless of any pre-existing health conditions.

How do I receive my subsidy?
Subsidies will be sent directly to the carriers. You will pay the remaining premium amount due to the carrier.