Obamacare


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ObamaCare is the unofficial name for The Patient Protection and Affordable Care Act (ACA) which was signed into law on March 23, 2010.   Some of the more important things in the Affordable Care Act (ACA) are:
34 states have opted for the health insurance exchange provided by the federal government.
  • The creation of a new Health Insurance Marketplace for individuals, families, and small businesses to get health coverage.
  • The requirement that insurance companies must cover people with pre-existing health conditions.
  • The inability for health insurance companies to arbitrarily cancel your health insurance just because you get sick.
  • The preservation of coverage on family plans for young adults under age 26
  • The end of lifetime and yearly dollar limits on coverage of essential health benefits.
California opted to create its own exchange called Covered California.  Covered California offers 4 plan tiers similar to the Federal Plan; Bronze, Silver, Gold & Platinum.  The plan summaries can be found below.
PLAN
Bronze 60
Silver 70
Gold 80
Platinum 90
(Benefits in Blue are Subject
to Deductibles)
(Copays in Black are Not
Subject to any Deductible
and Count Toward the
Annual Out-of-Pocket
Maximum)
www.hyehealth.com
Deductible
$5000 deductible for
medical & drugs
$2000 medical
deductible $250 brand
drug  deductible
no deductible
no deductible
Preventative Care Copay
(Deductible does not apply)
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
no cost
at least 1 yearly visit
Primary Care Visit Copay
$60
3 visits per year
$45
$30
$20
Specialty Care Visit Copay
$70
$65
$50
$40
Urgent Care Visit Copay
$120
$90
$60
$40
Generic Medication
$19
$19
$19
$5
Lab Testing Copay
30%
$45
$30
$20
X-Ray Copay
30%
$65
$50
$40
Emergency Room Copay
$300
$250
$250
$150
High cost and infrequent
services (e.g. Hospital Care)
30%of your plan’s
negotiated rate
20% of your plan’s
negotiated rate
HMO
Outpatient Surgery –
$600
Hospital – $600/day
up to 5 days
PPO – 20%
HMO
Outpatient Surgery
– $250
Hospital – $250/day
up to 5 days
PPO – 10%
Preferred brand copay after
Drug Deductible (if any)
$50
$50
$50
$15
Maximum Out-of-Pocket For
One
$6,350
$6,350
$6,350
$4,000
Maximum Out-of-Pocket For
Family
$12,700
$12,700
$12,700
$8,000
A Division of