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Ready or not, the new health insurance requirements are here! Everyone seems to have an opinion as to whether this is a good or bad thing. The fact is, though, it’s required and for many people in our county, it offers free or lower cost health insurance. Coverage will also not be denied for pre-existing conditions or dropped when someone gets very sick or chronically ill.
Covered California is the state entity that runs the new health insurance exchange. Those who have health coverage that covers certain “essential health benefits” such as hospital stays, emergency care, maternity care, pediatric care, prescriptions and more, and also doesn’t overcharge (the state provides a formula for this), can stay with their current plans.
People who do not have coverage or whose current coverage doesn’t meet the above criteria can now be insured through Covered California (coveredca.com). All Covered California plans cover the same essential health benefits, which are the minimum required by law for all plans, whether through Covered California or private insurance.
The Covered California website or a certified enrollment counselor can help customers determine if they qualify for Medi-Cal, “premium assistance” or other affordable plans through Covered California. Individuals making $15,857 or less per year or who are disabled will qualify for Medi-Cal, which is free health insurance. Those who make $15,857 – $45,960 will qualify for “premium assistance,” which means the federal government will pay a portion of the insurance premium each month.
Enrollment is open for all plans now. Customers must choose a plan (have their own private insurance or choose Covered California or Medi-Cal insurance) by Dec. 15 for coverage beginning Jan. 1, 2014, or risk paying a penalty. There is, however, a grace period lasting until March 31. After that, customers will be charged annually based on every month that they don’t have health coverage. The law requires this coverage; offenders will face a tax penalty of $95 per person or 1 percent of their annual income, whichever is greater for 2014, the first year (for the number of months they are without insurance). By 2016, the fine will be $695 per person or 2.5 percent of annual income, whichever is greater.
Covered California offers four levels of coverage. The more customers pay out of pocket, the less their deductible and maximum out of pocket will be. The website allows customers to compare plans. The website also lets customers know if they qualify for Medi-Cal. Plumas County has contracted with two Medi-Cal managed care plans: California Health and Wellness and Anthem Blue Cross. Customers can choose which one is best for them. If they don’t choose, one will be assigned to them, but they can opt to change to the other one at any time, and the change will take place the following month.
Which coverage people qualify for, as well as what plan is right for them, can seem daunting, and for that reason, certified enrollment entities (CEEs) and counselors are available to explain the choices help people complete their applications. Mimi Hall, director of Plumas County’s public health department, said she is currently applying to have her department become a CEE, and Eastern Plumas Health Care is applying as well. Jeri Nelson, EPHC chief financial officer, said that Sarah Skeels, Lisa Terry and Karina Avila, who is fluent in Spanish, will be trained as certified enrollment counselors to help people to enroll.
To find Covered California online and determine the right coverage, go to coveredca.com. Customers can also phone them at 800-300-1506 or TTY 888-889-4500. Service centers are open weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to 6 p.m. Information about Covered California in Plumas County is available by visiting the Plumas County Department of Social Services or calling 283-6351 Monday – Friday from 8 a.m. to 5 p.m., or calling Sarah Skeels at EPHC, 832-6568, Monday, Tuesday, Thursday and Friday from 8 a.m. to 5 p.m.
The Covered California website also will help customers determine if they qualify for Medi-Cal. If they do, they can apply for Medi-Cal and other benefits online at c4yourself.com. They can also call the Plumas County Department of Social Services at 283-6350 with questions or to get a paper application mailed. They can also visit social services at 270 County Hospital Road, Suite 207, in Quincy Monday – Friday from 8 a.m. to 5 p.m.
EPHC’s Sarah Skeels can help with filling out Medi-Cal applications, as well. Applicants will still have to go to social services in Quincy to show them original copies of their birth certificate and picture ID.
Finally, EPHC will have Covered California and Managed Medi-Cal brochures and information on a dedicated display board in each of its four clinics (Graeagle, Indian Valley, Loyalton and Portola) and in the Portola hospital lobby.
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