Af ffordable e Care Ac ct Quick R Reference e Guide

Afffordable
e Care Ac
ct Quick R
Reference
e Guide
Questions
Q
What is the Afford
dable Care Ac
ct?
Startting January 1,
1 2014, whatt will my choic
ces
be fo
or health care insurance?
A
Answers
A com
mprehensive h
health care re
eform law thatt was signed into law on
March
h 23, 2010, th at is also kno
own as Health
h Care Reform
m or
Obam
maCare and w
will be impleme
ented in Califfornia Januaryy 1, 2014.





How do I find out what I kind off coverage I am
a
eligib
ble for?
Mo
ost people with
h health care in
nsurance through their employyer will have no
o
ch
hange
Pe
eople over the age of 65 will ccontinue to havve Medicare an
nd other options
forr additional hea
alth insurance
Re
esidents underr the age of 64 will have new choices for hea
alth insurance
ded Medi-Cal P
un
nder the expand
Program or through the new h
health insuranc
ce
ma
arketplace, Co
overed Californiia
All US citizens a nd legal immig
grants will be re
equired to have
e health
surance (with a few exception
ns)
ins
Th
here will be a ta
ax penalty for p
people who do not get health insurance
By callling Covered
d California a
at 1-800-300-1506 (TTY 1--888-889-450
00)
or app
plying online a
at www.coverredca.com
Are tthere example
es of what I might
m
qualify for?
fo
When
n do I enroll in health
h
care cov
verage?




If I do
on’t qualify for Medi-Cal, what
w
health pla
ans
will b
be available in
n our region?
Op
pen Enrollmentt through Cove
ered California begins Octobe
er 1, 2013
Yo
ou must enroll by December 1
15, 2013 to be covered by Ja
anuary 1, 2014
Yo
ou must enroll by March 15, 2
2014 to receive
e health care co
overage for 2014
Me
edi-Cal enrollm
ment is year rou
und (income lim
mit of 138% FP
PL)
www.b
blueshieldca.co
om
https:///www.anthem.ccom/ca/health--insurance/hom
me/overview#

Ways th
he Affordable Care Act is
Incre
easing Access
s to Mental Health and
Subsstance Use Diisorder Servic
ces…


Th
he Affordable
e Care Act w
will expand me
ental health and substance
us
se disorder b
benefits and parity* protecctions
Most health pla
ans must now
w cover preve
entive service
es like
de
epression sc
creening for a
adults and be
ehavioral ass
sessments fo
or
ch
hildren at no ccost
Sttarting in 2014
4, plans won’’t be able to d
deny you cove
erage or charge
yo
ou more due tto pre-existin
ng health con
nditions, inclluding mental
illn
nesses
*Parity means coveragee for behavioral hhealth services m
must be generallyy comparable to
coverag
ge for medical an
nd surgical care
Afffordable
e Care Ac
ct Quick R
Reference
e Guide
Local Agencies Thatt Can Help
The D
Department of
o Social Serv
vices can assiist
with the applicatio
on process
Contac
ct Information
SANT
TA BARBARA
A OFFICE
234 Camino Del Re
emedio
(805) 681-4401
SANT
TA MARIA OF
FFICE
2125 S.
S Centerpoin
nte Pkwy
(805) 346-7135
TOLL-FREE
E AUTOMATED
(866) 404-40
007
(Best for existting Medi-Cal reccipients)
LOMP
POC OFFICE
1100 W.
W Laurel Ave
e
(805) 737-7080
The P
Public Health
h Department can assist wiith
the a
application pro
ocess
CARP
PINTERIA HE
EALTH CARE
E CENTER
931 Walnut
W
Ave
(805) 560-1050
FRAN
NKLIN HEALT
TH CARE CE
ENTER
1136 E.
E Montecito St
(805) 568-2099
SANT
TA BARBARA
A HEALTH C
CARE CENTE
ER
345 Camino Del Re
emedio
(805) 681-5488
LOMP
POC HEALTH
H CARE CEN
NTER
301 N. R ST
(805) 737-6400
The A
Alcohol, Drug
g & Mental He
ealth Services
s
Depa
artment can assist
a
with me
ental health ca
are
quesstions
SANT
TA MARIA HE
EALTH CARE
E CENTER
2115 S.
S Centerpoin
nte Pkwy
(805) 346-7230
CARE
ES North
212 West
W
Carmen Lane
Santa Maria, CA 93
3454
(805) 739-8700
ES South
CARE
2034 de
d la Vina
Santa Barbara, CA
A 93101
(805) 884-6850
COUNT Y OF SANTA BARBARA
Making a Difference Sin
nce 1962
A l c o h o l , D r u g & M e n t a l H e a l t h Se r v i c e s
Septe
ember 27, 20
013
ACCE
ESS
1-888--868-1649
Ley de Asistencia Asequible Guía de Referencia Rápida
Preguntas
Respuestas
¿Que es la Ley de Asistencia Asequible?
