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Obamacare: Answers to the 6 most frequent questions about Covered California (video)

Tuesday, November 19, 2013, 7:00pm - 8:30pm
The Crawford Family Forum 474 South Raymond Avenue Pasadena, CA 91105 Map and directions
KPCCRadio (via YouTube)
Covering California series icon 2013

The gradual rollout of the Affordable Care Act has raised many questions about affordability and coverage for the millions of Americans affected by it.

Despite its bumpy launch, one thing remains certain: the law will change the way we buy health insurance and the way health insurance companies do business, says Emily Bazar. Emily is the senior Writer for the CHCF Center for Health Reporting and author of their regular “Ask Emily” column on the Affordable Care Act, better known as "Obamacare."

Bazar was joined Tuesday night by moderator and KPCC's health care correspondent Stephanie O'Neill at KPCC's Crawford Family Forum to mull through some of the finer points of the new law and shed some light on what that means to individuals buyers and those who get insurance through their employer. 

Here are some some of the most frequently-asked questions Emily said she receives.

1. What are the penalties if I don't buy or have health insurance by 2014?

"If you don't have insurance, the tax penalty starts next year at $95 per person, or 1 percent of your income, whichever is greater, and every year it goes up until it hits $695 per person or 2.5 percent of your income, whichever is greater.

"The parents of children who are uninsured, will also have to pay the penalty. And the penalty is assessed based on your federal income taxes."

2. Who is exempt from the law?

"Members of federally recognized Native American tribes, people who are incarcerated, people who don't make enough money to be required to file federal income taxes, people who can't find affordable health coverage… if [their] premium costs more than 8 percent of your annual household income.

Also, people exempt are members of religious group who doesn't believe in accepting insurance benefits. You just can't say I'm anti-Obamacareian, for instance, but it has to be recognized by the social security administration.

And you can apply for a hardship exception, and you have to do this through the health insurance exchange — Covered California — and these can be a variety of things like if you had to file for bankruptcy in the last six months or if you are homeless part of the year. [You're] also exempt, if you don't live here legally…"

3. How does the new law affect the current health care system we have now?

"The first big thing is insurance companies are no longer allowed to deny coverage to people with pre-existing health conditions. So if you've had a heart attack or a stroke or cancer — I've even heard of cases of people being denied because of asthma because it's a chronic condition. They can't deny you anymore.

Right now there's no limit on how much insurance companies now can charge older people versus younger people. But starting January 1 they can charge no more than three times more the oldest person versus the youngest person.

California is chopped into 19 different geographic regions and the prices for each health insurance and the plans vary by region. They can charge families more than individuals. And in some states they can charge smokers more than nonsmoker, but that's not happening in California."

4. What is Covered California and how is that different from the federal marketplace?

"It's a new marketplace — a new mall basically — that sells health insurance throughout California, and some people will qualify for discounts. There are 11 health plans that are going to be sold across California but not all health plans will be available in all areas. Some are from large insurers like Kaiser, and some are from insurers that serve a limited geographic area like the Contra Costa Health Plan, or here the L.A. Health Care Plan.

These plans are going to be sold to people, individuals and families, and also small businesses. And some people will qualify for discounts, or tax credits.

The differences in prices come from the different insurers, but also there are four tiers of plans or four levels of coverage that you can choose from. They are called the 'metal' tiers.'"

5. What do the four metal tiers — bronze, silver, gold and platinum—mean and what do they cover?

"Bronze covers the least amount of your medical costs. Bronze covers 60 percent of your medical costs on average. Silver covers 70. Gold covers 80. Platinum covers 90.

So what that means is that for bronze, those are going to offer you the cheapest monthly premiums, however, you're also going to have the highest out-of-pocket costs with the bronze plans.

You have a $6,400 out-of-pocket maximum for the year, you have a higher co-pays. So you're going to be paying more for the services and out-of-pocket for the bronze than you would for platinum. You're going to pay a lot more per month for platinum but when you get the services you'll have a lower out-of-pocket maximum and you're paying less to see the doctor.

You gotta think about it for yourself: If you're making these kind of choices, do you go to the doctor a lot? People with chronic conditions might think about getting a platinum plan."

6. What happens if I can't afford a plan?

There are two forms of financial assistance: 

1. "Tax credits can lower the cost for monthly premiums for some people, and those people are the ones whose income qualify. Basically your income has to fall between 138 percent and 400 percent of the federal poverty level."

2. "Cost-sharing subsidies will go to people who make between 139 percent and 250 percent of the federal poverty level. And what these will do is they will lower your out-of-pocket costs: they will lower your co-pay, your out-of-pocket maximums."

Watch the entire conversation and hear other 'Obamacare'-related questions answered by Emily Bazar in our archive video above.