Covered California for Individuals

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Individuals and families who buy their own health insurance will see radical improvements in their ability to get quality and affordable coverage.

Big Changes in 2014

  • Guaranteed Issue: Health insurance companies will be required to cover anyone who applies regardless of health history or pre-existing conditions.
  • Premium Subsidies: Federal subsidies or “advance tax credits” are tiered financial payments graduated on income level to support the purchase of qualified health plan options exclusively through the Exchange.
  • Essential Health Benefits: All health plans, both inside and outside of the Covered California marketplace, will be required to offer at least the standard set of defined Essential Health Benefits. Consumers will be able to compare coverage much easier than today.

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4.7 Million Potential Consumers

The primary target of Covered California is the 3.25 million uninsured who will qualify of Medi-Cal, subsidized Qualified Health Plans (QFPs), and unsubsidized QFPs. A secondary target is the 1.45 million Californians who are currently insured by individual health insurance and will qualify for expanded Medi-Cal, and subsidized or unsubsidized QFPs in the Covered California. (Click image to enlarge.)

Exclusive Site for Premium Subsidies

Between 1.8 and 2.1 million Californians will have subsidized health coverage in 2019 due to the ACA and Covered California is the only place to get them. Those individuals and families with incomes between 133% and 400% ($92,200 for a family of four) of the Federal Poverty Level (FPL) will qualify. They will have to pay premiums on a sliding scale, between 2% and 9.5% of their income. The amount of the tax credit that a person will receive in Covered California will be based on the premium for the second lowest cost silver plan in the Exchange. A silver plan is a plan that provides the essential benefits and has an actuarial value of 70%.

Standardized Coverage

Individuals and families can choose between four levels of Covered California qualified health plans — bronze, silver, gold, or platinum — plus catastrophic coverage available for people younger than 30.

  • Platinum: Highest premium cost. Covers 90 percent actuarial value.
  • Gold: Covers 80 percent actuarial value.
  • Silver: Covers 70 percent actuarial value.
  • Bronze: Lowest premium cost. Covers 60 percent actuarial value.
  • Catastrophic: High deductible and low premium cost, available in the individual market only for people younger than 30. Also pays for three primary care visits.

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