Una amplia ley de reforma de salud fue firmada en ley el 23 de Marzo,
2010, también conocida como ObamaCare y que se realizara en California
el 1 de Enero, 2014.
¿Empezando el 1 de Enero, 2014, cuales serán
mis opciones para seguro de salud médica?
¿Cómo puedo informarme sobre cual tipo de
cobertura seré elegible?
La mayoría de las personas con seguro de salud vía su empleador no verán
ningún cambio
Personas sobre la edad de 65 años continuaran con cobertura de MediCare y
otras opciones para seguro de salud opcionales
Residentes con menos de la edad de 64 años tendrán nuevas opciones para
seguro médico bajo el Programa de Medi-Cal extendido o por el nuevo mercado
de seguro de salud, Covered California
Todos los ciudadanos Americanos e inmigrantes legales serán requeridos de
que obtengan seguro de salud (con pocas excepciones)
Habrá una penalidad de impuestos para las personas que no obtengan seguro
de salud
Hablando a Covered California al 1-800-300-1506 (TTY 1-888-889-4500) ó
aplicando en línea al www.coveredca.com
¿Hay ejemplos sobre lo que puedo calificar?
¿Cuando puedo inscribirme para cuidado de salud
medica?
¿Si no califico para Medi-Cal,cuales seran los
tipos de planes disponibles en mi region?
Inscripción abierta mediante Covered California empieza el 1 de Octubre, 2013
Debe inscribirse a mas tardar el 15 de Diciembre, 2013 para ser cubierto
empezando el 1 de Enero, 2014
Debe inscribirse a mas tardar el 31 de Marzo, 2014 para recibir cobertura de
salud para el 2014
Inscripción de Medi-Cal es durante todo el año (limite de ingreso de 138% FPL)
www.blueshieldca.com
https://www.anthem.com/ca/health-insurance/home/overview#

Maneras que la Ley de Asistencia
Asequible está aumentando el acceso a
cuidados mentales y servicios de desordenes
de substancias…

La Ley de Asistencia Asequible se extenderá a la salud mental y
beneficios de desorden de substancias y protecciones de paridad*
La mayoría de planes de salud ahora deberán cubrir servicios
preventivos como monitoreo de depresión para adultos y evaluación
de comportamiento para niños/as a ningún costo
Empezando en el 2014, planes no podrán negarle cobertura o cobrarle mas
si tiene una condición pre-existente de salud, incluyendo, enfermedades
mentales
*Paridad significa que la cobertura de servicios de comportamiento debe ser generalmente
comparable a cobertura medical y cuidado quirúrgico
Ley de Asistencia Asequible Guía de Referencia Rápida
Agencias locales que le pueden
ayudar
El Departamento de Servicios Sociales le
puede asistir con el proceso de aplicación
Información de Contacto
SANTA BARBARA OFFICE
234 Camino Del Remedio
(805) 681-4401
SANTA MARIA OFFICE
2125 S. Centerpointe Pkwy
(805) 346-7135
LINEA GRATUITA AUTOMATIZADA
(866) 404-4007
(Mejor para clientes vigentes de Medi-Cal)
LOMPOC OFFICE
1100 W. Laurel Ave
(805) 737-7080
El Departamento de Salud Publica le puede
asistir con el proceso de aplicación
CARPINTERIA HEALTH CARE CENTER
931 Walnut Ave
(805) 560-1050
FRANKLIN HEALTH CARE CENTER
1136 E. Montecito St
(805) 568-2099
SANTA BARBARA HEALTH CARE CENTER
345 Camino Del Remedio
(805) 681-5488
LOMPOC HEALTH CARE CENTER
301 N. R ST
(805) 737-6400
El Departamento de Alcohol, Droga, y Servicios
Mentales le puede asistir con el proceso de
aplicación
SANTA MARIA HEALTH CARE CENTER
2115 S. Centerpointe Pkwy
(805) 346-7230
CARES North
212 West Carmen Lane
Santa Maria, CA 93454
(805) 739-8700
CARES South
2034 de la Vina
Santa Barbara, CA 93101
(805) 884-6850
C ONDADO DE S A N T A B A R B A R A
Haciendo la diferencia desde 1962
A l c o h o l , Droga y Servicios de Salud Mental
September 27, 2013
ACCESS
1-888-868-1649
Inssure Th
he Unin
nsured Projectt
A Guid
