Confused About Health Care Reform?

The Affordable Care Act is set to take effect in January 2014. This change has been talked about extensively, but there is still a lot of confusion surrounding the requirements and penalties of this Act.

I am a small business owner with less than 50 employees. How will Health Care Reform affect me?

If you’re an employer with fewer than 50 full time employees, you will not be required to offer health insurance to your employees, nor will you face penalties for not providing this insurance. Since all larger businesses will be required to provide insurance, however, many smaller businesses will feel obligated to as well. Otherwise they run the risk of losing their best talent to larger organizations offering more enticing benefits packages. Our agents can help you find the most cost-effective option for your business to help you retain and recruit the most talented employees, regardless of the health care reform that will soon be taking shape.

I am an individual. What do I need to know?

If your employer has more than 50 full time employees, the company will be required to provide insurance to you as part of your benefits package. Your insurance will be required to cover most routine examines, including yearly physicals and well-child visits, as well as maternity and newborn care.

If your employer has fewer than 50 full time employees, the company will not be required to offer health insurance coverage. The caveat is that you will still be required to have health insurance. If your employer does not extend health care coverage to you, you will need to contract with an insurance company for an individual policy. You will also have the option of purchasing your insurance through Covered California, California’s health care exchange. If you meet income requirements, Medi-Cal may also help you afford your health insurance.

How am I going to afford health insurance?

While the cost of health insurance can seem astronomical, the cost of major medical expenses without insurance is even higher. While the Affordable Care Act requires that you have health insurance for yourself, you still have the ability to choose the level of coverage that best fits your needs. You may choose a plan that has low premiums, but high out of pocket expenses. You may also choose a plan with high premiums, but low out of pocket expenses. The choice is still yours. Additionally, the Affordable Care Act has mandated the creation of health insurance exchanges, designed to help you compare plans from competing insurance companies, so that you can easily choose the plan best for you. Also, depending on your income level, subsidies may also be available.

I am a small business owner with more than 50 employees. What changes for my business in 2014?

As of 2015, you will be required to offer insurance to your employees or risk being assessed a penalty. You have several options for offering this coverage. You may self-insure with a company and offer health care plans provided by that particular company. You may also choose to enter into Covered California and provide insurance to your employees through this insurance exchange. Whatever decision you make, you still have control over your contribution level and what plans you offer your employees.

What are Health Insurance Exchanges and how do they work?

Health insurance exchanges are a large marketplace for health insurance where companies and individuals can compare plans and have health insurance companies compete for their business by offering the best coverage at the lowest rates. Covered California offers both employers and individuals the ability to compare health insurance plans side by side and make informed decisions about their health care coverage.

If Health Insurance Exchanges allow me to compare plans, what can an insurance agent do for me?

Insurance agents like the agents of David B. Crother Insurance can help you make sense of the plans offered and handle the purchasing of insurance with ease. Insurance is a complex and important decision. You need someone on your side helping you navigate the complex world of insurance. Our agents can help you do that. Contact us today to help you get started.

— Interesting Facts About Obamacare —

Affordable Care Act Impact on Californians to date

  • During 2011, about 177,000 Californians age 19 to 26 kept health insurance by remaining on their parents’ plans. Without the ACA, most would have lost coverage when they turned 19 or ceased to be full-time students.
  • Over 7,000 Californians with serious medical conditions have coverage through a new Pre-Existing Condition Insurance Program. Without the ACA, they would have been uninsured.
  • Children under 19 can no longer be denied coverage due to a pre-existing medical condition.
  • New policies can no longer impose lifetime limits on benefits. This change protects the very sick from potentially devastating costs.

Affordable Care Act Impact on Californians in 2014

  • Medi-Cal eligibility will be expanded.
  • Insurers will be prohibited from denying coverage because of a pre-existing medical condition.
  • Individuals will be required to obtain health insurance, through an employer-sponsored plan, a public program such as Medi-Cal, or by purchasing it on their own, or face a penalty.
  • Large employers will be required to provide health insurance or be subject to potential penalties.
  • A health benefit exchange will be established to help consumers compare and enroll in insurance plans.
  • Federal subsidies will be provided to help qualifying individuals, families, and small businesses afford health insurance.

To view an online Covered California brochure, click the logo below.

To view additional Covered California resources and Tool Box, Click HERE.