Federal Insurance & Medicare Reform FAQs
1. What is an exchange?
An exchange, as created under the Affordable Care Act (ACA), is a place where consumers can purchase subsidized health insurance coverage. Each state has an exchange, operated by either the federal government or by the state. In Irvine, there is a federally-facilitated exchange.
2. Who can purchase insurance from the exchange?
- Qualified individuals include U.S. citizens and legal immigrants who are not incarcerated and do not have other public coverage.
- While anyone can purchase, only certain individuals will have access to federal subsidies.
- The ACA also provides a separate Small Business Health Options Program (SHOP) exchange for small businesses (fewer than 50 eligible employees) to obtain health coverage for their employees.
- It is important to note that there are no subsidies offered through the SHOP.
3. What types of benefits will be offered?
Since 2014, every new plan sold to individuals and small group, both on and off the exchange must include a basic package of benefits, called Essential Health Benefits (EHB).
California EHB package consists of benefits in at least the following categories:
Ambulatory patient services,
Maternity and newborn care,
Mental health benefits and substance use disorder services, including behavioral health treatment,
Rehabilitative and habilitative services and devices,
Preventive and wellness services and chronic disease management, and
Pediatric services including oral and vision care.
4. How much will the Insurance cost?
- The cost will vary by type of plan, location, coverage level, age and tobacco use, number of family members and if applicable, your subsidy.
INSURANCE & SELF PAYMENT PLANS
We accept and work with many insurance companies including:
- Rocky Mountain Health Plans
- United Health Care
- Blue Cross/Blue Shield
- Colorado Choice Health/CHP
- Confinity Network
- Great West
- Tricare Standard
- Sloan’s Lake
Your health care is important to us
Whether you have insurance or are uninsured, we do require a form of payment the day of your medical visit. We offer payment plans should you require one. Know that nearly 30% of our patients are not insured and we will work with you to create a payment plan that works for you.
CONTACT US FOR YOUR HEALTH INSURANCE OR BOOK A PHYSICIAN FOR YOUR HEALTH BELOW