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Covered California Health Insurance Exchange

Updated on May 29, 2013

Covered California Will Offer Affordable Health Insurance

Covered California will offer affordable health insurance to residents of the most populous state in the US.
Covered California will offer affordable health insurance to residents of the most populous state in the US. | Source

Covered California

California has the highest number of uninsured residents in the US, with 7.3 million in 2011. Covered California will change that by offering affordable health insurance to residents of the Golden State.

Covered California will become the primary California health insurance marketplace for individuals when it becomes operational on October 1, 2013. Covered California will provide online tools to enable easy comparisons between standardized health insurance plans offered by a number of reputable insurers.

Individuals shopping for health insurance through Covered California will not be denied coverage because they (or any of their family members) have a pre-existing health condition or get sick. Low-income individuals and families will qualify for free health insurance through Medi-Cal. Moderate-income individuals and families will qualify for premium subsidies to help make their health insurance affordable.

Access to Covered California

The health insurance marketplace called Covered California will begin enrollment on October 1, 2013 for coverage starting January 1, 2014. Millions of people will access Covered California's web site to compare standardized health insurance policies offered by different insurers online and to then complete an online application.

Individuals will also be able to speak to a Covered California Call Center Representative (CCR). The CCR will conduct a quick survey to establish family size and income. Low-income individuals who qualify for free health insurance through Medi-Cal will be referred to a county-based call center for assistance.

Income Verification and Premium Subsidies

Providing income information will be an important part of the Covered California application process since an individual or families income will determine whether they are eligible for free public health insurance or for premium subsidies.

Covered California applicants or their CCR will have access to income verification data from their last federal income tax return directly from the IRS' computers. This data will be sufficient to allow most people to estimate their income for the coming year. However, applicants will be allowed to override their tax data if they anticipate significant changes in income. Any discrepancy between estimated and actual income will be ironed out when the applicant files his tax return for the coming year.

Applicants who are eligible for premium subsidies for their health insurance will be asked if they receive or could receive "affordable" employer-sponsored group health insurance. If not, then they will be allowed to enroll with one of the health insurance plans offered by Covered California and have their premium subsidies applied in advance so it's paid directly to their selected health insurer.

Standardized Health Insurance Plans

Every insurance plan offered by Covered California will cover a list of healthcare services referred to as Essential Health Benefits (EHB). The EHBs will include doctor visits, hospitalization, emergency care, maternity care, pediatrics, prescriptions, medical tests and mental health care. The EHBs will also include preventive services like mammograms and colonoscopies with no out-of-pocket costs.

The coverage provided by the health insurance plans will be organized in four tiers. These tiers will be referred to as bronze, silver, gold and platinum, with coverage of 60%, 70%, 80% and 90%, respectively, of the actuarial health costs of the average person. The bronze plans will have the lowest premiums as they provide the least coverage, and the platinum plans will have the highest premiums.

Covered California will provide online tools for comparing the different plans.

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