Golden Ocean Insurance Center

Covered California 2014

• EXPANSION OF MEDICAID (MEDICAL)• NO MEDICAL UNDERWRITING, UNIVERSAL

COVERAGE – 새플랜 existing condition 모두커버

• MINIMUM ESSENTIAL BENFITS• ADVANCED TAX CREDIT (2014)• TAX PENALITIES

OBAMACARE /AFFORDABLE CARE ACT 오바마 케어

Covered California Insurance Carriers보험 회사

1. Alameda Alliance for Health HMO Hospitals: 12 Physicians: 3,1002. Anthem Blue Cross of California EPO HMO Hospitals: 300 Physicians: 30,0003. Blue Shield of California PPO Hospitals: 223 Physicians: 22,0484. Chinese Community Health Plan HMO Hospitals: 9 Physicians: 3155. Contra Costa Health Plan HMO Hospitals: 10 Physicians: 5,0006. Health Net PPO HMO Hospitals: 204 Physicians: 44,0007. Kaiser Permanente PPO Hospitals: 35 Physicians: 14,2198. L.A. Care Health Plan HMO Hospitals: 35 Physicians: 1,0059. Molina Healthcare HMO Hospitals: 29 Physicians: 4,56810. Sharp Health Plan HMO SAN DIEGO ONLY Hospitals: 7 Physicians: 2,60011. Valley Health Plan HMO SANTA CLARA ONLY Hospitals: 4 Physicians: 99312. Ventura County Health Care Plan HMO VENTURA Hospitals: 6 Physicians: 17613. Western Health HMO 8 NORTH COUNTIES Hospitals: 15 Physicians: 3,000

1. Ambulatory patient services 의료 수송2. Emergency services 긴급 서비스3. Hospitalization 입원4. Maternity and newborn care 임신5. Mental health and substance use disorder services, including behavioral health

treatment 정신 건강6. Prescription drugs 처방약7. Rehabilitative and habilitative services and devices 재활 및 서비스8. Laboratory services 실험실 서비스9. Preventive and wellness and chronic disease management 예방 검진10. Pediatric services, including oral and vision care 소아 구강 및 비전 케어

MINIMUM ESSENTIAL HEALTH BENEFITS필수 보험

Product Framework for Exchange Plans보험

Plans sold before 3-23-2010 are grandfathered and they can remain on the current coverage or move if they like.

Plans sold after 3-23-2010 are non-grandfathered. These will be migrated into the “off exchange” precious metal plans.

IN

OFF

Coverage Category Bronze Silver Gold Platinum

Covers 60% avg. Annual Cost

Covers 70% avg. Annual Cost

Covers 80% avg. Annual Cost

Covers 90% avg. Annual Cost

Deductible $5,000 $2,000 0 0

Preventive Care Copay No Cost No Cost No Cost No Cost

Primary Care Visit Copay $60 for 3 visits $45 $30 $20

Specialty Care Visit Copay $70 $65 $50 $40

Urgent Care Visit Copay $120 $90 $60 $40

Emergency Room Copay $300 $250 $250 $150

Lab Testing Copay 30% $45 $30 $20

X-Ray Copay 30% $65 $50 $40

Generic Medicine Copay $19 or less $19 or less $19 or less $5 or less

High cost and infrequent services like Hospital Care and Outpatient Surgery

30% of your plan’s negotiated rate

20% of your plan’s negotiated rate

HMO Outpatient Surgery - $600 Hospital - $600/day up to 5 days

PPO – 20%

HMO Outpatient Surgery - $250 Hospital - $250/day

up to 5 daysPPO – 10%

Imaging (MRI, CT, PET Scans) 30% $250 $250 $150

Annual Out-of-Pocket Max for Individuals $6,350 $6,350 $6,350 $4,000

Annual Out-Of-Pocket Max for Families $12,700 $12,700 $12,700 $8,000

Tax Penalty for individuals 벌금 처벌

2014:Greater of $95 or 1% of taxable income

2015:Greater of $325 or 2% of taxable income

2016:Greater of $695 or 2.5% of taxable income

2017 and beyond:Annual adjustments

8

Annual Open Enrollment Period등록 기간

October 1st 2013 through March 31st 2014

October 15th 2014 through December 7th 2014

October 15th 2015 through December 7th 2015

October 15th 2016 through December 7th 2016

Marital Status Changes to marital status are a qualifying event, which allow the policyholder to make changes to his policy. This can include adding a new spouse or removing a spouse.

EmploymentAn employment status change in a policyholder's dependent or spouse allows changes to health insurance coverage. For example, if a spouse changes from a full-time employee to a part-time employee. Or loss of Group coverage.

ChildbirthThe birth of a child is a life event that allows the baby to purchase off AOE.

Change in EligibilityDependents may become ineligible for health insurance coverage after completing school or getting married.

Affordability My current plan has become too expensive.

Just moved to the state

Qualifying events to purchase “OFF” Open Enrollment

Making Care More Affordable세금 공제

Number of People in Your Household

Annual Household Income

Medi-Cal Premium Assistance

1 $0 - $15,856 $15,856 - $45,960

2 $0 - $21,404 $21,404 - $62,040

3 $0 - $26,951 $26,951 - $78,121

4 $0 - $32,499 $32,499 - $94,200

5 $0 - $38,047 $38,047 - $110,280

Household size 100% 138% 150% 200% 300% 400%

1 $11,170 $14,856 $16,755 $22,340 $33,510 $44,680

2 15,130 20,123 22,695 30,260 45,390 60,520

3 19,090 25,390 28,635 38,180 57,270 76,360

4 23,050 30,657 34,575 46,100 69,150 92,200

5 27,010 35,923 40,515 54,020 81,030 108,040

6 30,970 41,190 46,455 61,940 92,910 123,880

7 34,930 46,457 52,395 69,860 104,790 139,720

8 38,890 51,724 58,335 77,780 116,670 155,560

For each additional person, add $3,960 $5,267 $5,940 $7,920 $11,880 $15,840

FEDERAL POVERTY LEVEL CHART

Modified Adjusted Gross Income (MAGI) is calculated by adding back certain items to your Adjusted Gross Income. Your Adjusted Gross Income (AGI) can be found on line 38 of your Form 1040; line 22 of your Form 1040A; or line 36 of your Form 1040NR.

The following items must be added to your Adjusted Gross Income (AGI) to calculate your Modified Adjusted Gross Income (MAGI):

Traditional IRA contributions that were deducted. Student loan interest amounts deducted. Tuition and fees deducted. Domestic production activities deducted. Foreign income or housing costs excluded on Form 2555. Foreign housing deduction taken on Form 2555. Savings bond interest excluded on Form 8815. Adoption benefits from an employer excluded on Form 8839.

Modified Adjusted Gross Income (MAGI)Line 32 on your 1040 form

The big picture for individuals

• Every American not covered under a government plan will have three options for health insurance in 2014:

1. Get coverage through their employer if available

2. Buy an individual market plan through either:• The individual market exchange –

Purchaser may be eligible for subsidy• The off-exchange market

3. Go uninsured (will pay penalty unless they qualify for anindividual exemption)

QUESTIONS?