Major health care reform milestone reached

After months of intense preparation, Covered California, the health insurance marketplace created by the Affordable Care Act (ACA), began its open enrollment period on Oct. 1. Consumers can now begin the process of comparing and purchasing affordable medical and dental insurance coverage online, and Covered California is offering in-person and phone support for those who need it. 

Any individual or small-business employer has the option to purchase private health insurance coverage through the new web portal found at coveredca.com. CDA members who currently have coverage through the California Dental Association Anthem Blue Cross Health plan will be contacted during open enrollment by a TDIC Insurance Solutions member service specialist to transition to a new plan that meets their needs.

In the new marketplace, medical and dental insurance companies have a set benefit package, designed to make it easier for individuals and small businesses, such as most dental offices, to compare the plans and make informed coverage choices. Covered California is what is known as an “active purchaser,” meaning that it has negotiated with medical and dental plans in an effort to make premium rates paid by consumers affordable compared to the current individual or small group market. 

Individuals making less than 400 percent of the federal poverty level (about $45,000 a year for an individual) may be eligible for federal subsidies based on a sliding scale if they purchase their coverage through the new online marketplace. 

Come Jan. 1, it will be a requirement that every individual have qualifying medical insurance coverage or pay a penalty. However, there are many ways people can achieve this requirement. Most individuals who already have coverage (whether through the individual or group market, as part of an employer-sponsored plan, or through government coverage like Medicare or Veterans benefits for example), are likely to already qualify, and thus will see little change. However, individuals who had been barred from coverage in the past (for having pre-existing conditions, for example) or who found coverage in the individual market too costly, should be able to access affordable, comprehensive coverage through the Exchange.

There is no requirement for businesses with fewer than 200 employees to offer health coverage to their workforce. However, small businesses can purchase more affordable coverage through a separate Exchange offering insurance products designed specifically for them and their employees. Furthermore, businesses with less than 25 employees may also be eligible for small business tax rebates to help cover the cost of the coverage they purchase for employees. More information on the small business tax credits can be found here.

Even with full implementation only a few months away, there are still many unknowns.  No one is quite sure what impact the ACA implementation will have on health insurance premium rates for coverage outside of the Exchange. It is still unclear whether employers will change the medical insurance options available to employees. And we don’t yet know how many more children will access dental benefits for the first time through the exchanges. These and other key issues will continue to evolve over the next few months and through the new year.   

CDA remains actively engaged in all the ACA’s implementation details as well as the ongoing policy debates — acting on its members’ behalf as California moves to fully implement this law in the near future. 

For more information, please contact CDA’s Manager of Legislative Affairs Nicette Short at nicette.short@cda.org or 916.554.4970.