Affordable Health Insurance is Here

Health Insurance Provides Peace of Mind

Health insurance can be affordable. For some, government subsidies offset the cost of insurance. Others may be eligible for Medicaid when previously they were not. Avoiding penalties for not having insurance should be a factor too. Most importantly, health insurance provides peace of mind.

The Heath Care Law

According to the Affordable Care Act, everyone who legally lives in the United States must have health insurance.

For millions of uninsured people, this law gives access to healthcare plans at different cost levels. Based on their income and family size, those who qualify also may receive financial assistance when purchasing these plans.

You may compare plans at the Health Insurance Marketplace, also known as an exchange. This one-stop shop allows you to choose a plan that fits your budget and coverage needs.

We’re here to help you learn about the law and how to select the right plan for you and your family.

What Will the Plans Cover?

All plans include coverage for doctor visits, hospital stays, wellness care, prescriptions, emergency services and more. In fact, there are 10 essential health benefits that are included in every plan, and certain preventive care services will be provided at no additional cost to patients. Insurers cannot deny coverage because of pre-existing conditions.

Open Enrollment Begins November 1

If you do not have health insurance, you must sign up for 2016 coverage during open enrollment, from November 1, 2015 to January 31, 2016. You can shop for plans by phone, through a broker or at the online Marketplace, where you can compare benefits and costs easily. Those who do not sign up will face tax penalties.

If you currently have “charity care,” you should sign up for health coverage. With health insurance, you will be covered for things like doctors’ visits and prescription medicines, which are not covered now – and may not be covered when your charity care coverage ends.

If you are interested in receiving one-on-one assistance to compare insurance options, call 559-396-3331 to speak with an enrollment representative. Or, visit CoveredCA.com for additional information.

The Marketplace

The Health Insurance Marketplace is available online, by phone or through an approved insurance broker. It’s designed to help you buy health coverage more easily.

You can compare plans side by side, in simple language, and there’s no fine print. You can choose between four levels of health plans—Platinum, Gold, Silver and Bronze—from a variety of approved insurance providers. Each offers different amounts of coverage and different monthly premiums. Only one simple application is required.

Open Enrollment Begins November 1!

Call 559-396-3331 to speak to an enrollment representative about local coverage options, or visit CoveredCA.com to apply for coverage, compare plans and enroll in coverage.

Insurance Renewal

Renewing Your Marketplace Health Insurance Plan

The Open Enrollment Period is when individuals can purchase health insurance plans. If you already have health insurance, it is the time for you to shop for new Marketplace coverage or decide to stay in the same, or a similar, plan. This year, the Marketplace Open Enrollment Period is from November 1, 2015 through January 31, 2016.

Your health insurance company will send you a letter by November 1, 2015 to let you know if your plan is still being offered and how the plan is changing.

  • If your health insurance company will offer a plan in your area for 2016: The letter you get from your health insurance company will tell you the new monthly premium amount and any changes to the plan. If you have questions about plan benefits, which providers are in-network, or how to pay your premiums, call your health insurance company directly.

  • If your health insurance company won't offer a plan in your area for 2016: Your health insurance company may decide to stop offering certain plans next year. If your health insurance company won't offer a plan in your area for 2016, then you'll need to choose a new plan for 2016 to continue having coverage.

Be sure to go to CoveredCA.com to make sure your current plan is still right for you. Be sure that the plan works for you – for example, that the doctors and hospitals you use, and prescription drugs you need, are still in-network. In most cases, if you do not take action, your health insurance company will automatically enroll you in the plan you currently have or the one most similar to it if your plan is no longer available.

From November 1, 2015 to January 31, 2016, you can:

  • Update your application information.
  • See if you qualify for new or different help paying for your premiums and out-of-pocket costs.
  • Compare available plans.
  • Enroll in a plan that meets your needs.

Remember, you must enroll in a plan by December 15, 2015 for coverage in your new plan to start on January 1, 2016.

Financial Assistance

To learn more about your coverage options or to find out if you qualify for financial assistance, including expanded Medi-Cal, call to speak with a Saint Agnes financial counselor, (559) 450-SAMC (7262). Even if you've been denied in the past, you could be eligible under Medi-Cal's expanded guidelines, which went into effect last year.

If your income or household size has changed, you will need to report that to Covered California so you get the right premium tax credit. If you do not update this information, you will get the same tax credit as in 2015. If your income has gone up or your household size changes and you do not report these changes, you may owe money when you file your tax return in 2016.

By using one of several good calculators that are available, you can estimate how much assistance you may obtain—before you even visit CoveredCA.com. However, only Covered California will let you know the exact assistance you can expect.

