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Covered California Open Enrollment Period Begins November 1, 2016
The next Open Enrollment will run from Tuesday, November 1, 2016 - Tuesday, January 31, 2017.
Need Help to enroll. Please call John Pham 1-714-531-3637
OE3 Income Guidelines (PDF)
Open Enrollment & Health Plan (PDF)

John L. Pham (CA Lic. #0649378)
John Pham Insurance Services
14541 BROOKHURST STREET, SUITE C1
WESTMINSTER, CA 92683
Mobile: 1-714-553-2404
Tel. (714) 531-3637 * Fax (714) 531-3633
Email: johnpham@muabaohiem.com

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Insurance Broker/Agent
35 years of experience
License No. 0649378 Since 1982

14541 Brookhurst Street, Ste. C-1
Westminster, CA 92683
  Phone: (714) 531-3637
  Mobile: (714) 553-2404
  Fax: (714) 531-3633
  Email: johnlpham@yahoo.com
 

 
 
 
John Pham Insurance Services
14541 BROOKHURST STREET, SUITE C1
WESTMINSTER, CA 92683 License #0649378
Tel. (714) 531-3637 * Fax (714) 531-3633
Email: johnpham@muabaohiem.com
 
Get covered. Avoid Penalties.
Qualify for a Government Subsidy.
 
 OE3 Income Guidelines (PDF)
 
So what is Covered California? This is the name our state has given to the California Health Insurance Exchange. To help with the process of getting Americans covered, the Affordable Care Act ("ACA") required the creation of a special health insurance marketplace for each state known as the "Exchange".
 
In California, our Exchange is called "Covered CaliforniaTM". In order to qualify for a government subsidy, California residents must have an annual income that is below 400% of the Federal Poverty Level ("FPL") and be enrolled in a Covered California health insurance plan.
 
The Process: How do I get covered?
 
To enroll in a Covered California medical insurance plan, you'll have to wait until October 1, 2013. Currently, standard plans are available that will help you bridge the gap until January 1, 2014. If you are interested in getting coverage now, start by getting California health insurance quotes or give us a call at 1-714-531-3637. Once the California Exchange is up and running, we can calculate your subsidy, help you choose an affordable plan that fits your needs and your budget, and let you know if you qualify for additional cost sharing (better coverage at no extra cost).
 
The Mandate: What is required?
 
In 2014, all American citizens and legal residents must have health insurance, be exempt, be on a Grandfathered Health Insurance Plan or pay a penalty. This is often referred to as "The Mandate". You must have coverage in place that meets the minimum essential benefit requirements for at least 9 months in 2014. All Covered California health insurance plans will meet these benefit requirements. There will also be coverage offered outside the exchange that will meet these requirements.
 
The Subsidy: Will the government pay for my health insurance?
 
Not all of it! The government will not pick up the entire tab, but if you enroll in a Covered California health plan and depending on how much money you make, you may qualify for a subsidy that will cover a considerable portion of your monthly premiums. If you make less than 133% of the Federal Poverty Level, you qualify for Medicare or Medicaid. If you make over that amount but less than 400% of the federal poverty level based on your household income and number of dependents, then you will be eligible for an up-front subsidy (also referred to as a tax credit)1.
 
 
Basically, the government will pay for part of the premium and you will pick up the rest. The amount the government pays initially is dependent on your estimate of what your annual income will be. If at tax time the next year, it turns out that you made less money than predicted, then you will get a tax credit. If you made more, then your taxes will increase to make up for the government's overpayment on your subsidy. Whether or not you get a subsidy from the government is based on three things: your household income, number of dependents and you being on a Covered California exchange plan.
 
So what if I make more than 400% of the FPL? Why should I care? The reason you'll care is not so you can get a subsidy, but so you can avoid the penalty. In your case there's no carrot, but there is a stick, and the penalties get more and more severe as we get closer to 2017.
 
The Penalty: What if I don't get covered?
 
Whether or not you qualify for a subsidy, you will get a penalty if you do not have a health plan with the minimum essential benefits for at least 9 months out of the year in 2014. There are also some exceptions for those who are exempt or on a grandfathered plan2.
 
The penalties for not having qualified health insurance coverage start at the greater of $95 per person (capping off at 3 persons per household) or 1% of taxable household income in 2014 and go up each year after that until 2017.See chart below for more details.
 
Healthcare Reform Penalties for the Uninsured
 
* Note: The $95, $325 or $695 is per adult in the household up to a maximum of three people. For children, the dollar amount penalty is 50% of the adult penalty ($47.50, $162.50 or $347.50).
 
Due to the fact that penalties are lower at first, some California residents may opt to simply pay the penalty and go without health insurance coverage or get cheap coverage that doesn't meet the minimum essential coverage requirements. If your taxable income is $50,000, your penalty (at 1%) will be only $500 in 2014, but by 2016 it will go up to 2.5% or $1,250. At $1,250 per year, that is still only
 
Health Insurance Options in 2014
 
 
about $104 per month. If you compare that penalty with paying a theoretical $375 a month for a Covered California plan, it may make sense to just pay the penalty. You have 3 options and two of them involve a penalty: getting no insurance, getting cheap insurance (that doesn't meet the minimum essential benefits requirements) and enrolling in a qualified health plan. The qualified health plan does not have to be through Covered California to avoid the penalty, but it does have to be a Covered California plan in order to qualify for a subsidy.
 
Cost Sharing: If I make under a certain amount do I qualify for better benefits?
 
If you make under 250% of the Federal Poverty Level (about $59,000 for a family of four), you qualify for cost sharing. This means better benefits for you at the same monthly premium. For example, instead of paying a $40 doctor visit, cost sharing may lower your doctor visit copayment down to $10. The less you make the more cost sharing will save you at the point of service. The goal here is that people with low incomes won't feel too big of an ouch when they go to use the services that are provided by their California health care plan.
 
SHOP: The California Exchange for Small Business
 
Do you own a small business? As long as you have at least one employee on a W-2 who is a non-owner and a non-spouse of the owner, then you can get coverage through SHOP (Small Business Health Options Program). Some small groups of 24 or less employees will qualify for tax breaks of up to 35% in 2013 and up to 50% in 2014 if the small business meets certain criteria and purchases coverage through the SHOP. However, due to the fact that employee salaries must be low and employer contributions for health insurance must be high, most small business don't qualify for this tax credit.
 
However, there are other benefits to purchasing coverage through the California small business exchange (SHOP). If you want to offer coverage from multiple carriers, you can do that through the SHOP and still have only one bill for your California group health insurance. Prices will be the same on all California group health plans inside and outside of the SHOP; however, you may have more options outside the SHOP.
 
1 In order to be eligible for the tax credit/subsidy you must not be eligible for any government programs such as Medicare, Medicaid, the Children's Health Insurance program or military coverage and you must not work for an employer that offers health insurance coverage (unless the employer plan covers less than 60% of the cost of benefits).
 
2 If you enrolled on your current plan before March 23, 2010 and have not changed coverage, then you may have grandfathered status. However, not all carriers in California are giving the option to maintain grandfathered status. As of early 2013, California health insurance carriers that allow for grandfathered plan status include Kaiser Permanente, Aetna, Health Net, United Health Care and Sharp. Carriers that do not allow for grandfathered status in California include Anthem, Blue Shield, Western Health and CalChoice.
 
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