TAHOE/TRUCKEE — Hillary Talbot has peace of mind.
Earlier this month, the Tahoe City resident enrolled in and selected a health care insurance plan for 2014, as mandated by the Affordable Care Act for most Americans.
“Being an active skier up here, it’s a huge relief going into the winter knowing that I’m fully covered,” she said. “Not having any lapses in coverage is good peace of mind.”
This fall, Talbot was notified by her current health care provider her coverage would be dropped at the end of March 2014, and her deductible would rise significantly starting January 2014.
Rather than risk it, Talbot signed up for a new plan — with help from a local insurance agency — through Covered California, the state’s marketplace where individuals and small businesses can shop for coverage.
In order to have coverage effective as of Jan. 1, 2014, individuals need to enroll and select a plan by Monday, Dec. 23. Additionally, one must pay the first month’s premium.
Originally, the payment deadline was Dec. 31, but some insurers are extending it to Jan. 10, 2014, according to the federal government’s ACA website, www.healthcare.gov.
Open enrollment for 2014 coverage will continue until March 31, 2014. Those who obtain coverage by then will not have to pay a penalty for previous uninsured months.
After March 31, however, private health insurance for 2014 can only be obtained through a special enrollment period if one has a life-changing event such as a job loss, birth or divorce.
“If you haven’t started the process, you still have time,” said Melissa Ausilio, community outreach specialist for the North Tahoe Family Resource Center, specializing in health care and nutrition programs. “No need to panic.”
Californians trying to enroll for coverage will be directed by the federal website to Covered California, at coveredca.com.
According to Covered California, 109,296 state residents have enrolled in an insurance plan between October and November. For the week of Dec. 1-Dec. 7, 144,146 applications were completed, and 49,708 individuals selected plans.
“We are very encouraged by the tremendous response as more and more Californians learn about the health coverage available through Covered California,” said Toby Douglas, director of California Department of Health Care Services, in a statement. “Our partnerships with the counties and others are helping lay the groundwork for a significant improvement in the health of all Californians.”
One local organization helping spread the word is the North Tahoe Family Resource Center.
“It’s the first time this has been rolled out, so there are going to be challenges, but we’re out there to assist the public with whatever they need,” Ausilio said.
When asked for recommendations for those starting the application process, she advised having all of one’s financial data and identification information at hand and giving oneself enough time to study and compare insurance plans.
“It’s more than just a monthly premium; it’s about your wellbeing,” Ausilio said.
Covered California offers four insurance plan categories: Bronze, Silver, Gold and Platinum.
These categories offer the same set of essential health benefits, which include emergency service; hospitalization; maternity and newborn care; and preventive, wellness and chronic disease management, among others.
The differences come down to monthly premium costs and one’s deductible.
Based on income, individuals can be eligible for either Medi-Cal — California’s Medicaid program — or subsidized coverage.
For example, an individual earning $15,856 or less annually, or a family of four making $32,499 or less, may qualify for Medi-Cal at low or no cost. An individual making between $15,857 and $45,960 annually, and a family of four earning between $32,500 and $94,200, may qualify for federal premium assistance based on a sliding scale.
One objective of the Affordable Care Act is making coverage more secure for those who have insurance and extended affordable coverage to the uninsured, according to the U.S. Department of Health and Human Services.
According to the U.S. Census Bureau, 48 million Americans were without health coverage in 2012 — that’s 15.4 percent of the population.
“I think (the Affordable Care Act is) a beginning, not an end point,” said Dr. Lawrence Danto, a professor of surgery for UC Davis who used to practice medicine in Truckee. “I don’t think it’s a permanent solution to access — or lack of access — to health care in our country.”
Eligible adults without coverage in 2014 must pay either a $95 fee, or 1 percent of his or her income, whichever is higher. The penalty will increase in subsequent years to $325, or 2 percent, and $625, or 2.5 percent, for 2015 and 2016, respectively.
FINDING THE COST
Under Talbot’s new coverage plan, she will see a increase of $2 a month in her premium starting in 2014.
“(It’s) definitely not a bad change,” she said.
While some individuals will see an increase in their monthly premium, Ausilio said those premiums cover previously non-included benefits such as behavioral health treatment and the assurance that you will not encounter annual and lifetime caps.
The Affordable Care Act also makes it illegal to be denied coverage based on pre-existing conditions, age and occupation.
It’s no secret federally mandated health care has been a controversial topic, as liberals laud its intent to care for all Americans, while conservatives argues its merits and question if it’s the constitutional thing to do.
However, for Talbot, looking beyond the politics is perhaps what’s best for residents.
“If you’re not 100 percent sold, find out what it would cost you for what type of plan,” Talbot said. “I feel like (it’s) important for people just to break down these barriers of being for or against it, and truly find out what it’s going to cost you, and what it’s going to cost you if you don’t have health insurance.”