Financial Assistance Calculator

One very simple calculator can be found at CoveredCa.com: http://www.coveredca.com/shopandcompare/2016/ 

Another calculator option, from the Kaiser Family Foundation, is found below:

This tool estimates health insurance premiums and subsidies for people purchasing insurance in the Marketplace. It was developed by the Kaiser Family Foundation.

You can enter different incomes, ages and family sizes to estimate your eligibility for subsidies and how much you could spend on health insurance.

Financial Assistance Income Chart

Look for your income and household size on this chart to see whether you qualify for financial assistance when purchasing health insurance.

Household size

100%

133%

150%

200%

300%

400%

1

$11,770

$15,654

$17,655

$23,540

$35,310

$47,080

2

$15,930

$21,187

$23,895

$31,860

$47,790

$63,720

3

$20,090

$26,720

$30,135

$40,180

$60,270

$80,360

4

$24,250

$32,253

$36,375

$48,500

$72,750

$97,000

5

$28,410

$37,785

$42,615

$56,820

$85,230

$113,640

Why Choose Us?

When you compare plans, you’ll be able to see what hospitals are included in each one. Make sure you choose a plan that includes Saint Agnes Medical Center so you’ll always have the latest treatment options, leading-edge technology, and physicians from some of the nation’s finest medical schools. You deserve the best that medicine has to offer and we’re passionate about providing nothing less. The highest quality of care delivered with the utmost compassion … that’s the Saint Agnes promise.

Learn more about Saint Agnes Medical Center >>

These health insurance plans offered through Covered California include Saint Agnes Medical Center: 

  • Blue Shield of California
  • Blue Cross of California

Preventive Care Services

All marketplace plans must cover the following list of preventive services without charging you additional fees (copayment or coinsurance), even if you haven't paid your yearly deductible. However, you must receive these services from a healthcare provider in your network. Screenings are also available based on certain criteria and conditions.

Preventive Screenings For All Adults

  1. Abdominal aortic aneurysm one-time screening
  2. Alcohol misuse screening and counseling
  3. Aspirin use
  4. Blood pressure screening
  5. Cholesterol screening
  6. Colorectal cancer screening
  7. Depression screening
  8. Diabetes (Type 2) screening
  9. Diet counseling
  10. HIV screening
  11. Vaccines and immunizations
  12. Obesity screening and counseling
  13. Sexually transmitted infection (STI) prevention counseling
  14. Syphilis screening
  15. Tobacco use screening

Preventive Screenings For Women

  1. Anemia screening
  2. Breast cancer genetic test counseling (BRCA)
  3. Breast cancer mammography screenings
  4. Breast cancer chemoprevention counseling
  5. Breastfeeding comprehensive support and counseling
  6. Cervical cancer screening
  7. Chlamydia infection screening
  8. Contraception
  9. Domestic and interpersonal violence screening and counseling
  10. Folic acid supplements
  11. Gestational diabetes screening
  12. Gonorrhea screening
  13. Hepatitis B screening
  14. HIV screening and counseling
  15. Human papillomavirus (HPV) test
  16. Osteoporosis screening
  17. Rh incompatibility screening
  18. Sexually transmitted infection (STI) counseling
  19. Syphilis screening
  20. Tobacco use screening and interventions
  21. Urinary tract or other infection screening
  22. Well-woman visits

Preventive Screenings For Children

  1. Alcohol and drug use assessments for adolescents
  2. Autism screening
  3. Behavioral assessments
  4. Blood pressure screening
  5. Cervical dysplasia screening
  6. Depression screening
  7. Developmental screening
  8. Dyslipidemia screening
  9. Fluoride chemoprevention supplements
  10. Gonorrhea-preventive medication
  11. Hearing screening
  12. Height, weight and body mass index measurements
  13. Hematocrit or hemoglobin screening
  14. Hemoglobinopathies or sickle cell screening
  15. HIV screening
  16. Hypothyroidism screening
  17. Immunization vaccines
  18. Iron supplements
  19. Lead screening
  20. Medical history
  21. Obesity screening and counseling
  22. Oral health risk assessment
  23. Phenylketonuria (PKU) screening
  24. Sexually transmitted infection (STI) prevention counseling and screening
  25. Tuberculin testing
  26. Vision screening

10 Essential Health Benefits

All private health insurance plans on the Health Insurance Marketplace provide the same essential health benefits.

These are minimum requirements, but plans may offer additional coverage. Compare plans side-by-side on the Marketplace to see exactly what each offers.

Essential Health Benefits

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services

Source:
www.healthcare.gov/coverage/what-marketplace-plans-cover

On a mission to heal body, mind and spirit