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Health Care Reform - How it can Help You.

Member news | Monday, April 14, 2014

New Health Coverage Options

While open enrollment through Covered California is now closed until the fall, the Affordable Care Act may still help you or a family member get coverage in 2014 through:

  • Medi-Cal Expansion:Starting January 1, 2014, the eligibility requirements for adults changed. If you are 19-65 years old, you may now qualify for Medi-Cal if you earn less than 133% of the federal poverty level (currently $15,521 per year for a family of one; $31,720 per year for a family of four). Contact the Santa Clara County Social Services Agency to apply at 1-877-96-BENEFITS or 1-877-962-3633, or
  • Covered California:If you or someone in your family is not eligible for Medi-Cal or Healthy Kids, you may be able to purchase affordable coverage through the state operated health coverage marketplace, called Covered California. Open Enrollment through Covered California is closed until fall, but you may still be able to apply through Special Enrollment.

For legal residents of California, Covered California helps you compare and choose a health plan that works best for your health needs and budget. You can't be turned down because of a pre-existing condition (like diabetes or asthma), and rates won't be higher because of a pre-existing condition.

Residents can shop for health insurance online, over the phone, or in person. Certified Enrollment Counselors are available to assist you at agencies throughout the county, including County Social Services and Valley Medical Center. The counselors can educate you about health care options and guide you through the enrollment process. You can also find a local Certified Enrollment Counselor and obtain one-on-one assistance through Santa Clara County Health Connection or by calling Community Health Partnership at 1-408-556-6605.

There are five options for health insurance available through Covered California for people who live in Santa Clara County, including the County's Valley Health Plan. Other local carriers for Covered California include Anthem, Kaiser Permanente, Blue Shield, and Health Net.

Through Covered California, you may be eligible to receive financial assistance to make health care more affordable. Some residents insured through their employers may also qualify for subsidies to cover their dependents if their employer-offered plans do not meet certain affordability criteria. The amount of any financial assistance is determined on a sliding scale, which means the lower your income, the more help you may receive.

If you or family members are already enrolled in Medi-Cal, Healthy Kids, or a plan offered by your employer, nothing changes for you. Just make sure you complete your renewal forms on time and continue to pay your premiums on time, if you have premiums.

For your health and for your peace of mind, take advantage of these new options to get health coverage. And tell your friends and family members so they can apply.

Coordinated Care Initiative
The Coordinated Care Initiative (CCI) includes two programs:

  • Managed Long Term Services and Supports – for eligible Medi-Cal beneficiaries 21 and older
  • Cal MediConnect – for beneficiaries with both full Medicare and full Medi-Cal

The CCI brings your health care and your Long Term Services and Supports into one plan so your benefits and services work better together. Beneficiaries continue to receive all the benefits they receive today, plus more.

If you receive Medi-Cal only, read this flier from the Aging Services Collaborative for more information about the changes, timing and notices:

If you have both Medicare and Medi-Cal, read this flier from Sourcewise for more information about the changes, timing and notices:

For resources in Santa Clara County for beneficiaries with Medi-Cal only, and for beneficiaries with both Medicare and Medi-Cal, read this Sourcewise Resource List:

For information on Santa Clara Family Health Plan's Cal MediConnect plan that will begin January 1, 2015, click here.