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Navigating California's Health Insurance Exchange

Navigating California's Health Insurance Exchange

California’s Health Insurance Exchange opened on October 1. As part of the Affordable Care Act, the federal government developed a model called the Health Insurance Exchange where Americans can now purchase private health insurance via a network of Exchanges. California’s version of this Exchange is called Covered California (coveredca.com).

One upside is that plan benefits are defined in four groups (bronze, silver, gold, and platinum), and it’s easier to compare prices between plans. One possible challenge is that consumers must be careful to understand which physicians and hospitals are participating in Covered California.

Open enrollment for legal California residents and small business employers to purchase individual health insurance policies through Covered California runs until March 2014. According to State Senator Ted Lieu’s office, if you are eligible for Medi-Cal, the open enrollment period does not matter.

The reason to take advantage of this open-enrollment period is that during this time, Californians may qualify for federal “premium assistance” to reduce their costs if they have incomes below certain levels. (This premium assistance is only available through Covered California.)

If you have a life-changing event, such as the loss of a job, a marriage or divorce, or the birth of a child, you qualify for special enrollment throughout the year—both in Covered California and in the individual market outside. In the case of a life-changing event, you would be eligible to enroll within 60 days of that event.

The next open enrollment period begins in October 2014 for coverage in 2015. (At press time, national news outlets reported that open enrollment may be extended past March 2014 this year, but that has not been confirmed.)

Torrance Memorial has contracted with the Anthem Blue Cross EPO and Blue Shield PPO plan on Covered California; consumers should check with their physician to confirm his or her participation.

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