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Questions And Answers
The Obama Care Mandate: What is required?
The “mandate” refers to the federal law that requires all American citizens and legal residents to have qualified medical insurance. This medical coverage may be acquired off-exchange or through Covered California. The mandate is also known as the Affordable Care Act, or Obama Care. For more information, visit Obama Care California. Under the mandate, Americans and legal residents are required to do one of the following:
* You can be uninsured for part of the calendar year and not be subject to a penalty so long as you are uninsured for less than three consecutive months.
What is a qualified health plan?
For Californians to be in compliance with the mandate, they’ll need to be enrolled on a qualified health plan, plan that meets the government’s requirements for minimum essential coverage. The main coverage requirement is that the insurance must cover the 10 minimum essential benefits, such as preventive services, Prescription Drug Coverage, and maternity and newborn care. A medical plan can still be a qualified health plan without the minimum essential benefits if the plan is a grandfathered plan, which is a medical plan that was in force before March 23, 2010 when the mandate was passed and which has not undergone major changes. Qualified health plans may be acquired through Covered California, Medi-Cal, Medicare, group insurance, a plan through the military, or off-exchange directly through the carrier.
What Does The California Health Exchange Do?
The Exchange helps Californians comply with the Obamacare mandate. It helps individuals and families obtain health coverage that includes the minimum essential benefits required by the law. Certain carriers are certified to offer subsidized Obama Care Plans and Prices plans and dental plans through the Exchange. These Covered California plans can sell insurance on or off the Exchange. But for qualified consumers, rates can be better if the medical plan is purchased through the marketplace. For people with a household income that is below 400% of the Federal Poverty Level (“FPL”), Covered Ca may qualify them to receive financial assistance, also called a “Subsidy”, which reduces their premium. And if income is between 138% and 250% of the FPL, the State Exchange may also qualify individuals for extra discounts that reduce their cost for medical services. These extra discounts are referred to as “Cost Sharing Reductions”. To be eligible for a subsidy and potentially for cost sharing reductions, you must fall within Covered California income limits and not be offered affordable, full coverage healthcare through an employer, Medicare, etc. Enrollments need to be submitted through the State Marketplace, a Certified Insurance Agent, or a Certified Enrollment Counselor.
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