Health Care Reform

Kaiser Permanente and the Affordable Care Act ("Obamacare")

With the Supreme Court's June 28, 2012 decision to uphold the Health Care Reform mandate, most American citizens and legal residents will soon either have health insurance or pay a penalty. If you are not yet insured or looking to understand what makes the best sense for your situation, follow this easy-to-follow road map.

Obamacare Open Enrollment: Start Shopping for Kaiser Exchange Plans

Open Enrollment for the Affordable Care Act began October 1, 2013 and it continues until March 31, 2014. According to the Health Care Reform mandate, most Americans are required to have health insurance for at least eight months in 2014. As long as you enroll by March 31, 2014 and begin your coverage by May 1, 2014 you will not receive the penalty for being uninsured. So start shopping for health insurance now. Get quotes and find out plan information by phone or by shopping online. Be sure to look at “exchange plans” because unless you are on an exchange plan you won’t be able to qualify for a government subsidy. 

So what is an “exchange plan”? Is that an “Obamacare Plan”?

In reality, there is no such thing as an Obamacare Plan. However, there are exchange plans offered in the Individual Marketplace by all the major carriers including Kaiser Permanente. Exchange plans are health insurance plans that have been approved by the state exchange. The creators of the Affordable Care Act believed that if health insurance carriers had to negotiate with government run exchanges in order to get their plans and pricing approved that this would result in greater affordability and richer benefits for consumers. So the carriers submit plan ideas to the state run exchanges, the exchanges approve the plans and then you purchase one of these exchange plans so you can qualify for an up-front government tax credit to make the premiums for your health plan more affordable. The lower your income is, the more government subsidy money you qualify for. However, if your income is below 138% (or 100% depending on the state you live in) of the Federal Poverty Level, you will not be able to enroll on a Kaiser Permanente exchange plan, but you will end up on Medicaid (or Medi-Cal).

What if I don’t want Medicaid?

Many consumers have said they’re sick of being on Medicaid and they want better coverage. If you’re one of those people, then you have three options. You can either go uninsured (and pay a penalty), pay full price for your health insurance plan, or you can work on increasing your income so you get yourself out of the Medicaid range. As much as I hate to say, “Get another job,” that’s basically what I’m saying. If you increase your hours or get a part time job, the healthcare plan you qualify for may drastically improve. If you can increase your income up to 139% to 250% of the Federal Poverty Level, you can purchase an incredibly good Kaiser Permanente health plan at an amazing price. Consumers in this income bracket qualify for the highest subsidies and for a little known perk of Health Care Reform called “Cost Sharing Reduction”.

Cost Sharing Reduction

Cost Sharing Reduction (CSR) enables you to purchase a Kaiser Permanente Silver Plan with improved benefits at the same price as you would be paying for a standard Silver Plan. The Silver Plan normally covers 70% of your out-of-pocket expenses, but with Cost Sharing Reduction your plan could be bumped up to 73%, 87% or even 94% coverage. If you are able to enroll on Silver 94 Plan, you will have the best possible benefits that you could get and you still only have to pay the rate that you would be paying for a Standard Silver Plan.