California’s new health insurance marketplace — part of federal health reform — is preparing a massive information blitz to let state residents know about their new options for buying coverage.
The health benefit exchange, called Covered California, will start enrolling members in October of this year for insurance coverage that will begin next January.
The exchange is offering $43 million in grants to help non-profit clinics and community groups point their existing clients to Covered California’s website, once it is up and running. Recently, local agencies in Riverside and San Bernardino County met to plan their strategy for winning some of that grant money. The group included representatives from about 30 organizations, including the Desert Healthcare District and Borrego Community Health Foundation.
The plan estimates that close to 320,000 people in Riverside and San Bernardino Counties will be eligible to buy insurance from the exchange.
“We know the need that is out there,” says Cynthia Preciado, Chief Development Officer for Borrego Community Health Foundation, a federally qualified health center. “We want to be able to inform the community and those that are eligible for the new insurance.”
Many people may not understand that they are eligible, says Victoria Stephan, a consultant for the Inland Empire Children’s Health Initiative Collaborative. She offers this example: “An employed person may get their insurance through their employer, but the premiums for their family aren’t covered or are too high for them to pay out of their income. So the family members would be eligible to purchase insurance through the health exchange.”
These Inland Empire agencies are competing with hundreds of others across the state for grant money that will allow them to reach out to their existing clients and help patients find the right health plan.
More than 20 percent of the patients at Borrego Community Health Foundation are uninsured, Preciado says. Insurance will help them access more of the care that they need and can’t get at the clinic. “They’re paying for a portion of their care based on their income but often can’t afford to get the diagnostic tests or to go to the specialists,” she says. “So this insurance will help them take care of their chronic health.”
The health exchange will primarily serve the working poor: individuals who make up to $18,000 per year, and families of four who make up to about $90,000 per year.
The remaining $3 million of the grant money is reserved for promoting the Small Business Health Options Program (SHOP), which will educate small business owners on the corporate plans that will be offered on the exchange.
Small businesses, families and individuals will be able to use federal tax credits to help purchase health plans on the Covered California exchange. The plans have to meet minimum coverage requirements. They will be rated as bronze, silver, gold and platinum plans, according to how much they cover and
what they cost. The bronze plans will have the lowest monthly premiums but have a $5,000 deductible for individuals, and tack on $70 per office visit. The silver plans will have a $2,000 deductible and a $45 charge to visit your primary care doctor. The gold and platinum level plans will have no annual deductible and office visits would cost about $25.
Preciado is optimistic that the uninsured will find what they need. “There will be certain incentives and the average cost to the person will be much less than the commercial insurance currently is. But it will provide adequate coverage for all of the health conditions that they have.”
The Department of Health and Human Services recently released the final rules on what the plans will be required to cover in ten categories, including maternity and newborn care, hospital visits, and prescription drugs. The plans are intended to be similar to coverage offered by the average employer-based plan.
Stephan hopes that the Affordable Care Act will eventually bring down health-care costs, “People get sick and they need health coverage somewhere,” she says. “If they don’t have a way to keep that affordable, they’re going to back into urgent care or emergency care, which is ten times more expensive than going to your local doctor. And it’s only used in an emergency. So it eliminates that whole preventative component of health care, which is what really keeps us healthy.”