Laura Hunt of Modesto has had trouble getting health insurance since she survived a medical crisis when she was 18.
Starting today, federal health reform gives her a chance to enroll in affordable coverage through Californias health exchange, with no fear of being denied for a previous health issue.
Hunt, 45, said her bout with acute respiratory distress syndrome got her blackballed by insurance companies, even though her only long-term complication was mild asthma, she said. She was insured off and on through her husbands employers, but not since he died in a 2006 car crash while driving home from his job with a Bay Area security firm.
Hunts job with a home health care service does not provide benefits. She expects to pay $86 per month for a health plan through Covered California, the insurance marketplace established by the Affordable Care Act.
It will give me peace of mind knowing that if something should happen, I wont lose everything I have, Hunt said.
About 108,000 residents of Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties are believed to be eligible for subsidized coverage under the federal health law signed by President Barack Obama in 2010, which gives people the choice of being insured or paying a tax penalty next year. Covered California approved four health plans for that region, offered by Anthem Blue Cross, Kaiser Permanente, Blue Shield and Health Net at premiums between $223 and $508 a month for a 40-year-old single adult, depending on level of coverage.
Uninsured single adults earning between $15,860 and $45,960 are eligible for tax credits to lower their premiums; the same goes for a family of four with annual income between $32,500 and $94,200.
Covered California said it has call centers running in the Sacramento area and Contra Costa County to assist the uninsured or people with coverage that doesnt meet the new federal standard. People also can enroll online at www.coveredca.com or meet face-to-face with certified insurance brokers to sign up for plans.
Stanislaus Countys Community Services Agency has 23 staff members ready to assist callers asking about Medi-Cal eligibility who are transferred by Covered California, said Kathy Harwell, director of the agency. The county center also is handling Medi-Cal eligibility for Napa and Marin counties under the Affordable Care Act, which makes the program available to those earning up to 138 percent of the poverty level ($15,860 for a single adult, $32,500 for a four-member family) and up to 200 percent of poverty level for children.
No delays in California
Enrollment was set to begin despite Republican threats of a federal government shutdown if Democrats in Congress do not agree to defund the Affordable Care Act. Covered California said it would not delay enrollment because of the clamor in Washington.
Nick Bavarro, a Modesto broker certified to enroll consumers, said a number of customers called Monday asking how a government shutdown would affect their ability to get insurance. I am going to have a baby before they defund Obamacare, Bavarro quipped. This is all just theater. We are telling people that Covered California enrollment is starting and your benefits will be effective Jan. 1.
Kaiser Permanente nurses represented by the California Nurses Association held informational pickets in Modesto, Oakland and Sacramento on the eve of the enrollment kickoff, charging that Kaiser has made it harder for patients to receive hospital care when needed. Claiming theyve reported 2,500 cases of unsafe care to Kaiser, the nurses suggested consumers be wary of insurers that limit access to hospital care.
Kaiser responded that the union is upset about a labor dispute with the Oakland-based health provider. This is just more of the same from the California Nurses Association, who continue to distort facts and make exaggerated and misleading claims to advance their agenda, a Kaiser statement read.
On the day before enrollment, consumers still were unable to see lists of hospitals, doctors and pharmacies connected with the four health plans in the region. Bavarro said he was told that provider directories, showing which health care providers accept the insurance, would be available from the insurers starting today.
Bavarro Benefit Plans in downtown Modesto formed a separate division called EZ1 Health Insurance for selling either the Covered California-approved plans or individual coverage on the open market now that consumers cant be denied for previous health problems.
Be honest about income
Bavarro said he expects many valley residents, especially those with diabetes or high blood pressure, or those paying for expensive COBRA benefits, will jump at the chance of getting coverage. People will be on their honor for stating income when applying for tax credits to lower premiums. Bavarro advised them to be honest because the Internal Revenue Service will be closely watching tax returns filed by April 2015 for 2014.
Understating income will result in having to repay all or a portion of the tax credit, Bavarro said. People who start earning more at midyear, because of a promotion or job change, should report that to Covered California or their brokers so their premiums are adjusted, he added.
Expecting long wait times today, Modesto resident Sandra Barker said she will try to reach Covered California next week. She said the exchange estimated she could get insured for $9 to $162 a month and then advised her to make sure her doctor accepts the plan she chooses.
Plans covering from 60 to 90 percent of medical bills are available, each with deductibles and annual limits on out-of-pocket payments.
I have no medical insurance at all, Barker said. This is going to help me.
Bee staff writer Ken Carlson can be reached at email@example.com or (209) 578-2321.