At the very same moment the government shutdown its “non-essential’ activities, Obamacare’s insurance exchange marketplace site was officially launched to the public to compare and shop for affordable healthcare plans, or even apply for Medicaid if their state allowed the Medicaid expansion to the poorest citizens, as a part of the Affordable Care Act. The long-anticipated website was faced with glitches, time-outs, and crashes, due to the overwhelming traffic and demand in the first hours. The administration estimates the number of visitors to be around 4.7 to 6.1 million visitors in the first 36 hours of the websites launch.
The federal exchange marketplace is available through Healthcare.gov. The Affordable Care Act originally required every state to create its own marketplace site and expand the Medicaid for the poorest citizens who earn less than 100 percent of federal poverty line. Twenty-seven states refused to create their own marketplace, and 14 states opposed the Medicaid expansion program (including Texas, the state with highest rate of uninsured residents), their decision resulted in defaulting them into the federally-facilitated website, thus, higher-than-expected visitors were browsing their options in the open enrollment day.
Unlike Rick Perry’s Texas, the State of California does not sit tight, watching its citizens suffer from the skyrocketing costs of health insurance. Being the state with highest number of uninsured Americans — in terms of population – and the eighth highest state with the percentage of uninsured (20 percent vs 24 precent for TX), California took the lead in implementing and enacting provisions of the Affordable Care Act. Covered California is the state’s official gateway to the Affordable Care Act, and also the state’s official insurance exchange marketplace where Californians can shop, compare, and navigate through the options offered by the ACA. Despite minor glitches that were fixed quickly, the website was fully operational on the open enrollment date.
While the federal marketplace requires registration before any detailed information can be displayed, Covered CA does not have the same requirement. Thus, I was able to navigate through available options and plans by providing basic, general information like age, annual income, and household size. The search results were better than what I have expected. As individuals and families who live in Los Angeles County, and earn an annual income below the federal poverty guideline ($15,000 for individuals, $33,000 for a family of four) are eligible for Medicaid (Medi-Cal in California) as a part of the Medicaid expansion. While young individuals — 27 years old — who earn an annual income between $16,000 to 28,000 are eligible for a monthly subsidy that ranges from 15 to 94 percent of the total premium cost, based on their income. Those who are near poverty, making $16,000, are looking for silver plans with a monthly premiums of $19 only. Such plans offer the benefits of extremely low out-of-pocket costs with no annual deductible, and costs range from only $3 for a primary care visit to $25 for an emergency room co-pay.
However, this is not the cheapest, most affordable option for young adults in Los Angeles area. In fact, people in the same income group, who feel invincible enough, and think they shouldn’t be required by the new law to choose between purchasing a health plan that they don’t need, actually have the option to purchase a bronze plan for as little as $1 per month. The highest monthly cost on the bronze plan for that age group is $58, which is approximately the same monthly cost as average gym membership fees. By choosing this plan, they can avoid the penalty and be covered in case of any medical emergency at the same time. Not to mention the importance of young people participation in the success of the overall law.
A family of four, with an annual income of less than $33,000 in Los Angeles county are eligible for Medicaid, regardless of members’ age. Such families who earn an annual income between $33,000 to $92,000 are eligible for subsidies and tax credits to help with the monthly expenses of premiums. These subsides and tax credits can cover somewhere between %90 to only %1 of the monthly premium, depending on their income. Families who are near poverty can end up paying as little as $2 a month for a basic bronze plan with a $5,000 annual deductible. Or choose a silver plan that covers almost 94 of medical expenses with a premium rate that ranges from $45 to $183 a month. Deciding what plan to choose from the variety of the available options is entirely up to individuals, based on whether they do not need that much medical care, or whether they have special medical needs that require more frequent visits like diabetes, cancer, or any chronic disease.
Individuals and families who earn more than four times the poverty line are not eligible for any subsidy or tax credits. Also, workers who are covered through employer-provided insurance plans do not receive any type of assistance, unless their premium cost more than 9.5 percent of their monthly income, as the new law defines any plan that costs less than 9.5 percent of the household income to be an affordable plan.
As we can see from the two pictures, the plans are displayed all at the same time, one next to the other. Shoppers can compare the benefits and costs of all plans and decide which offers the best services. Each plan displays the detailed costs of primary care, specialists visits, deductibles, co-pays, and emergency room costs. Some plans may cost twice as much for the exact same benefits — and this is the first time in history the public has had access to easily visible side-by-side comparisons.
Editorial note: Exploration of the Cover Oregon website reveals there are bronze plans available for as low as $1 for low-income young adults, as well.