California Sets Benefit Standards for Health Plans in Exchange

On Wednesday, California became the first state to set benefit standards for health plans offered through its state health insurance exchange.


The Affordable Care Act requires states to launch online insurance marketplaces by 2014. California’s exchange — named Covered California — primarily will serve individuals and small businesses. The exchange is expected to open for registration in October.

In January, exchange officials told Gov. Jerry Brown (D) and the Legislature that health plans offered through Covered California will be classified by “metal ratings” — including platinum, gold, silver and bronze — based on the coverage they offer.

  • Platinum plans will offer 90% coverage
  • Gold plans will offer 80% coverage
  • Silver plans will offer 70% coverage
  • Bronze plans will offer 60% coverage

Plan members will have to pay out of pocket for the percentage not covered by the plan.

Details of Standardized Rates

  • Platinum and gold plans will have no annual deductibles and will charge as low as $25 for physician office visits
  • Silver plans will have $2,000 in annual deductibles and will charge $45 for physician office visits
  • Bronze plans will have $5,000 in annual deductibles and will charge $70 for physician office visits

Monthly premiums will vary, based on the plan chosen and the income level of the policyholder. For example, a family of four with an income between $22,000 and $35,000 annually would pay between $39 and $118 each month for a silver plan.

Tax credits are available for individuals and families who meet certain income requirements and do not have access to affordable health insurance through their employer or another government program.

There are some key facts about tax credits.

Tax credits lower the cost of your premium. Tax credits reduce the amount of the premium you will pay for insurance

Tax credits help low- and middle-income individuals and families. Tax credits are available to individuals and families who meet certain income requirements.

Tax credits can be used when you enroll. Tax credits can be applied to the cost of your health plan when you enroll – you do not need to wait until you file a tax return at the end of the year.

Tax credits are only available through Covered California. You must enroll in a health plan through Covered California if you want to use your tax credits.

Tax credits are paid directly to your health plan. These tax credits are paid by Covered California to your health plan to keep your costs low.

Tax credits will be adjusted at the end of the year based on your actual income. At the end of the year, the tax credits may be adjusted if your income is different than you anticipated. This means that you will want to notify Covered California if your income changes.

*Modified from a California Healthline and website



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