The Affordable Care Act in CA

by Karl on February 20, 2013[printfriendly]

In California, the organization responsible for the implementation of the Affordable Care Act (ACA) is Covered California ( On Wednesday, February 13, 2013 California became the first state to standardize health insurance plans under ACA.

ACA requires that plans be classified as bronze, silver, gold and platinum. California further is requiring insurers to set standardized deductibles and co-payments (see chart on page 2). There is no premium information yet but Peter Lee of Covered California expects those to be announced in June.

ACA requires plans to cover maternity, prescription drugs and accept all applicants regardless of preexisting medical conditions.

Implementation is scheduled to begin January 1, 2014. Millions of uninsured residents will be required to buy insurance or face fines. There will be tax credits available but only for plans purchased through Covered California. These credits will be applied at time of enrollment.

There will also be cost-sharing subsidies that will help to pay health care expenses at the time of medical care. Medi-Cal will also cover those under age 65 including people with disabilities and making less than $15,000 for singles and $31,180 for a family of four.

According to information from the California Department of Managed Health Care, if you have a Medigap plan (PPO) you will not be required to change this coverage. For those on long-term care Medi-Cal, Medicare is your primary health insurance, your Medigap is secondary and Medi-Cal is third. Medi-Cal allows a deduction from the monthly Share of Cost to pay the Medigap premiums. As of right now, this will not change.

But those with just Medicare and Medi-Cal (Medi/Medi’s) will have to enroll in a Medi-Cal HMO. Keiro ICF and Nursing Home will be enrolling those residents in Care More. Keiro South Bay has not a made a choice yet.

Switching gears, California was the first state to receive approval from the Centers for Medicare & Medicaid Services (CMS) to enact the Community First Choice Option. CMS will give California an additional $573 million in Medicaid (Medi-Cal) funds for two years. This pilot program will allow chronically ill people to receive services at home rather than a nursing home. In California this program is called In-Home Supportive Services (IHSS).

There is a lot happening, some good and some not good, to healthcare affecting all ages in California. If you are on our e mail list, you will get updates as they happen. If you would like to be added to our e mail list, please send an e mail request to

Karl Kim, CFP, CLTC is the President of Retirement Planning Advisors, Inc. and is a Medi-Cal specialist. His office is located in La Mirada, CA and can be reached at 714-994-0599 or at He has submitted over 1000 applications with a 99.9% success rate over the past twenty years. This is meant to be an educational article. Do not make any decisions solely on the information contained herein. Consult your tax advisor, financial planner and attorney before taking any action. We are not responsible for any inaccuracies or misinformation.

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