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Healthcare Reform

The Patient Protection and Affordable Care Act (ACA), otherwise known as federal healthcare reform, was passed by Congress and signed into law by President Obama on March 23, 2010. The California Department of Insurance, as the regulator of the health insurance industry, has a significant role in the implementation of the law and is working with State and Federal agencies to ensure that reforms both expand coverage and protect consumers.

How will health care reform affect me?

In California, consumers already have new rights under the health care reform law. For example, most policies now let you keep your children on your insurance until age 26. Insurers can't deny children coverage because they have an existing health condition.  And as long as you fill out the application honestly, your health insurance cannot be rescinded, cancelled or not renewed just because you get sick. Many policies now provide preventative services, such as immunizations and mammography and many other cancer screenings, with no out-of-pocket cost to you.

Below is a list of insurance reforms that are already in place and more reforms coming in 2014:

Reforms Already in Effect Reforms Coming in 2014
  • No cancellation, rescission or nonrenewal of your policy when you become sick.
  • Children under age 19 cannot be denied coverage because of their health status, nor can their coverage be delayed due to a pre-existing condition.
  • No more lifetime limits on essential health benefits.
  • Annual limits on essential benefits are also ending. This year insurers can cap these benefits at $750,000 per year.  In 2013, insurers can cap these benefits at $1.25 million per year and after that insurers cannot cap your limits on these benefits at all beginning January 1, 2014.
  • No charge for preventive care such as mammograms, vaccinations, well-child care, contraception and many health screenings.*
  • You don't need to get a referral for pregnancy and other gynecological care, as long as the provider is in your network.*
  • Generally, children can stay on their parents' policy until age 26, as long as the policy offers dependent coverage.*
  • Your rates cannot be based upon your gender.

 

* There are certain exceptions for 'grandfathered' plans - plans that existed before the passage of the ACA.

  • A health insurance company cannot deny you coverage based upon your health status (such as pre-existing medical conditions). In addition, a health insurance company cannot delay your coverage if you have a pre-existing condition.
  • No annual limits on essential health benefits.
  • Medi-Cal coverage will expand to include more low-income Californians.**
  • Millions of Californians will be eligible for premium subsidies from the federal government to help them pay for their health insurance coverage. There will be tax credits available for small businesses as well.
  • The California Health Benefits Exchange opens a one-stop shop where you will be able to shop for and buy insurance. Visit The California Health Benefits Exchange for more information.
  • Your health care premiums can only be based upon where you live, your age (with limitations), and the number of people on your policy.

 

 

** California will expand Medi-Cal coverage to include all individuals under 133% of the federal poverty level.


Other Important Insurance Reforms

Healthcare reform also requires that insurers spend between 80 to 85% of your premium on actual medical expenses. If the cost of administration and/or profit exceed these amounts, consumers will receive a rebate check for that amount. The Department monitors these costs.

The California Department of Insurance reviews all proposed insurance rate changes. While the Department does not have the authority to reject rate changes, our experts review "rate filings" and determine whether the rate change is reasonable or unreasonable. The Department makes each rate filing available to the public.

Contact the California Department of Insurance

The California Department of Insurance is the state agency that regulates the insurance industry and protects the rights of insurance consumers. We can help you better understand your health insurance and we can help you if you have a problem or want to file a complaint against an insurer.

Other Healthcare Reform Resources:

Federal Healthcare Reform Information Learn more about the Federal Affordable Care Act.

California Health Benefits Exchange Find out the latest information about the California Health Benefits Exchange and its mission for California.

Frequently Asked Questions (FAQ)

California Consumer Assistance Program Help with health plan grievances and appeals and information about Health Care Reform in California.

California Consumer Assistance Program Partnerships Local help with health plan grievances and appeals and help for the uninsured to find and obtain health coverage.

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