Aug. 01--Beginning in 2014, many Californians who do not have health insurance coverage through a job will be able to buy it through the online California Health Benefit Exchange.
At that time, nearly everyone will be required to have health insurance or pay a penalty.
Here are answers to questions about how the exchange will work:
Q: Who will qualify for a subsidy to help pay for premiums?
A: Those who earn between 138 percent and 400 percent of the federal poverty level. This year, that would be up to $44,680 for an individual and $92,200 for a family of four.
Q: How much will the subsidies be?
A: Subsidies will vary based on income and family size, and will be in the form of tax credits that can be advanced.
Depending on an income ranging from $35,137 to $93,700 and a monthly premium of $1,187, the subsidy for a family of four might range from $117 to $742 for a "silver" or midrange plan.
Q: What type of plans will be offered?
A: Four main types -- labeled bronze, silver, gold and platinum -- with bronze providing the least amount of coverage and platinum the most. As you move from bronze to platinum, premiums rise but your coverage improves and out-of-pocket costs go down.
Q: How much will people pay if they don't have health insurance?
A: Most citizens and legal residents will be required to have coverage or pay a penalty. Some people will be exempt, including those who are uninsured less than
three months or who would have to pay more than 8 percent of their household income for premiums.
The annual penalties, which will be phased in, will be:
--2014: $95 per adult and $47.50 per child (up to $285 for a family), or 1 percent of family income, whichever is greater.
--2015: $325 per adult and $162.50 per child (up to $975 for a family), or 2 percent of family income, whichever is greater.
--2016: $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5 percent of family income, whichever is greater.
--Beyond 2016: Amounts increase annually by the cost of living.
Q: How much will large businesses pay if they do not provide employee health insurance?
A: Beginning in 2014, companies with 50 or more employees will pay $2,000 annually per full-time worker, excluding the first 30 workers.
Q: What are the essential benefits health plans must provide in 2014?
A: Ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.
(c)2012 the Contra Costa Times (Walnut Creek, Calif.)
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