Having health insurance is mandatory in California, if you are a small business, individual or family do not pay a penalty for not having health insurance. Let one of our experienced agents help you.
Health Insurance Regulations
The purpose of state health insurance exchanges is to make health insurance more affordable and easier to purchase for small business and individuals.
The health reform legislation (Patient Protection and Affordable Care Act) signed into law in March 2010 by President Obama creates state-based health insurance exchanges. States can choose to operate their own exchanges or participate in a multi-state exchange.
California early on chose to operate its own exchange, now known as "Covered California."
The California exchange's vision is to improve the health of all Californians by assuring their access to affordable, high quality care.
Our mission is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.
Covered California health insurance plans — and all health plans in the individual and small-group markets — are sold in four primary levels of coverage: Bronze, Silver, Gold and Platinum. As the metal category increases in value, so does the percentage of medical expenses that a health insurance plan covers, compared with what you are expected to pay in copays and deductibles. Plans in the higher metal tiers have higher monthly premiums, but you pay less when you need medical care. If you choose to pay a lower monthly premium, then you will pay more when you need medical care. You can choose the level of coverage that best meets your health needs and budget.
The breakdown of costs that you pay (dark shading) and costs the plan pays (lighter shading) for the standard Bronze, Silver, Gold and Platinum tiers is shown below.
- Bronze: On average, your health plan pays 60 percent of your medical expenses, and you pay 40 percent.
- Silver: On average, your health plan pays 70 percent of your medical expenses, and you pay 30 percent.
- In some cases, individuals may qualify for an Enhanced Silver plan. This means that when they choose a Silver plan, they have – based on their income – enhanced out-of-pocket savings through lower copays, coinsurance and deductibles. Individuals in these savings categories get the benefits of a Gold or Platinum plan for the price of a Silver plan. In the three categories of Enhanced Silver, the plan pays either 94 percent, 87 percent or 73 percent of expenses, with the enrollee responsible for the rest.
- Gold: On average, your health plan pays 80 percent of your medical expenses, and you pay 20 percent.
- Platinum: On average, your health plan pays 90 percent of your medical expenses, and you pay 10 percent.
Off- exchange providers have adopted the ACA – feature and functions of metal tiers to be ACA compliant with the exception of tax saving based on household income.