A Few Q & A’s on the ACA

Q: I’m currently on Medicare but pay out of pocket for a Blue Shield  supplement policy. Will insurance companies offer Medicare supplement policies and prescription drug policies on the new health insurance exchange?

A:  No, you won’t be able to buy Medicare plans through Covered California, the state’s health insurance exchange. Covered California specializes in private insurance policies for individuals, families and small businesses. It does not sell plans for government-sponsored health programs like Medi-Cal or Medicare.  On  Oct. 1, 2013 — Covered California will begin offering 12 health plans across the state (not all in each region), with coverage to begin on Jan. 1.   Individuals and families who earn between 138 percent and 400 percent of the federal poverty level will be eligible for sliding-scale tax credits to purchase those plans.


Medicare recipients will have to look outside the exchange for policies, much as you do now.

For Medicare Plans  I suggest searching the “plan finder” on Medicare.gov if you’re looking for Medicare Advantage or prescription policies. If you want Medicare supplement insurance — also called Medigap — she points to California’s Department of Insurance website: www.insurance.ca.gov

Medicare open enrollment runs from Oct. 15 through Dec. 7.


Q: Will Covered California offer plans for dental and vision for adults? I’m 25, and I’m thankfully on my parents’ health insurance for another year, but I’m currently without dental or vision coverage through my job.

A: Under the new health law, all health plans sold to individuals and small businesses must include coverage for 10 categories of services, including emergency care, hospitalization and prescription drugs. These categories are known as “essential health benefits.”

I’m sorry to say, but vision and dental care for adults are not among them.

As a result, Covered California will not be offering dental and vision coverage for adults. That also means you cannot receive tax credit assistance for dental and vision coverage, even if your income qualifies, says Covered California spokeswoman Anne Gonzales.

Covered California may consider linking Californians who shop for its medical plans to adult vision and dental plans elsewhere, but that idea, Gonzales says, is still just that.

So, if you really want dental and vision coverage, you’ll have to buy the policies separately and off the exchange.

Q: What about dental and vision coverage for children?

A: For children, on the other hand, dental and vision coverage are considered “essential.” That means they must be offered by Covered California.

Children’s vision services will be embedded in medical plans (but not all) sold by Covered California, Gonzales says.

Dental is another matter and has been the subject of significant debate. I won’t get into the drama here, but suffice it to say that many children’s advocates are frustrated.


In short, Covered California decided that children’s dental plans will not be embedded in medical plans. They will be sold separately by the exchange and will be offered by five insurance companies.

Depending on the plan and your region, premiums will range from $10 to $30 a month per child. The rate maxes out at three times the single premium, so if you have more than three kids, that’s the most you will pay, Gonzales says.

And even though they’re considered essential health benefits for kids up to age 19, families won’t be required to buy them.

Theoretically, some families may have tax credit dollars left over from buying medical plans to apply toward children’s dental plans, but that’s not likely to happen often, Gonzales says.

Eileen Espejo, health policy director for Children Now, says the children’s dental contracts only last a year and that she and other advocates will push for dental plans to be embedded in medical plans in the future.



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