Viewpoints: Are you ready for open enrollment and state’s new health care exchange?

Published: Friday, Sep. 13, 2013 - 12:00 am

The new health care reform law is both exciting and confusing. Beginning Oct. 1, millions of Californians will have the opportunity to shop for health insurance through the state’s new health care exchange or online marketplace. Yet, a recent poll by the California Wellness Foundation shows that only 15 percent of Californians feel “very knowledgeable” about the new health care law.

With open enrollment only a few weeks away, everyone should have a basic understanding of the health care law’s key elements. Understanding important health care terms, and knowing how they impact your bottom line, will help you choose the right plan. With this knowledge, you’ll have a better grasp of your options and you’ll be more informed about which coverage works best for you, your family and your budget.

About 2.6 million Californians will qualify for federal financial help to buy health insurance in 2014. So, even if you have insurance now, there may be more affordable options in your future. Through tax credits, subsidies to lower out-of-pocket medical costs and less restrictive eligibility requirements for Medi-Cal, there are many options that may lower the cost of your health insurance.

You can prepare for open enrollment by gathering tax statements and other paperwork, assessing current and upcoming health needs and budgeting for new ongoing monthly premiums and intermittent out-of-pocket costs.

Also, you may want to review some important health care terminology – because you will pay a portion of the costs of your new health plan. A “premium” is the amount you pay monthly to the insurance company. A “co-payment” is what you will pay your health provider when you receive medical services, including a visit to the doctor or hospital, or for lab tests. A “deductible” is what you will pay your health provider for a medical service before your coverage kicks in. The amount of your deductible depends on your plan and whether you are single, married or have children.

There are many places to get more information, including Covered California. As the state’s health care marketplace, Covered California has a website,, and has opened a call center in the Sacramento region that can help answer your questions. The website has an online calculator to estimate your cost of insurance and your eligibility for financial support, as well as “certified enrollment counselors,” people throughout the state to help you with the signup process. And Covered California is equipped to help people in at least 13 different languages.

You can also access “Healthcare Coverage in 2014: Five Things Californians Should Know,” a guide that breaks down the new law into simple yet important and easy-to-understand components.

Finally, be aware the new law includes a penalty if you choose not to have coverage. While there are some exceptions due to very low income, religious views or other reasons, most Californians will be charged a tax penalty by the government if they do not obtain coverage. Businesses with 50 or more full-time-equivalent employees may be subject to a penalty if they do not offer adequate health insurance to full-time-equivalent employees and their dependents.

You may already be benefiting from the ACA, through free preventive care and – if you are an adult under age 26 years – the ability to remain on your parents’ coverage, for example. But for many Californians, Oct. 1 really is the dawn of a new era. The process is fluid, and we are all learning more about it each day. While the state is implementing the new law, you too have a responsibility to play an active role in your care. By staying informed and learning about your health care choices, you can be your own best advocate.

Carmella Gutierrez is president of Californians for Patient Care, a nonprofit organization that seeks to ensure that all Californians have fair and equitable access to high-quality health care.

Read more articles by Carmella Gutierrez

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