Health Care and the Affordable Care Act

While many of the key provisions of the Affordable Care Act have already taken effect, many more will be implemented as we head into next year. One of the biggest changes in the coming months is the requirement that everyone has health insurance starting on January 1st, 2014. I want to make sure that all Central Coast residents understand the simple steps they need to take in order to be covered under the law.

What if I need insurance?

In California, will be the one stop shop to compare prices and plans that are offered on the California exchange, also known as the Marketplace. You can begin applying for coverage on October 1st, 2013. Options will be grouped into simple, easy to understand levels of price and services covered: bronze, silver, gold, and platinum. You’ll be able to apply online, on the phone, or in person, and the application process will automatically determine if you qualify for cost-sharing subsidies or tax credits. Those who still can’t afford subsidized plans from the marketplace might be eligible for expanded Medicaid.

Click here to learn more about the Affordable Care Act's health insurance marketplaces and how you can get ready.

Questions? Please visit or call 1-888-975-1142, Monday through Friday between the hours of 8:00 am and 5:00 pm Pacific. (TTY: 1-855-889-4325)

What if I have already have insurance through my job?

If you have job-based health insurance you like, you can keep it. You're considered covered. You may be able to change to Marketplace coverage if you prefer.

Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014.

What if I am a small business owner?

The Small Business Health Options Program (SHOP) simplifies the process of buying health insurance for your small business. You can call the SHOP Marketplace to get your SHOP and small business questions answered by a customer service representative at 1-800-706-7893 or (TTY: 1-800-706-7915 ). The call center is open Monday through Friday, 9 a.m. to 5 p.m. EST.

How the health care law protects you

  • Creates Affordable Insurance Exchanges: Insurance Exchanges are marketplaces where consumers can choose a private health insurance plan that fits their health needs. Each state is responsible for having their Exchanges ready by 2014. They will offer to the public the same kinds of insurance choices available to Members of Congress.
  • Provides Free Preventive Care: Insurance companies are now required to cover a number of recommended preventive services, such as cancer, diabetes and blood pressure screenings, without additional cost sharing such as copayments or deductibles.
  • Provides Coverage for Young Adults: Young adults who cannot get coverage through their employer can stay on their parents' plans until age 26.
  • Closes the Medicare Prescription Donut Hole: The "donut hole" in senior prescription coverage (coverage currently ends at $2700 and then restarts only after a patient has spent $6700) will close gradually over the next few years.
  • Ends Pre-Existing Condition Discrimination: Insurance companies can no longer deny coverage to anyone because of a pre-existing condition.
  • Ends Lifetime Limits on Care: Insurance companies can no longer impose lifetime dollar limits on essential health benefits.
  • Ends Coverage Cancellations: Insurance companies can no longer drop your coverage when you get sick due to a mistake you made on your application.
  • Ensures the Value of Your Premium Dollar: Insurance companies must spend at least 80 percent of your premium dollars on medical care and quality improvements rather than advertising, overhead, and bonuses for executives, otherwise they will have to provide customers with a rebate.
  • Stops Unreasonable Rate Increases: Insurance companies are required to publicly notify and justify raising premiums.
  • Provides Tax Credits to Small Businesses: Small businesses can now receive tax credits to provide health insurance to their employees.
  • Fights Fraud: The health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology.

For more information on the new health care law, please visit