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Young people benefit from Obamacare

Low-cost plan available

Cynthia E. Griffin | 10/18/2013, midnight

The 2010 Patient Protection and Affordable Care Act, (Obamacare) which goes into effect January 2014 and began enrolling people on Oct. 1, has a number of provisions that specifically speak to the health needs of adolescents and young adults.

Among the changes the law makes are:

• Children through age 18 cannot be excluded from coverage because of a pre-existing condition.

• Young people can stay on their parent’s/guardian’s health insurance plans until age 26.

• Beginning in 2014, young adults under age 30 will have the option of purchasing a minimum coverage or “catastrophic” health plan to satisfy the requirement that all individuals and families must have health insurance coverage beginning Jan. 1 or pay a penalty.

Californians may buy minimum plans if they are under the age of 30 or prove they are experiencing a hardship preventing them from buying even the lowest-priced conventional plan.

The plans, offered by all 13 insurers in the state, generally feature lower premiums and higher out-of-pocket ceilings. Minimum coverage is designed to meet the needs of younger people and low-income individuals in a hardship category, including those who can prove they would spend more than 8 percent of their income on conventional health insurance.

Minimum care plans meet all the requirements for health insurance coverage in the individual market and provide coverage for three primary care visits per year and preventive services. No co-payment is charged to the enrollee for these services. After that, the enrollee is responsible for paying for all visits or care, except routine preventive visits, up to an annual deductible of $6,350.

This option also offers preventative services such as blood pressure, diabetes and cholesterol tests; cancer screenings such as mammograms and colonoscopies; counseling on quitting smoking, losing weight, eating healthy, reducing alcohol use and depression; routine vaccinations; flu shots; well-baby and well-child visits for birth to age 21; birth control; and voluntary sterilization for women.

For a 25-year-old person, the premium for this plan could be as low as $148 per month without the subsidy, and even lower for those who qualify for a federal subsidy.

The catastrophic plan offered in the insurance marketplace covers three visits annually to a primary care physician and covers all free preventative benefits.

• The state has expanded Medi-Cal to cover all people with incomes below 138 percent of the federal poverty level, including independent young adults. Consequently, if you sign up in or before 2014, young adults under age 21 will also be eligible to receive the full range of Medi-Cal benefits. It also extends the Early and Periodic Screening, Diagnosis and Treatment services to those under 21.

• Medi-Cal coverage must also be provided for youth who are aging out of foster care until they reach age 26.

• People can claim a hardship exemption from the enrollment requirement under the following circumstance: you are/were homeless; you were evicted in the past six months or are facing eviction or foreclosure; you received a shut-off notice from a utility company; you recently experienced domestic violence; you recently experienced the death of a close family member; you experienced a fire, flood or other natural or human-caused disaster which caused substantial damage to your property; you filed for bankruptcy in the last six months; you have medical expenses you couldn’t pay in the last 24 months; you experienced unexpected increases in necessary expenses due to caring for an ill, disabled or aging family member, you expect to claim a child as tax dependent who’s been denied Medi-Cal and CHIP coverage, and another person is required by court order to give medical support to the child. In this case, you do not have to pay for the child; as a result of an eligibility appeals decisions, you are eligible for enrollment in a qualified health plan through Covered California.

Young people can go to the coveredca.com web site to sign up or call the information line at (800) 300-1506.