========================================================= ACA MEDICAL:
< > ACA = Federal Patient Protection & Affordable Care Act = ObamaCare Medical:
< > Covered California Health Benefit Exchange: www.CoveredCA.com in California
www.HealthExchange.CA.gov in 36 States.
( ) Platinum Plans
( ) Gold Plans
( ) Silver Plans
( ) Bronze Plans
( ) Premium Costs
Vary by Age, Zip Code, Coverage Level, Subsidies. Older People can be charged no more than 3 times Young People
( ) Coverage
Essential Health Benefits +
( ) Provider Doctors
Different Plans have different numbers of Doctors
( ) Comparisons
No Insurer Ratings posted allowed. Previously: 4* = Excellent. 3* = Good. 2* = Fair. 1* = Poor
( ) HMO
Kaiser 4*. Sharp 3*. Western Health 3*.
( ) 13 Medical Insurers in Covered California Insurance Exchange:
( ) Covered California: is an Active Purchaser, & has contracted with Dental Insurers
Dr. Lauren Friedman DDS is a Member Dentist of the PPO DPPO EPO DEPO Dental Insurers. 1-310-418-7788
============================================================ ACA Insurers:
< > ACA Medical Insurers = QHP = Qualified Health Plan:
( ) HealthCare.gov: www.HealthCare.gov 36 States in the U.S. CGI Federal Group of Canada is designer. CA + 13 States have their own Online Medical Exchanges. Dept. of Health & Human Services. CGI programmers
( ) UnitedHealth Group: 1st largest Health Insurer in the U.S. No CA Individual Healthcare for 2014 - 2019
( ) Aetna: No CA Individual Healthcare for 2014 - 2019
( ) Cigna:
( ) Anthem Blue Cross of CA: 1st largest Health Insurer in CA. 2nd largest Health Insurer in the U.S. No CA Small-Business Healthcare for 2014 - 2019
( ) Blue Shield of CA: 3rd largest Health Insurer in CA
( ) Kaiser Permanente HMO: 2nd largest Health Insurer in CA. www.kff.org
( ) Health Net HMO: in CA, AZ, OR. 5.4 Million Insureds
( ) eHealth Exchange: Private online Health Insurance Exchange. www.eHealthInsurance.com
( ) Getinsured Exchange: Private online Health Insurance Exchange. www.Getinsured.com
( ) "Keep your Old Coverage" Insurer Trick: January 1, 2014 Start Date delayed for ACA ObamaCare up to 1 year
( ) "EPO Doctors are Fewer than PPO Doctors" Insurer Trick: Different Plans offer Less Access to Fewer Doctors
( ) "Grandfathered Health Plans" Insurer Trick: Different set of Rules, lower benefits, higher premiums
( ) "Open Enrollment" to Change Plan from HMO to PPO: Oct 1, 2014 thru Dec 15, 2014 for January 1, 2015
( ) Rebates of Premiums: ACA gave 13 Million Americans Refunds for the 80% Benefits clause in the ACA Law
=========================================== ACA for Children & Students:
< > Students under 26 years old & Children under 18 years old:
( ) Dependent Coverage: Dependents covered under Parent's Health Insurance up to 26 years old.
( ) Children: Dental Insurance included in Health Insurance Plan. 10 Essential Health Benefits for being under 18 yo.
( ) 3 Million Students: have been able to stay on their Parents' Health Insurance, because of the ACA Law.
Dr. Lauren Friedman DDS is near UCLA & is in West Los Angeles near the 405 & 10 Freeways. www.Dental.ws
< > Employees & Employers:
( ) Employees: 53% of California's Employees have Health Insurance from their Employers.
( ) HSA = Health Spending Account: Deductible of $1,250 for Self-Coverage, or $2,500 for Family Coverage. Contribution is Pre-Tax per year. Unused $ roll-over to next year. Money follows you even if you change Jobs. 20% Penalty for non-medical use of HSA Funds.
( ) FSA = Flexible Spending Account: $2,500 Max Contribution Pre-Tax per year. Unused $ are lost.
( ) Consumer-Directed Health Plans: Health Insurance Plan with very High Deductible + HSA or FSA Account. 20% of California's Employers offer this to their Employees.
