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 are required to 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

Open Enrollment for the Affordable Care Act began October 1, 2013 and continued 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 enrolled by March 31, 2014 and began your coverage by May 1, 2014 you will not receive the penalty for being uninsured. So start shopping for health insurance now.

If you did not get enrolled for an Obamacare health plan by the March 31st deadline, you can still get health insurance if you have a qualifying life event and you enroll within 60 days of the event. Some examples of a life event are loss of coverage, marriage, birth, etc. Get quotes and find out plan information by phone or by shopping online. If you are uninsured and there is no qualifying life event, then, your next opportunity to enroll is the Fall of 2014.

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 Medi-Cal?

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 Medi-Cal range. Note that you can enroll for Medi-Cal year round, but you cannot enroll for a standard health plan until the next open enrollment the Fall of 2014, unless you have a qualifying life event.