Affordable Care Act and California

When it comes to health insurance, California is trying to have at least access to basic health care services in place for its residents.

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California Offers Great Packages

Certain things are very difficult to understand, particularly health insurance. In terms of health insurance, California does its best to make sure people understand as much as they need to. However, the figures don't lie and shows us that 15.3% of the country remains uninsured. The other 84.7% have plans from a variety of locations, such as employers, Medicare, Children's Health Insurance and so on. Health insurance in California as a concept is not that difficult to understand. Basically, you pay a monthly rate to a provider and if you fall ill or need medical help, this provider pays a percentage of the costs you have incurred. Unfortunately, there is a big issue with people who are under-insured. In fact, 35% of those who do have insurance in place don't have sufficient coverage. California is making great strides in ensuring that all people have adequate health insurance.

The Affordable Care Act

Recently, a lot of changes have been made through Congress' legislation. This bill, known as Obamacare, has turned into one of the most difficult to understand pieces of legislation. There is no need for anybody to understand all of the 2,000 pages of the bill, but understanding the basic process and how it affects them is important. When it comes to health insurance, California is trying to have at least access to basic health care services in place for its residents. Obamacare was passed in March of 2010. This was the biggest change in decades that the country has seen in its health care system. Unfortunately, politicians being politicians, real decisions couldn't be made. Hence, the bill turned out to be 2,000 pages long with very little compromise for everyday Americans. The idea behind it was good: the cost of health care for Americans was too high. Hence, a pool was set up for high-risk people and employers are obliged to offer health insurance. Hence, so long as you are employed, you will have healthcare. If you are unemployed and can't afford healthcare, it will also be provided for you. In terms of insurance California is following the rules set out in the bill completely. However, people have fears that it isn't working properly. Some California residents fear that there will be rationing on care. They also worry that small businesses and middle class families will end up not being covered. There is also a worry about increased taxes.

Health Insurance Categories

There are three main categories of health insurance. The three categories are private insurance, public insurance and uninsured. California is working towards eliminating the category of uninsured. Within these categories, there are sub categories. As stated, the idea is that nobody is completely uninsured as even those people that don't have insurance should be able to receive some level of care. Private health insurance is the most commonly found type of insurance. 59.3% of insured Americans have private health insurance. This is generally through the coverage packages offered by an employer. This group coverage pool is a very efficient way to provide care for people with a common denominator - the employer. Usually, a group pool is cheaper since it is not based on any risk. The rate varies on a person-to-person basis. California health insurance companies premiums depend on a number of factors, including age and preexisting medical conditions. The benefits from the package stay virtually the same for each person. To provide better care for employees who have health insurance California encourages employers to also cover spouses and children in the packages that they offer. It is also possible to have an individual plan outside of your employer. In this case, you are responsible for finding the best insurance package yourself, through California health insurance brokers, and deciding yourself which package is best for you.

Different Health Insurance Plans

There are different health insurance plans available. The two most commonly found plans are the indemnity plans and the fee-for-service plans. The lines that differ these two are very blurry. Basically, anybody is allowed to choose their own medical provider and can have input in the treatment they receive. The bill is then paid by the individual and claimed back - in part - from the insurance company. Managed care plans are also popular and basically include a flat rate that has to be paid based on theoretical service. With these plans, all you pay is a monthly rate and your medical bills are completely paid for. These plans are often more expensive. Health insurance companies in California offer two main types of managed care plans. These are the PPOs (Preferred Provider Organizations) and the HMOs (Health Maintenance Organizations). HMO means that you will be allocated a health facility and doctor and these will be paid by your insurance. With PPOs, however, you are able to visit other physicians too, although this may mean that your insurance provider will not pay for the care. However, you are likely to be able to find out details before you opt for a certain physician.

Benefits And Restrictions

There are four main benefits for private plan holders: basic provisions, riders, major medical and hospital surgical benefits. Hospital surgical benefits mean that any inpatient services you require are being covered. Basic provisions only include your ambulance, certain tests, oxygen and small treatment. Major medical is for both in and outpatient care and is fully comprehensive. Lastly, the rider is an add-on that people get for their prescriptions, prosthetics, glasses and so on. Naturally, in terms of health insurance, California also has restrictions. Each individual plan has its individual restrictions, but there are some that seem to be quite universal. Deductibles are one example. This is the amount that you have to pay before your insurance company starts paying. Depending on your plan and carrier, the deductible amount varies. Another restriction is co-pay. Co-pay is what you pay your insurance company every time you use a medical service. These are in place to make the process of private insurance more efficient. Other restrictions tend to be in place to make sure people don't visit the hospital unless they really need to. For instance, a treatment has to be medically necessary or the bill will not be paid. Health insurance plans in California are always subject to statistical analysis. One big restriction is on preexisting conditions, which is a highly politically charged subject, as many insurance companies will charge more or refuse insurance for people who already have a medical condition.

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