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Health Care Reform

Health Care Reform / Affordable Care Act / ObamaCare


Covered CA logoIf you are like most people, the new Affordable Care Act, otherwise known as “ObamaCare”, can be a little confusing. Our expert and friendly staff can help explain how this new law affects each one of us, in terms we can all understand.

What is the Affordable Care Act?


The Affordable Care Act was signed into law March 23, 2010. It is the largest piece of legislation passed since Medicare and will have ripple affects beyond the Health Insurance Industry which constitutes around 1/6 of our economy. Although the law was passed in 2010, the major provisions of the law take affect January 1, 2014. Here are just a few of the major points to the law:

  • Places a mandate on all Americans to purchase a “Qualified Health Insurance Plan” (Qualified is defined by the Federal Government) or pay a tax penalty. The penalty in 2014 is 1% of your income. In 2016 the tax penalty will increase to 2.5% of your income.
  • Expands Medicaid to millions of Americans. Medicaid will be expanded to Americans making up to 138% of the Federal Poverty Level. (100% of 2013 FPL for an individual is $11,490 and a family of four is $23,550)
  • Mandates that Preventive Care benefits be provided at $0 cost to the insured and not subject to deductibles or copayments.
  • Mandates that insurance companies can only rate a person on their age, geography (where the insured lives), how many members of the family are insured and if they use tobacco or not. (Some states, like California passed State amendments that prohibit charging more for tobacco use)
  • Health Insurance companies cannot ask medical history questions and cannot deny coverage due to a pre-existing condition.
  • Mandates that each “Qualified” policy must contain certain Essential Health Benefits like:
    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity
    • Mental health and substance abuse services
    • Prescription Drugs
    • Rehabilitative services and devices
    • Laboratory services
    • Preventive and wellness services
    • Pediatric services, including oral and vision care
  • Defines what a “Qualified Health Plan” is and creates tiers of plans; Bronze, Silver, Gold and Platinum
  • Creates Federal Subsidies for Americans purchasing individual health insurance through an Exchange or Market Place. Subsidies vary for people making between 138% and 400% of the Federal Poverty Level. 400% of FPL for an individual is $45,960 and 400% of FPL for a family of four is $94,200.
  • Creates Exchanges or Market Places where people must go to purchase health plans if they want a subsidy.
  • Creates annual Open Enrollment periods when we can buy or change our Health Insurance plans. Annual Open Enrollment is October 15 to December 7 of each year, with a January 1 effective date.
  • Creates an Initial Open Enrollment period from October 1, 2013 to March 31, 2014 when we can buy health insurance with guaranteed issue.
  • Insurance companies cannot accept applications for insurance outside of the Enrollment periods except for a few minor exceptions.

What if I Have Pre-Existing Conditions?


Health Insurance companies cannot ask any medical questions. So, the rates are the same for everyone, regardless of health and everyone will be accepted if they apply for coverage during the Enrollment Periods.

Is the Affordable Care Act Really Affordable?


When the law was being sold to the American people and written into law, one of the selling points that President Obama touted was that health insurance premiums would go down by $2400 per year for each family.
Unfortunately, the rates in California appear to be going up around 80% for 40 year olds. More for those that are younger and less for those that are older.

When and How Can I Enroll?


Our friendly staff understands the law and how it affects each one of us. We are certified with the Covered California, the State Exchange or Market Place for the State of California.

Lewis Financial Insurance Services, Inc. can help you and your family get quotes for plans on and off of the Exchange and help you enroll in the plan that is right for you and your budget.
Give us a call today to learn more about your Affordable Health Insurance plan options!