Three years after “Obamacare” was passed, California has unveiled the first details about what people will be charged for coverage by 13 health plans offering policies in the state’s exchange.
All health plans purchased through Covered California must cover a range of services called Essential Health Benefits that include mental health and substance use disorder services such as behavioral health treatment. More than twice as many drug and alcohol addicts in California will be eligible for substance abuse treatment under the plan, with coverage beginning Jan. 1, the Associated Press reports. Nationwide, an additional 3 million to 5 million people with drug and alcohol problems will become eligible for insurance coverage, according to the AP’s analysis of government data. The benefits fit into the following 10 categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
The requirement for insurance policies to offer Essential Health Benefits is just one of many changes coming in 2014. In addition, people can no longer be denied coverage based on pre-existing medical conditions, prices cannot vary by gender, and insurers are not allowed to set a maximum dollar amount they will pay during a policyholder’s lifetime.
When the California exchange opens in October, uninsured residents who visit the website, coveredca.com, will see that insurance plans are separated into four tiers: bronze, silver, gold and platinum. The levels correspond to the medical bills that must be paid by the insured individual. However, the requirement that all uninsured Americans purchase health insurance from the new exchanges comes with significant subsidies.
Those who may qualify for federal tax subsidies and credits to help buy health insurance include those with incomes between 133 and 400 percent of the federal poverty level, and businesses with fewer than 50 employees.
For example, a 35-year-old single mother of three earning $35,000 per year would pay about $113 per month to cover her family, with the government picking up $1,035 of the estimated $1,149 monthly premium.
On the other end of the example spectrum, a software engineer earning $94,000 per year with a family of four, also age 35, would pay $744 per month, after receiving a $404 tax credit.
California’s largest health insurers — Kaiser Permanente, Anthem Blue Cross, Blue Shield of California and Health Net Inc. — will be part of the insurance exhange. The other nine health plans are Alameda Alliance for Health, Chinese Community Health Plan, Contra Costa Health Services, L.A. Care Health Plan, Molina Healthcare, Sharp Health Plan, Valley Health Plan, Ventura County Health Care Plan and Western Health Advantage.
California was the first state to create a health benefit exchange following the passage of the federal health care law.