( ) HRA = Health Reimbursement Arrangements: Employer holds a pool of Funds for Qualified Medical Bills Pre-Tax
( ) Working under 30 Hours per Week?: You are not eligible for Employer Health Policy payments, as per ACA Law.
( ) Working over 30 Hours per Week?: You are Covered under Employer Health Insurance Policy, as per ACA Law.
You can Pay Dr. Lauren Friedman DDS with your HSA Account or your FSA Account. www.Dental.ws
< > Medicare Part B:
( ) Open Enrollment starts October 1, 2013 thru December 7, 2013 for January 1, 2014 Insurance Coverage.
( ) UnitedHealthcare? Concordia?:
( ) Blue Shield of California: Medicare Advantage Plan. 1-800-747-0010
Dr. Lauren Friedman DDS is a Member Dentist of the PPO EPO Medicare Dental Insurers. 1-310-418-7788
==================================================== Medi-Cal & Denti-Cal:
< > Medi-Cal: www.MediCal.ca.gov 1-800-456-2387
( ) Medi-Cal will continue to be administered by the Department of Health Care Services (DHCS)
( ) DHCS = Department of Healthcare Services: 1-800-322-6384
( ) HFP = Healthy Families Program: All 880,000 of you Children are being moved to the Medi-Cal and Denti-Cal Program. & be administered by the the Managed Risk Medical Insurance Board (MRMIB)
( ) Adult Denti-Cal: Most Dental Benefits were eliminated for Adults in July, 2008. Emergency & Extractions will be paid
( ) Chronically ill Patients: moved to HMO Medi-Cal in CA
( ) Seniors on Medicare + Medi-Cal: moved to HMO Medi-Cal in CA
============================================================= Tax Credits:
< > ACA Tax Credits & Penalties:
( ) Tax Credits: based on multiples of the FPL = Federal Poverty Level
( ) MAGI = Modified Adjusted Gross Income: 2012 Tax Return Page 1 bottom $ +Tax Exempt Interest. SSI and/or Veterans Disability benefits are not added onto your MAGI
( ) Tax Credits and Subsidies available in 2014 to Californians with incomes between 133 and 400 percent of the federal poverty level (approximately $25,000 to $94,000 for a family of four)
( ) Older People get more generous Credits than Younger People.
( ) Federal Subsidies for Single Person up to $45,900 a year, for a Couple up to $62,040 a year, for a Family it depends.
( ) Provide refundable and advanceable premium credits to eligible individuals and families with incomes between 100-400% FPL to purchase insurance through the Exchanges. The premium credits will be tied to the second lowest cost silver plan in the area and will be set on a sliding scale such that the premium contributions are limited to the following percentages of income for specified income levels:
100-133% FPL: 2% of income
133-150% FPL: 3 – 4% of income
150-200% FPL: 4 – 6.3% of income
200-250% FPL: 6.3 – 8.05% of income
250-300% FPL: 8.05 – 9.5% of income
300-400% FPL: 9.5% of income
( ) Increase the premium contributions for those receiving subsidies annually to reflect the excess of the premium growth over the rate of income growth for 2014-2018. Beginning in 2019, further adjust the premium contributions to reflect the excess of premium growth over CPI if aggregate premiums and cost sharing subsidies exceed .54% of GDP.
( ) Provisions related to the premium and cost-sharing subsidies are effective January 1, 2014.
( ) Provide cost-sharing subsidies to eligible individuals and families. The cost-sharing credits reduce the cost-sharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of the basic benefit plan to the following percentages of the full value of the plan for the specified income level:
100-150% FPL: 94%
150-200% FPL: 87%
200-250% FPL: 73%
250-400% FPL: 70%
( ) 80% of Employers have less than 25 Employees: 35% - 50% Tax Credit for Group Health Insurance Premiums
( ) Tax Penalties for not having the Mandatory Health Coverage:
( ) ACA requires U.S. citizens and legal residents to have qualifying health coverage.
( ) Tax penalty for 1st year = $95 or 1% of Income whichever is greater for 2014. Tax penalty for 2nd year = $365 for 2015. , up to $695 in 5 years, for being Uninsured.
