ASK EMILY NOW
If you’d like to submit a query, email AskEmily@usc.edu. To see an index of past questions, read Bazar’s column at www.centerforhealthreporting.org.
Its debut has been touted for months, and on Oct. 1, the Affordable Care Act — aka Obamacare — officially begins taking applicants, with coverage set to begin Jan. 1. Now, as residents try to wade through the intricacies of Covered California, USC’s Center for Health Reporting is running a biweekly column to explain the health-reform overhaul and how it affects consumers.
I’m currently on Medicare but pay out of pocket for a Blue Cross supplement policy. Will insurance companies offer Medicare supplement and prescription drug policies on the new health insurance exchange?
You will not 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.
Medicare recipients will have to look outside the exchange for policies — much as you do now.
Elaine Wong Eakin, executive director of the Medicare advocacy and education group California Health Advocates, has some tips. She suggests searching “Plan Finder” on medicare.gov if you’re looking for Medicare Advantage or prescription policies. If you’re seeking Medicare supplement insurance — known as Medigap — she points to California’s Department of Insurance website, www.insurance.ca.gov
Medicare open enrollment runs from Oct. 15 through Dec. 7.
Will Covered California offer plans for dental and vision for adults? I’m 25 and thankfully on my parents’ health insurance for another year, but I’m without dental or vision coverage through my job.
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 that 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 are not able to receive tax credit assistance for dental and vision, even if your income qualifies, said 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 said, 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.
What about dental and vision coverage for children?
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 sold by Covered California, Gonzales said.
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 but rather sold separately by the exchange and offered by five insurance companies.
Depending on the plan and your region, she said, 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.
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 noted.
Eileen Espejo, health policy director for Children Now, said 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.
“There will be changes coming in 2015,” she said.
For more information, go to Covered California’s website, www.coveredca.com.