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David Fluker Insurance Services
Gilroy, California - Serving California Residents Since 1995
California License 0B58920
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David J. Fluker, Licensed Life & Health Insurance Agent. California State License # 0B58920
Authorized Independent Agent Serving California Residents.
Web Site 1999-2014  by David Fluker - David Fluker Insurance Services. All Rights Reserved.
Instant Online Free Insurance Quotes
California Healthcare Reform (ObamaCare)
This page will be updated frequenty
Beginning in 2014, all California residents are required to purchase and maintain qualified health insurance coverage or face a tax penalty for non-compliance (there are certain exceptions).  If coverage is not provided through your employer or a government plan (medicare or Madicaid) you must purchase an individual & family health plan.

The initial Open Enrollment Period will run from October 1, 2013 to March 31, 2014.  You can enroll or change plans at any time during that open enrollment period.  Once the Open Enrollment ends, you will not be able to purchase or change your health insurance coverage until the next open enrollment (with exceptions for qualifying events).























While I can assist with your enrollment in Covered California, be aware that many times there are specific income and subsidy requirements by the exchange and I can't assist with those issues.  I am neither a tax professional nor an attorney and cannot render advice outside of the scope of my license, which is an insurance license.  Covered California specifically instructed us during the training not to discuss nor address income and subsidy issues as these are tax-related issues.


Do I have to buy new health insurance/change my current health insurance plan?


Most individuals and families in California will be required to change their health insurance plan in 2014 to comply with the PPACA rules regarding qualified health plan coverage.  The new health plans, known as Qualfied Health Plans (QHP) are currently in the design phase and should be available for public review in California in the early summer of 2013.  These new plans must meet the requirements to include precious metal tier, actuarial value and contain the mandatory essential heatlh benefits.  Those on grandfathered health plans (purchased prior to 3/23/2010) may continue on their current health plan and are not required to purchase a QHP so long as the insurance company continues the grandfathered plan.  Those on non-grandfathered plans (purchased or changed to after 3/23/2010) will be required to replace that plan with a QHP.

What are grandfathered and non-grandfathered health insurance plans?


A health plan is considered grandfathered if it was purchase prior to the signing of the PPACA on march 23, 2010 and has not experience any significant plan benefit changes.  Some grandfathered plans experienced benefit adjustments which made them non-grandfathered and some insurance company rules regarding adding/subtracting family members may also have made a grandfathered plan non-grandfathered.  A grandfathered health plan is allowed to be kept in lieu of a QHP so long as the insurance company continues to keep the plan open for existing members

Non-grandfathered plans are health insurance plans purchased after PPACA was signed on 3/23/10 or plans that have made material changes to benefits or adding/subtracting family members.  Non-grandfathered plans not protected against QHPs and those on non-grandfathered health plans must change to a QHP in 2014.

How will I buy new health insurance for myself and/or my family in California?

Individuals & families in California will purchase new health insurance coverage plans from several sources.  Those in very low income range will enroll in Medi-Cal (CA Medicaid) and children may enroll in the California Healthy Families program.  Those between 133% and 400% of the FPL ( Federal Poverty Level ) may purchase health insurance plans from the California Health Benefits Exchange known as " Covered California " and may receive a subsidy for both premium and plan benefits (co-pay, deductible, out of pocket) by purchasing through the California Health Benefits Exchange.  Those who do not qualify for a subsidy may still purchase through Covered California but may also purchase outside of the exchange in the open market.  Insurance carriers will have QHPs for inside of the exchange and QHPs sold exclusively outside of the exchange.

Are the new Qualified Health Plans Standardized?

Qualified Health Plans sold in the California health exchange (Covered California) will be standardized to meet certain rules including a metal tier, actuarial value and essential health benefits. 

Health plans will fall into five tiers:

Platinum
Gold
Silver
Bronze
Catastrophic

Subsidy levels for those eligible for subsidy will be based on the Silver tier level.  There will continue to be some differences between each insurance company's plans particularly in terms of network, drug formulary and so on.


Who may assist me in enrolling in a Healthcare Reform Qualified Health Plan?

For those purchasing health insurance inside of the Covered California exchange or via Medi-Cal/Healthy Families, you can purchase your health coverage from:

* Licensed Insurance Agents/Brokers
* Navigator and Certified Counselors
* Direct Benefit Assisters - includes trade unions, community services organizations, trade associations, some
  government departments like Fish & Game, medical groups, hospitals, some tax advisors and attorneys

* Directly through the Covered California Web Site

For those purchasing health insurance outside of the Covered Califronia exchange or small group plans outside or through the SHOP exchange:

* Licensed Insurance Agents/Brokers
* Directly from the Insurance Company
* SHOP may have direct enrollment as well for small group coverage

What do I have to do and when?

Beginning on October 1, 2013, the first annual open enrollment period kicks off.  The first year open enrollment will last a full six months to allow time for the large number of anticipated enrollments and plan changes.  Subsequent open enrollments will (as of today) be annually at the end of each calendar year for a shorter period.

Beginning in the late summer of 2013, you should start investigating your options in terms of whether you have to buy new coverage and what the plans and prices look like for the new QHPs.  We should have details by the middle of summer 2013. 

Beginning October 1, 2013, you will need to be prepared for open enrollment and what plan you are interested in purchasing. 


Helpful Links

Covered California Health Benefits Exchange

California Health Benefits Exchange Web Site

National Healthcare Cost Calculator  (UC Berkeley)

Healthcare.gov

Covered California Cost Estimator/Calculator
Click here to get online quotes and subsidy calculations from Covered California
Covered California Online Quotes and Calculator Now Available
Clck here for Covered California Information Brochure
Covered California Plans and Rates Brochure (5/13)
Berkeley MAGI Cheat Sheet
Help Calculating Your Income
Covered California Application Form 
(downloadable)
Covered California Health Benefits Exchange
800-509-0659