This is another installment of "Ask Emily," a biweekly column by Emily Bazar, senior writer with the California HealthCare Foundation's Center for Health Reporting. It is a Q&A exploring the practical questions that consumers have about the Affordable Care Act. You can submit questions for "Ask Emily" at AskEmily@usc.edu.
Here it comes, folks, the deadline that I have been harping on for months: March 31 marks the end of Obamacare’s inaugural open-enrollment period and your last chance to sign up for a health plan through the state’s health insurance exchange, Covered California, or the private market.
Your last chance, that is, until the next open-enrollment period begins late this year. (It’s time to abandon your scheme to wait to sign up until an ambulance whisks you from your totaled car to the hospital. It doesn’t work that way.)
If you’re among the elite group of procrastinators who delayed until now, expect long wait times online or by phone. Instead, consider attending an enrollment event in your area (there are scores scheduled around the state) or visiting an insurance agent who has been certified by Covered California. You can find listings for both on CoveredCA.com.
Anyone who enrolls in a plan now will have coverage starting May 1. But remember, it’s not just about signing up. Your first month’s premium is due by April 25.
Q: Does Obamacare cover ambulance fees?
A: Ambulances make 2.7 million trips each year in California. And they don’t come cheap.
For Californians with private insurance, the average charge for an ambulance ride was $1,274 in 2011, says June Iljana, executive director of the California Ambulance Association.
Before the Affordable Care Act, many insurance plans didn’t cover ambulance fees.
Obamacare changes that. Under the law, “emergency services” – including ambulance rides – is one of the 10 categories of care that all health plans sold to individuals and small businesses must include.
But don’t breathe a sigh of relief just yet. You still have to pay your share of the ride.
“Basically, everyone with insurance is going to have ambulance coverage, but how much they’re going to have to pay for it depends on the level of their plan,” Iljana says.
For instance, if you selected a bronze-level plan from Covered California, which has the highest out-of-pocket costs, your ambulance ride would come with a $300 co-pay.
If you have a platinum plan, which has the lowest out-of-pocket expenses, your co-pay would be $150.
But wait. There’s more. Those figures don’t include your emergency room co-pay, which also ranges from $150 to $300 and could top that in some instances.
Look at the bright side. As you’re gritting your teeth from the pain of your newly broken leg, at least you won’t have to worry whether the ambulance that’s coming to fetch you is in your plan’s network.
“You’ll get the same coverage no matter who picks you up,” Iljana says.
Q: You have said in the past that anyone who is eligible for Medi-Cal is ineligible for tax credits from Covered California. Are there any exceptions?
A: Of course! What would Obamacare be without exceptions?
Medi-Cal, our version of the federal Medicaid program, provides health coverage to low-income Californians.
Most of its 9.4 million members get Medi-Cal for free. But a portion of the Medi-Cal population – about 471,000 people in July 2013 – make too much money to qualify for free coverage. Instead, they have to pay what’s called a “share of cost” each and every month they receive medical care.
It works kind of like a high-deductible plan that resets monthly, says Vanessa Cajina, a lobbyist for the Western Center on Law & Poverty.
Cajina provided an example: For a family of three that brings home $2,165 a month, mom and dad would have to pay $1,231 out of pocket for health care before Medi-Cal takes over for that month. (Their child would qualify for free Medi-Cal.)
I’m no math major, but that’s more than half of their monthly income.
Lucky for them, this is where the exception comes in.
If you’re a Medi-Cal member with a share of cost, you can sign up for a Covered California plan and receive tax credits – which will offset the cost of your insurance premiums – if you meet the income and other guidelines. Chances are, you will.
There is an exception to the exception. If you have a share of cost but are over 65 or have a disability, you probably won’t qualify for the credits for reasons I won’t get into here. The rest of you: Check with Covered California. You could save a boatload.
“If you’re an able-bodied adult between 19 and 64, and you have Medi-Cal share of cost, it is worth calling your county Medi-Cal office or Covered California to see if there’s a less expensive exchange plan for you,” Cajina says.
As I mentioned at the start of this column, you better get on it. Quick.
Questions for Emily: AskEmily@usc.edu
Learn more about Emily here.
The CHCF Center for Health Reporting partners with news organizations to cover California health policy. Located at the USC Annenberg School for Communication and Journalism, it is funded by the nonpartisan California HealthCare Foundation.