FAQs

Q?

Does the Affordable Care Act affect my employer’s group plan?

A.

Yes. For employer-based insurance, it means: preventive services at no additional cost (unless you have an older, grandfathered plan); an end to lifetime/annual dollar limits and cancellation of coverage if you get sick; guaranteed coverage for your adult children until age 26; guaranteed coverage if you have a pre-existing condition; and the right to appeal a denied claim. If your employer's plan costs more than 9.5 percent of your income or doesn't meet the law's minimum coverage requirements, you might qualify for subsidized coverage on your state health marketplace, or exchange.

Q?

I’ve had the same policy for years. Does health care reform affect my plan?

A.

Some provisions of the Affordable Care Act do not apply to so-called grandfathered plans written before the law took effect. These include the freedom to choose your own doctor, preventive services at no additional cost, and the right to appeal if your insurer denies a claim. However, as with new policies, grandfathered plans are required to cover children up to age 26, provide a simple summary of coverage and costs, and cease any lifetime limits on benefits.

Q?

How do I qualify for an Obamacare subsidy to cut health insurance costs?

A.

If you earn between $16,106 and $46,000 per year for a single person or $32,913 and $95,400 for a family of four and do not have affordable employer-sponsored coverage, you could receive an "advance premium tax credit" to help with the cost of insurance purchased through your state's exchange, or marketplace. A premium discount is deducted from your federal income tax, and you decide how much to put toward your insurance payment each month.

Q?

I can’t afford to buy health insurance. What should I do?

A.

Depending on your income, you may be eligible for lower-cost, subsidized coverage purchased through Covered California's exchange. Or, you may qualify for free or low-cost coverage through Medicaid or the Children's Health Insurance Program, aka CHIP

Q?

Do I really have to buy health insurance?

A.

The Affordable Care Act's "individual mandate" requires all Americans, with a few exceptions, to have health insurance that typically offers "minimum essential coverage." Going without insurance could bring a tax penalty. For 2014, that penalty is 1 percent of your annual income or $95, whichever is higher, and $47.50 for each uninsured child, to a family cap of $285. The penalty increases to the greater of 2.5 percent of income or $695 per person by 2016. The penalty will show up as an additional tax or a reduction in your federal tax refund.

Q?

What is the Affordable Care Act, and why do we need it?

A.

The Patient Protection and Affordable Care Act, commonly known as Obamacare, was signed into law by President Barack Obama on March 23, 2010. It includes a broad range of reforms designed to make health insurance better and more affordable, rein in health costs and expand coverage among America's nearly 50 million uninsured. The act requires most Americans to have health insurance or face a penalty. It also makes it illegal for insurers to set dollar limits on coverage, drop you if you get sick or charge more or deny coverage because of a pre-existing condition.

Q?

What’s the difference between a deductible, a copayment and coinsurance?

A.

All three are medical charges you must pay out of your own pocket, even if you have insurance. Your deductible is the initial amount you must pay each year for covered health services before your insurer will start to chip in. Plans may have separate individual and family deductibles and/or deductibles for separate services such as hospitalization. A copayment is a fixed amount you pay toward each medical service, such as $25 for a checkup. Coinsurance is a fixed percentage, rather than a flat amount, that you pay toward each service.

Q?

Why do I need Health Insurance?

A.

It's no secret that health care is expensive today. The government says the cost to treat a broken leg can run $7,500 and an average three-day hospital stay can set you back $30,000. Without insurance, many Americans would be one health setback away from financial ruin. Regularly paying a set premium for health coverage assures that money will be available to defray the cost of everything from routine checkups to catastrophic medical bills.

Q?

How much do your services cost?

A.

This is a questions that we get all the time. All of our services are FREE! We do not charge to meet with you. We are here to provide you with free assistance with your insurance questions and applications. It cost the same to use an agent or do it on your own.

Q?

What is health insurance?

A.

Health insurance is a contract with an insurance company, which agrees to pay some or all of your medical bills based on your "coverage," or the terms of your policy. In exchange, the insurer is paid a set amount of money -- a "premium" -- on a monthly basis. Most Americans have private health insurance, either through their employer's group plan or through buying their own individual policy. Others are covered under public "safety net" programs such as Medicare and Medi-Cal.