de to th
he
Afford
A
are Actt (ACA
A)
able Ca
Maain Goa
als of th
he ACA
A:
1. Increase health care coveragge 2. Reduce health care costs and improve afffordability 2013
3. Imp
prove people’s health Medi-Cal
Houseehold sizze 1 1
100%
133%
F
Federal Po
overty Levvels
150%
200%
300%
% 400%
$11,490 $15,282 $17,235 $22,980 $34,4770 $45,960 Under the ACA in California, all U
U.S. 2 2
$15,510 $20,628 $23,265 $31,020 $46,5330 $62,040 citizen
ns and legal p
permanent 3 3
$19,530 $25,975 $29,295 $39,060 $58,5990 $78,120 residents will be eligible for Medi‐‐‐ 4 4
$23,550 $31,322 $35,325 $47,100 $70,6550 $94,200 014 if their Cal on January 1, 20
5 5
$27,570 $36,668 $41,355 $55,140 $82,1770 $110,2800 3% FPL. These
e income is up to 133
6 6
$31,590 $42,015 $47,385 $63,180 $94,7770 $126,3600 duals are calle
ed “newly individ
eligiblee” and will incclude parentss, and adults w
without children. Pregnannt women willl have coveraage up to 200%
% FPL, and ch
hildren up to 2
250% FPL. For fam
milies and individuals, othe
er than the agged and disab
bled, eligibilit y will be deteermined baseed on a person’s modified adjusteed gross incom
me (MAGI). TThis is the sam
me method used for countting income w
when househ
holds file taxees. There will also bee no asset testt for these grroups unless tthey would like long‐‐‐term care servicess. For sen
niors, people with disabilitties, people n
needing long‐‐ ‐term care, p
people eligiblee for both Meedicare and M
Medicaid, and individuals in the M
Medically Needy program tthe enrollment process an
nd rules will rremain the saame. Individu
uals without legal peermanent ressidence may b
be eligible forr limited scope benefits forr emergency care and preggnancies. Coovered Califorrnia
Coveered Californiaa is our state’’s new health insurance exxchange. It is a marketplacce for people to shop for affordable healtth insurance ccoverage. The
e marketplace
e will offer on
nline educatioonal tools, price calculatorrs and information abou
ut how to rece
eive financial assistance to
o make coveraage more affoordable. Coveered California will allow p
people to makee apples‐‐‐to‐‐‐apples comparrisons of heallth insurance plans. Only ccitizens and leegal permaneent residentss are able to bu
uy coverage tthrough Cove
ered Californiia. More info
ormation is avvailable at w
www.coveredca.com. In Co
overed California, the fede
eral governm
ment will help individuals p
pay for a porttion of their h
health insuraance by providing premium subsidies. These subsid
dies will be baased on incom
me so that ho useholds with
h lower incom
mes receive moree assistance. TThese subsidies will help m
most middle aand lower‐‐‐inccome familiess to pay for health insuran
nce if they do no
ot qualify for Medi‐‐‐Cal, and have incom
mes between 133% and 40 0%FPL. The feederal govern
nment will alsso provide subsiidies that reduce co‐‐‐pays aand any dedu
uctibles for ho
ouseholds at oor below 2500% FPL. So, in addition to reduced prem
mium costs, th
hese individuaals will have lower co‐‐ payss when they ssee a health ccare provider or have a preescription filled
d. Conssumers will be
e able to buy different tierrs of health insurance. Heaalth plans will offer bronzee, silver, gold
d, & platinum levels off coverage in Covered California. Each metal level w
will have the ssame benefits but will cover a edical cost for the year. Beenefits will in
nclude hospitalizations, do
octor visits, different amount of a person’ss expected me
alth services,, and others. (Continued o
on the other sside.) presccription drugs, mental hea
A Gu
uide to the Affo
ordable
e Care A
Act (AC
CA)
Cove
ered Caliifornia
Insurrance M
Market
R
Reforms:
(c
cont’d.)
