California Health Insurance Exchange
California was the first state to create a health insurance exchange after the passage of the Affordable Care Act (ACA). After January 1, 2014 nearly all Americans will be required to carry health insurance under the new law.
The California health benefit exchange is designed to help individuals, families and small businesses get access to comprehensive and affordable benefit plans. The exchange will help individuals:
• Who do not receive employer-sponsored health coverage
• Whose employer-sponsored plan costs more than 9.5% of their income, or
• Whose employer-sponsored plan does not provide adequate coverage, based on ACA standards
Some of the state’s leading health insurance companies, including Kaiser Permanente, Anthem Blue Cross of California, Blue Shield of California and Health Net will be offering plans through the health insurance exchange.
Coverage California is Your Resource for Health Insurance
Coverage California is an Exchange Certified agency that works with carriers both inside and outside the exchange. We provide objective advice to help you determine the best options for affordable, comprehensive coverage for you, your family or your small business employees. Our step-by-step application form makes it easy to apply for coverage.
Benefits Included in the California Health Benefit Exchange
All plans offered through the exchange must include the following 10 Essential Health Benefits, as outlined in the ACA:
1. Ambulatory patient services
2. Emergency services
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services
In addition to covering the Essential Health Benefits, plans in the exchange must follow a standard design, as outlined by the ACA. Plans will be offered in a tiered system that includes the following levels:
The plans with a higher value metal designation have a higher premium, but they also cover more, while the lower value metals have a lower premium but cover less. A Platinum-level plan has a higher premium but covers 90% of expenses, for example, while a Bronze-level plan has a lower premium but covers just 60% of expenses.
Subsidies/Tax Breaks to Help Pay for Coverage
Individuals and Families
Individuals who earn between 138% and 400% of the federal poverty level (FPL) may qualify for a subsidy to help pay for coverage. Use our tax credit calculator to determine whether you may qualify for a subsidy. Tax credits are paid directly to the qualified health plan, so you can receive immediate savings.
Small businesses with fewer than 25 full-time employees may be eligible for a tax credit on a sliding scale. In the first phase (2010-2013) businesses may qualify for 35% of insurance premium expenses in the form of a tax credit, or 25% for tax-exempt organizations. In the second phase (2014) businesses may qualify for 50% of insurance premium expenses in the form of a tax credit, or 25% for tax-exempt organizations.
Rating Regions in California
There are 19 different rating regions in California; each includes one or more counties. The specific types of health plans offered (HMO, PPO, EPO) vary by region. The regions by county are listed below:
Region 1: Alpine, Del Norte, Siskiyou, Modoc, Lassen, Shasta, Trinity, Humboldt, Tehama, Plumas, Nevada, Sierra, Mendocino, Lake, Butte, Glenn, Sutter, Yuba, Colusa, Amador, Calaveras, Tuolumne
Region 2: Napa, Sonoma, Solano, Marin
Region 3: Sacramento, Placer, El Dorado, Yolo
Region 4: San Francisco
Region 5: Contra Costa
Region 6: Alameda
Region 7: Santa Clara
Region 8: San Mateo
Region 9: Santa Cruz, Monterey, San Benito
Region 10: San Joaquin, Stanislaus, Merced, Mariposa, Tulare
Region 11: Madera, Fresno, Kings
Region 12: San Luis Obispo, Santa Barbara, Ventura
Region 13: Mono, Inyo, Imperial
Region 14: Kern
Region 15: North Los Angeles County zip codes starting with 906, 907, 908, 909, 910, 911, 912, 915, 917, 918 and 935
Region 16: South Los Angeles County, all other zip codes
Region 17: San Bernardino, Riverside
Region 18: Orange
Region 19: San Diego