With the passing of the Affordable Care Act, Americans were required to purchase some form of health insurance, or face a tax penalty. Options for health insurance were made available through each state’s online marketplace. However, the question often arises, “do I need health insurance if I have Medicare or Medi-Cal?”
What is the Affordable Care Act?
The official name for the health care act is the Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) for short. It was signed into law in 2010, as a means of health care reform. The purpose of the act is to provide more Americans with access to affordable, quality health insurance, while reducing the steady increase in health care spending in the United States.
The purpose of the Affordable Care Act
The Affordable Care Act essentially expands the affordability, quality, and availability of private and public health insurance, through various means. What the Affordable Care Act does not do, is replace private insurance, Medi-Cal or Medicare. Nor does it regulate your health care, but instead it regulates health insurance practices in order to better protect consumers.
Does everyone have to purchase health insurance?
If elderly, disabled or low-income individuals qualify for Medi-Cal or Medicare they may not be required to purchase health insurance. Medi-Cal is the health insurance program, run by each state, which provides coverage for individuals, families, children, and people with disabilities under the age of 65. Qualification for this program is based on income and family size. If you are already covered by Medi-Cal, there is no need to purchase additional health insurance.
Medi-Cal qualification requirements and benefits
Many states have expanded the Medi-Cal coverage they offer to individuals with higher income levels. For instance, an individual making up to $15,800 or a family of four with income up to $32,500 a year, can qualify for Medi-Cal. Generally, Medi-Cal benefits include inpatient hospital services, X-ray and laboratory services, and physician services.
Medicare qualification requirements and benefits
Medicare, unlike Medi-Cal, is a federal health insurance program, only available to individuals who are age 65 or older or suffering from a disability. Like Medi-Cal if you are covered by Medicare, you are not required to purchase health insurance. One requirement to be qualified for Medicare is that either you or your spouse worked at a Medicare-covered job for at least 10 years and you are at least 65 years old. Medicare has different “parts” which provide different services. For instance, Medicare Part A covers inpatient hospital care as well as hospice care. Medicare Part B covers outpatient care, medical equipment expenses, health care provider services and some preventative screenings, which have been expanded under health care reform.
If you have questions regarding the Affordable Care Act, or any other Medi-Cal planning needs, please contact the Schomer Law Group either online or by calling us at (310) 337-7696.