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What San Diegans Need To Know About California’s Health Care Exchange

Aired 7/18/13 on KPBS Midday Edition.


Gary Rotto, Director of Health Policy and Strategic Communications at the Council of Community Clinics

Jeannette Shay, Director of Government and Community Relations at Family Health Centers of San Diego


President Obama today countered criticism of his health reform law from Republicans, saying insurance companies are sending half a billion dollars in rebates to some 8.5 million people.

In spite of efforts in Washington DC to delay the start date of the reforms, in California, the new health insurance exchange, Covered California, is in place. The date when those who are uninsured can start signing up, is barreling towards us but few people know exactly what it will mean for them.

Special Feature Obamacare Explained: A Guide For Californians

From KQED News and The California Report

Covered California will begin enrolling individuals for health coverage on October 1. This week the health exchange started training 2,000 workers who will help people with enrollment.

To help you get the answers to key questions we spoke to two San Diego health care professionals: Gary Rotto, Director of Health Policy and Strategic Communications at the Council of Community Clinics and Jeannette Shay, Director of Government and Community Relations at Family Health Centers of San Diego.

What happens on October 1?

Covered California will open their website for pre-enrollment. Individuals and families who are uninsured can find out if they are eligible to enroll in the health insurance exchange or in Medical. Enrollment will continue through March 31, 2014.

Who's eligible to buy health insurance under the exchange?

Legal residents who don't have health insurance through an employer, or who are not eligible for Medical. Officials estimate about 5.3 million people are eligible for insurance in Covered California.

Who's eligible for a tax credit, subsidy?

Officials estimate that up to 15,000 San Diegans will be eligible for a subsidy in the first year of the health exchange. Tax credits are available for individuals and families who meet certain income requirements. Those who make between 138 percent and 400 percent of the federal poverty level may be eligible for a tax credit. Covered California estimates about 2.3 million California residents will be eligible for a tax credit or subsidy.

There's also Medi-Cal assistance. California is expanding Medi-Cal under the Affordable Care Act starting in 2014. Health coverage will be free for those under the age of 65 who earn less than $15,000 for a single individual and $31,180 annually for a family of four. Previously single adults were not eligible for coverage under Medi-Cal.

How many health plans do I have to chose from?

Covered California has approved 13 health plans. San Diegans will have 6 insurance companies to choose from. Blue Cross, Blue Shield, Health Net, Kaiser, Molina and Sharp Health Plan.

What medical services do the health plans cover?

The plans cover 10 essential benefits, ambulatory patient services, emergency services, hospitalization, maternity new born care mental health substance abuse prescription drugs, rehabilitation services, laboratory services, preventative and wellness, chronic disease management and pediatric services. Coverage for dental and vision is still being worked out.

How much will it cost?

What you pay will depend on which plan you buy and whether you are eligible for tax credits or subsidies. There are also four levels of coverage: Platinum, Gold, Silver and Bronze. The higher the metal category the higher percentage of medical expenses that a health plan will cover.

Covered California has an online calculator to help you find out your potential insurance cost.

How much is the penalty if I don't buy health insurance?

In 2014, the penalty will be 1 percent of annual income or $95, whichever is greater. You will have to pay the penalty when you file your taxes at the end of the year. But the penalty will become increasingly more expensive after the first year.

If you have a specific question about the Affordable Care Act you can submit it here.

Follow our weekly Q-and-A series, Second Opinion, where our Speak City Heights reporter Megan Burks answers questions from San Diegans on the Affordable Care Act.

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Avatar for user 'beachcomber'

beachcomber | July 18, 2013 at 12:28 p.m. ― 3 years, 8 months ago

As a senior on Medicare, is there any way I can sign up for a dental plan?

I estimate that I would have to spend $5000/year to go to a California dentist so I get my work done in Mexico which brings it down to around $1000/year. However, if I could afford it I would prefer to patronize my local dentist.

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Avatar for user 'Megan Burks'

Megan Burks, KPBS Staff | July 18, 2013 at 6:26 p.m. ― 3 years, 8 months ago

Hi beachcomber, thanks for reading and commenting! We're doing a weekly series where we take reader questions on the Affordable Care Act, work with experts to find the answers, and present the answers on the air and website. Email me at if you'd like to participate.

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Avatar for user 'GarySDClinics'

GarySDClinics | July 19, 2013 at 3:30 p.m. ― 3 years, 8 months ago

There were a few points that I made which may need clarification:
1. We believe that there are 190,000 to 220,000 resident of San Diego County who would be eligible to buy insurance through Covered California and receive a subsidy (tax credit or premium reduction).
2. Anyone who does not have insurance (or the cost of insurance provided by their employer exceeds 9.5% of their gross income) may apply to purchase coverage through Covered California.
3. The figure of 30,000-60,000 people is an estimate of the number of San Diegans who will purchase insurance through Covered California in the first year. This number will go up during the 2nd Open Enrollment period (late 2014) as more people learn about the Health Insurance Exchange (Covered California)
4. Currently, some insurance companies have up to five age categories. Covered California will reduce these “age bands” to three. And the cost of coverage for folks in the older age band cannot be more than 3 times that of the youngest age band. Currently, there are seven age bands.
5. The Individual mandate is still in effect. There are limited exemptions from the mandate to have and keep health insurance coverage
a. If available cost of coverage 8% of household income
b. If household income is below tax filing threshold ($10,000 for an individual/$20,000 family)
c. Some very limited religious objection
d. Undocumented immigrants (Also, they are prohibited from buying into Covered California or any state exchange even paying full price)
e. Incarcerated persons
6. The penalty for not having health insurance is
a. $95 or 1% of income (whichever is more) in 2014
b. $325 or 2% of income in 2015
c. $695 or 2.5% of income in 2016 (and subsequent years)

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