The meetal tiers will cover the following costs: • Bronze plan
ns will cover 6
60% of a person’s expected
d medical cossts • Silver plans will cover 70
0% • Gold plans w
will cover 80%
% • Platinum plans will cover 90% • Catastrophic plans will b
be available fo
or those unde
er 30 or with a financial hardship exxemption The higgher the metaal level, the higher the plan’s monthly p
premium will be. So, if a person
n spends more
e each month
h on premium
ms, he/she will spend less m
money in co‐‐ pays when they vvisit the doctor. If a person spends lesss money eachh month on premiu
ums, he/she w
will spend mo
ore money in co‐‐‐pays when
n they visit thhe doctor. With the A
ACA, insurancce companies must follow
w new rules, including: • Covering preventivee services withou
ut co‐‐‐pays • Allowing children (d
dependents) under the age of 26
6 to stay on their p
parent’s plan. In 2014, otther rules will take effect. Insurance companies w
will be required urance to everryone during to sell insu
open enrollment, and they must also
o renew thatt coverage. In
ndividuals will no longer b
be denied covverage based
d on pre‐‐‐exissting conditio
ons (e.g. diabetes, aasthma). Also
o, plans can only vary tthe cost of inssurance based
d on geograp
phy, family size, and age.
Peoplee can only buyy health insurrance during aa specified tim
me called opeen enrollm
ment. Insuran
nce will also be
b available if someone encounters a sppecial circumstance, such as marriage, divorce, child
dbirth, loss orr change of employyment. Open enrollment ffor Covered C
California plan
ns will be from
m October 1, 2013
3 to March 31
1, 2014. Cove
erage will beggin on January 1, 2014 if you apply by Deccember 15, 2013. Sim
mplifie
ed Enrollm
ment
CalHEEERS, a new on
nline system, w
will help to determine if so
omeone is eliigible for Medi‐‐‐C
Cal or for buying health coverage through Covered C
California. Thiis determ
mination will b
be based on aan individual’s household ssize, age & in come. Individuals can select their own p
plan and leve
el of coverage
e. Individuals ccan also apply ffor both Medi‐‐‐Cal and Covvered Californ
nia by mail, ph
hone and in‐‐‐pperson at countyy social service offices, clinics, doctor’s o
offices, hospitals, broker’ss offices and others. Individ
dual M
Mandatee:
The ACA reequires that everyone have health
h insurance in
n 2014. If an individual d
does not havee health insurance aand is not exeempt from the individu
ual mandate,, then he/she
will have to
o pay a penaltty fee as described b
below: • $95
5 or 1% of inccome in 201
14 • $39
95 or 2% of in
ncome in 201
15 • $69
95 or 2.5% off income in 2016 and thereaafter Oth
her He
ealth Optio
ons No
ow
Individuals who do no
ot qualify for M
Medi‐‐‐Cal or Covered California may be eligiible for health program
ms, emergencyy Medi‐‐‐Cal or m
may receive carre at communi ty clinics. other h
For a list of community clinics in Saanta Barbara and San Luis Ob
bispo Countiess please go to: ww
ww.cencalhealtth.org For Provviders/Contraccted Provider D
Directory. In Santta Barbara Cou
unty, the Mediccally Indigent A
Adult (MIA) pro
ovides paymennt for medical care on
n a ‘medical ne
ecessity’ basis ffor uninsured, low‐‐ income ad
dults between the ages of 21 and
d 64 years. You
u may apply at the County Cliinic locations in Lompoc, Sannta Barbara more information, call (805) 6
681‐5390. or Santta Maria. For m
ounty, the County Medical Se
ervices Program (CMSP) provvides In San Luis Obispo Co
nsured, low‐‐‐inccome adults paymeent for medical care on a ‘medical necessityy’ basis for unin
betweeen the ages of 21 and 64 years. For more in
nformation, call (805)7881‐‐ 4838. SLO No
oor Foundation Free Clinic, lo
ocated in San LLuis Obispo, prrovides free heealth care to uninsured people. To
o make an appo
ointment, call: (805) 439‐‐‐179
97. 2
*Note: The individual mustt pay the amount thatt is higher. ual can be exeempt from An individu
paying the penalty fee d
due to financial haardship* or a religious exemption. *A financial hardship is wh
hen the most affordable in
nsurance optio
on exceeds 8% of household
d income. Or, tthe household income is beelow the tax‐‐‐filiing threshold.
