By Jason KUROSU
Another deadline for the Affordable Care Act has come and passed with those who signed up for healthcare by Dec. 23 able to attain health coverage this month. The Obama Administration hoped that 3.3 million Americans would sign up for healthcare through state and federal based online marketplaces, but stated in late December that just over two million people had signed up.
Californians, who can purchase insurance through Covered California, the state’s online insurance exchange, now have until Jan. 15 to pay their initial premiums.
Those seeking insurance have now entered the open enrollment period, which lasts from Jan. 1 until March 31. Some may be exempt from having to purchase insurance during this period due to a variety of factors. Those who have experienced “qualifying life events,” such as recent marriage, childbirth or adoption, losing health coverage among other things, will qualify for a special enrollment period that lasts 60 days from the date of the qualifying life event.
All the plans offered through Covered California will provide for certain areas of coverage called “Essential Health Benefits.” These include emergency services, hospitalization (such as surgery), ambulatory patient services (such as outpatient services), maternity care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management and pediatric services.
Health insurance issuers will be unable to deny coverage based on pre-existing conditions, health and age, among many other factors.
But tax penalties will be assessed for those without insurance coverage starting in 2014. These penalties are calculated as either 1% of a household’s yearly income or $95 per person ($47.50 per child under 18 years of age). These penalties will be adjusted for inflation in subsequent years. Paying the penalty will not count as being covered.
To be considered covered and thus avoid paying the fee, one must have what is considered “minimum essential coverage.” Along with plans available at Covered California, minimum essential coverage may include job-based plans (including COBRA), Medicare, Medicaid, Children’s Health Insurance Program (CHIP) and veterans’ health care programs among others.
Certain health plans will not qualify as minimum coverage, though, such as plans that cover only vision or dental health, workers’ compensation and plans that only offer discounts on medical services.
But for many Californians who could not previously afford health insurance, the Jan. 1 deadline saw many of these individuals qualifying for Medi-Cal. According to Cynthia Carmona, director of Government and External Affairs for the Community Clinic Association (CCA), 300,000 individuals have transferred from Healthy Way L.A., a county run free health care program, to Medi-Cal.
“We’re trying to make sure the transition is as smooth as possible,” said Carmona, who said the CCA’s enrollment counselors have been working with many people who have little to no experience having health insurance.
“Patient education has been a major focus for us,” said Carmona. “We really want to get other community-based organizations engaged so that we can show patients what’s available to them.”
La Crescenta’s St. Luke’s of the Mountains will be featuring a forum to address aspects of the Affordable Care Act. According to Bryan Jones, vicar of St. Luke’s, Shelley Weitzel, Episcopal Diocesan Health Outreach coordinator, will answer questions about the Affordable Care Act this Sunday, Jan. 12. Weitzel will speak briefly during the service and will also stay afterwards to answer questions about the new online marketplace and help attendees maneuver through the new exchanges in order to obtain healthcare. According to Jones, the service starts at 10 a.m. and is open to everyone. St. Luke’s is located at 2563 Foothill Blvd.