( ) Those without coverage pay a tax penalty of the greater of $695 per year up to a maximum of three times that amount ($2,085) per family or 2.5% of household income.
( ) The penalty will be Phased-in according to the following schedule: $95 in 2014, $325 in 2015, and $695 in 2016 for the flat fee or 1.0% of taxable income in 2014, 2.0% of taxable income in 2015, and 2.5% of taxable income in 2016. Beginning after 2016, the penalty will be increased annually by the cost-of-living adjustment.
( ) Exemptions will be granted for financial hardship, religious objections, American Indians, those without coverage for less than three months, undocumented immigrants, incarcerated individuals, those for whom the lowest cost plan option exceeds 8% of an individual’s income, and those with incomes below the tax filing threshold (in 2009 the threshold for taxpayers under age 65 was $9,350 for singles and $18,700 for couples).
( ) Assess Employers with 50 or more full-time employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. Employers with 50 or more full-time employees that offer coverage but have at least one full-time employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees from the assessment. (Effective January 1, 2014).
Exempt employers with up to 50 full-time employees from any of the above penalties.
< > LAWS - FEDERAL & the STATE of CALIFORNIA:
( ) ACA = Affordable Care Act = ObamaCare: March 2010, Congress passed and President Obama signed the Patient Protection and Affordable Care Act, also known as Health Care Reform or the ACA. 2,000 Pages of Legality.
( ) Benefit Summaries: simplified for side-by-side comparisons
( ) Essential Health Benefits: Minimum Requirements of all Health Insurance Policies
( ) All Adult Americans: are Required to carry Health Insurance or they must pay a Penalty of 1% or more.
( ) Sick Children: Guaranteed Health Insurance Coverage
( ) Older People: Insurer can NOT charge Older People more than 3 times the Premiums charge for Younger People
( ) Pre-Existing Conditions: Insurer can NOT deny coverage to you.
( ) Benefits: 80% of Premiums received are to be paid out in Medical Care Benefits. 20% for Administration
( ) MLR = Medical Loss Ratio: Insurers' Profits are Monitored by the Government
( ) Adult Children under 26 Years Old: Dependent Coverage must allow Parents to insure their Children under 26 yo
( ) Lifetime Benefits Limits: NONE. No Lifetime Caps on person's healthcare
( ) Annual Limit: Basic Benefits Maximum of $2 Million per year
( ) Preventive Care: at No Cost to Patient. No Deductibles. No Copays. (Immunizations, Mammograms, Screenings)
( ) Emergency Care & Ob-Gyn Care: Expanded Access. No required Pre-Authorization
( ) Appeal Rights: Denied Claims will be guaranteed an Independent External Review of the Denial
( ) Rescissions ban: Insurers may NOT Terminate coverage when person gets Sick
( ) Federal Healthcare: www.Healthcare.gov
( ) DMHC = Department of Managed Health Care of CA: overseas Health Insurance. www.DMHC.CA.gov
( ) Department of Insurance of CA: overseas Health Insurance. www.Insurance.CA.gov
( ) California Association of Health Plans: Insurance Industry Trade Group & PAC. www.CalHealthPlans.org
( ) Federal Fair Labor Standards Act & ACA: Employers must notify asl Employees of ACA & CoveredCA
( ) CA AB 1761: Unauthorized individuals/businesses cannot represent the CA Health Benefit Exchange
( ) CA AB 792: Job Loss / Health Insurance lost - info about the CA Health Benefit Exchange & Medi-Cal
( ) CA AB 1083: Self-Employed / Sole Proprietor / Entrepreneur can get Small Business Health Insurance
( ) CA AB 1453 + SB 951: Insurers must meet Minimum Coverage Standards for Benefits & Services
( ) CA AB 1526: Managed Risk Medical Insurance Board of CA will Subsidize Uninsurable Individuals' Premiums
( ) RomneyCare of Massachusetts - 2006 Law: almost 96% of MA Residents have Health Insurance. ObamaCare was modeled from RomneyCare by the Republicans in Congress, then approved by the Government & the Courts
- Your MAIN RESOURCE for the Dental Insurance info from our favorite
- Humor Dentist, Dr. Lauren Friedman, DDS.
- Covered California! Healthcare.gov!