2014
Sliding Scale Benefits
| SINGLE PERSON
Silver Plan (Eligible for Federal Subsidy)
Annual Income
$15,856 – $17,235
$17,235 – $22,980
$22,980 – $28,725
$28,725 – $45,960
Consumer Portion of Monthly
Premium for Silver Plans
$19 – $57
$57 – $121
$121 – $193
$193 – $364
(Balance paid by Federal subsidy)
Copays In the Yellow Sections are Not Subject to ANY Deductible
and Count Toward the Annual Out-of-Pocket Maximum
Benefits In Blue are Subject to Either a Medical Deductible,
Drug Deductible or Both
Deductible (if any)
No Deductible
$500
$1,500 Medical Deductible
$2,000 Medical Deductible
Preventative Care Copay
No Cost
No Cost
No Cost
No Cost – 1 Annual Visit
Primary Care Visit Copay
$3
$15
$40
$45
Specialty Care Visit Copay
$5
$20
$50
$65
Urgent Care Visit Copay
$6
$30
$80
$90
Lab Testing Copay
$3
$15
$40
$45
X-Ray Copay
$5
$20
$50
$65
Generic Medication Copay
$3
$5
$20
$25
Emergency Room Copay
$25
$75
$250
$250
High cost and infrequent
services like Hospital Care
and Outpatient Surgery
10%
15%
20% of your plan’s
negotiated rate
20% of your plan’s
negotiated rate
Brand medications may
be subject to Annual Drug
Deductible before you pay
the Copay
No Deductible
$50 then pay the copay amount
$250 then pay the copay amount
$250 then pay the copay amount
Preferred brand Copay after
Drug Deductible
$5
$15
$30
$50
MAXIMUM OUT-OF-POCKET
FOR ONE
$2,250
$2,250
$5,200
$6,350
MAXIMUM OUT-OF-POCKET
FOR FAMILY
$4,500
$4,500
$10,400
$12,700
The Affordable Care Act:
Resources for You
RESOURCE LIST
The Patient Protection and Affordable Care Act provides you and your family more freedom and control
over health care choices. This resource list provides contact information for organizations dedicated to
helping you better understand and navigate your health care coverage.
California Department of Managed Health Care
California Health Benefit Exchange
The California Department of Managed Health Care
(DMHC) is the state agency that oversees health plans
and protects the rights of health plan members.
Starting in 2014, the Exchange will help individuals
and small businesses buy affordable health coverage.
1-888-466-2219
www.HealthHelp.ca.gov
California Department of Insurance (CDI)
CDI regulates, investigates and audits insurance
businesses in the State of California. In most cases
PPO, EPO, POS, indemnity and association plans are
regulated by the CDI.
www.HealthExchange.ca.gov
Healthcare.gov
Provides information about the Affordable Care Act,
insurance options, prevention and wellness.
www.HealthCare.gov
U.S. Department of Labor COBRA
CDI Consumer Hot Line: 1-800-927-4357
www.insurance.ca.gov
Provides information on the Federal COBRA program
to help you keep group health insurance if you lose
your job or your hours are cut.
Health Consumer Alliance (HCA)
1-866-444-3272
www.dol.gov/dol/topic/health-plans/cobra.htm
HCA provides one-on-one assistance to low-income
consumers in many counties. HCA offers services in
multiple languages.
U.S. Department of Labor HIPAA
www.HealthConsumer.org
Health Insurance Counseling and Advocacy Program
(HICAP)
HICAP provides counseling and advocacy for people
who have or will soon have Medicare.
1-800-434-0222
www.cahealthadvocates.org/HICAP
Medi-Cal Managed Care Ombudsman
The Medi-Cal Managed Care Office of the
Ombudsman helps ensure people on Medi-Cal receive
all medically necessary covered services through their
health plans.
1-888-452-8609 (many languages)
Provides information on your Federal HIPAA rights to
buy or keep health insurance.
1-866-444-3272
www.dol.gov/dol/topic/health-plans/portability.htm
Health Services Advisory Group (HSAG)
HSAG assists Medicare members with certain
problems and appeals.
1-800-841-1602
www.hsag.com
Office of the Patient Advocate (OPA)
The OPA educates health care consumers on their
rights and responsibilities and promotes transparency
and quality health care by publishing an annual
Health Care Quality Report Card.
1-800-466-8900
www.opa.ca.gov
For assistance, call the Help Center at 1-888-466-2219, email us at
[email protected] or log onto healthhelp.ca.gov.