Come Oct. 1, more than 5 million Californians will be eligible to purchase health plans from competing companies as part of a federal health care reform package known as the Patient Protection and Affordable Care Act.
California was the first state to create a health benefit exchange and in May, Covered California, a five-member board appointed by Gov. Jerry Brown and state legislators, unveiled the 12 health insurers who have agreed to be part of the marketplace, including the state's largest such as Anthem Blue Cross, Blue Shield and Kaiser Permanente.
Since then, Californians have been able to view and compare costs under tiered policies known as the "precious metals plans." They include Bronze, Silver, Gold and Platinum -- each providing different levels of out-of-pocket costs, based on income. The plans listed are for individual coverage.
Covered California's executive director Peter Lee has said his goal is to make buying an insurance policy "as easy as buying a book on Amazon."
And it has to be that easy because if California succeeds in enrolling a large swath of the uninsured by Jan. 1, the Affordable Care Act will succeed in America, experts have said.
"There hasn't been a comprehensive reform like this since Medicare and Medicaid's creation, so I would say Oct. 1. -- the beginning of open enrollment -- and Jan. 1 -- the beginning of Medi-Cal and Exchange coverage -- will be a big milestone in reaching universal coverage," said Dylan Roby, assistant professor of health policy and management at the UCLA Fielding School of Public Health.
Of the 5.3 million Californians eligible for coverage under Covered California, roughly 2.6 million may be eligible for tax subsidies to help pay for health care coverage. Those subsidies will be available for individuals earning up to $46,000 and for families with incomes of up to $94,200. Although consumers can purchase insurance directly from brokers, only those who go through the exchange are eligible for the subsidies.
Range of plans available
In Los Angeles County, for example, an estimated 780,000 are eligible for subsidies through the exchange. In San Bernardino County, at least 341,000 people qualify.
For those who don't qualify for subsidies, Covered California provides a rate chart so that those who live in Southern Los Angeles County, who are 40 years old, for example, can consider a range of plans offered by Health Net, Anthem, Molina Healthcare, L.A. Care, Blue Shield and Kaiser Permanente.
At the Platinum level, a consumer can pay from $311 to $429 a month. Under the Bronze level, the range would be $204 to $301. The Platinum level provides the lowest deductible and co-pays, but it comes with higher premiums. In contrast, the Bronze plan includes a higher deductible but a significantly lower premium.
All plans cover the 10 basic health benefits, including ambulatory care, hospitalization, prescription drugs, laboratory services and pediatric care.
But Roby also said those who already carry insurance shouldn't be fooled into thinking they can't buy on the exchange. He said a message that pops up on the cost calculator on the Covered California site is misleading.
"The cost calculator is really good and is easy to navigate with the actual premium and the subsidy premium presented in a clear way," Roby said.
"My one problem with their cost calculator now is that it states: 'Before you get started: If you currently receive affordable health insurance through an employer or public program, unfortunately, you can't buy insurance through Covered California. Covered California is primarily designed to help individual Californians get coverage, many of whom will get financial help'."
That is technically incorrect, Roby said.
"While people who are offered affordable coverage through an employer or Medi-Cal are not allowed to use subsidies to buy coverage, they and everyone else except the undocumented are allowed to purchase coverage through the exchange at full price," Roby said.
"Given the excellent prices and value plans available in the exchange, it may be an option for people who are offered coverage they don't like or want through their employer."
Plenty of information available
To help people better understand the exchange, Californians for Patient Care, a nonprofit organization that works to help people find access to health care, has compiled a guide called "Healthcare Coverage 2014: Five Things Californians Should Know" on its website, Calpatientcare.org.
Consumers need to be prepared and to anticipate and assess their health needs before buying, said Carmella Gutierrez, president of Californians for Patient Care.
"Do they have chronic health needs? Will they have children? Is there a hospital or provider that they prefer?" she said. "It's important to prepare all those needs."
And she said people need to understand their budget limitations.
"People are going to have to budget for an ongoing expense," Gutierrez said. "We want to educate people to what those costs will be."
Gutierrez also recommends that consumers have documents, such as income tax returns, ready before they fill out information.
"The biggest fear that people have is that they won't be able to afford insurance," Gutierrez said. "What we want people to do is to go on CoveredCA.com, view the calculator icon, get a rough estimate."
When it was signed into law by President Obama in 2010, the Affordable Care Act included several provisions that would protect Americans, including prohibiting insurance providers from rejecting clients for pre-existing illnesses. It also allowed parents to include their children up to age 26 on their health insurance policy.
For nearly half the population there aren't a lot of changes coming to their health coverage because of the Affordable Care Act, said Nicole Evans, spokeswoman for the California Association of Health Plans.
"If they have government coverage like Medicare, Medi-Cal, if they work for the government, there are not a lot of changes for those programs," she said.
But there is no guarantee premiums won't rise, she and others have said, and that has to do with the cost of medical care.
"What we still need to address is affordability," Evans said. "The underlying medical costs that drive up premiums hasn't been addressed yet. There's lots of advances in technology used in hospitals. These are among many factors driving up medical casts. Premiums need to reflect the cost of care. As the cost of care increases, the premiums need to reflect that."
Patrick Johnston, president and CEO of the California Association of Health Plans, has praised Covered California and participating insurers, but has also said that while many people are going to see a lower premium and help with subsidies, there will be those who will see some increases, especially younger people who don't visit doctors as frequently. They offset the costs from older patients who need health care more.
"The Affordable Care Act is a balancing act, seeking to spread costs by enrolling the young and old, sick and healthy, lower and higher income earners," Johnston has said. "The subsidies will also enable many Californians to pay less for more extensive coverage than they had before."
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