With the availability of supplemental health insurance plans, increased access to care, and increased financial assistance, getting health insurance has never been more affordable.
Shopping for health insurance for 2024? It's a good idea to learn about the new rules and regulations and how to get or keep coverage. Here's what you need to know.
More health plans to choose from through Covered California
Covered California's pool of quality health insurance companies continues to grow, offering even more affordable branded plans for you and your family. Inland Empire Health Plan has joined Covered California, providing more choices for consumers in Riverside and San Bernardino counties. Aetna CVS Health, which first joined in 2023, will begin offering plans in Contra Costa and Alameda counties. In addition, Health Net will begin offering coverage to residents of Imperial County. As a result, there will be a total of 12 insurance companies across the state from which to choose. All residents will have at least two options, and more than 90 percent of consumers will be able to choose from four or more insurance companies.
More financial aid through Covered California
Beginning in 2024, California state taxes collected under the individual mandate will be used to lower the cost of health insurance for those enrolled in Covered California. These state subsidies are in addition to existing federal financial assistance, which together make health insurance more affordable than ever before!
Approximately 650,000 Californians will be eligible for these new subsidies (known as cost-sharing reductions). This financial assistance will not only allow them to waive deductibles, but also reduce costs for prescriptions, emergency care, and doctor visits. These government subsidies are expected to increase in future years.
Medi-Cal for everyone, regardless of immigration status
Beginning in 2024, all Californians, regardless of immigration status, can enroll in Medi-Cal if their income qualifies. Over the past few years, Medi-Cal has been expanding coverage to include undocumented immigrant adults. Californians under age 26 have been receiving this coverage since 2020. On January 1, 2023, these benefits became available to eligible adults between the ages of 26 and 49. And starting this year, Medi-Cal is extended to all eligible low-income adults age 50 and older. This is just one of the many ways the state continues to invest in the overall health of its residents.
Medi-Cal discontinues asset limit reporting
In the past, some Medi-Cal programs, such as Medi-Cal for people age 65 and older or people with disabilities, took into account both your income and your assets when determining your eligibility. These included bank accounts, real estate, vehicles, and more. As of July 2022, the state of California began phasing out the asset test, and as of this year, eliminated it altogether. Historically, the test required people to spend down their assets - selling a car or house - before receiving assistance under Medi-Cal for the elderly and disabled, Medicare Savings and Long-Term Care programs. Now, people with qualifying income will be able to access these vital benefits regardless of assets. Keep in mind that while owning property itself is not counted, any income paid to you for the use of property, such as rent, is still counted.
Greater access to health services
Consumers suffering from limited access to providers and the associated unanticipated costs of out-of-network treatment will soon have more options. Starting in 2024, health plans must offer at least one substance use disorder treatment center and one mental health facility in each county within the health plan's service area. These facilities are known as Essential Community Providers, which already include free clinics, children's hospitals, family planning clinics, facilities operated by Indian tribes, rural health centers, and centers dealing with chronic diseases such as HIV/AIDS or cancer. This also includes health centers serving low-income consumers or residents of underserved areas. The addition of these behavioral health centers not only further empowers consumers, but also increases their choices when selecting a provider.
Expanding access to abortion services
California is allowing more practicing physicians to perform certain abortion procedures. The new law, effective January 1, 2024, allows physician assistants, also known as physician assistants, who have been trained and achieved the clinical competency required by law, to perform abortions in the first trimester of pregnancy without the presence of a supervising physician. This puts physician assistants on par with nurse practitioners and midwives when it comes to performing abortions without a physician present. The new law means fewer barriers and shorter waiting times for such care.
More time to get insurance after losing Medi-Cal and CHIP
Starting January 1, Californians who lose their Medi-Cal or Children's Health Insurance Program (CHIP) coverage will have more time to enroll in Covered California. The special enrollment application period is now 60 days before you lose coverage and up to 90 days after your coverage ends. If you have lost Medi-Cal, you can learn more about how to keep your coverage here.
No more unexpected out-of-pocket expenses
Navigating the cost of health insurance can be difficult. Consumers often have to guess how much a particular medical procedure, test or treatment will cost them after co-payments and deductibles. But health insurers and employers offering health insurance plans are now required to provide online calculators for a range of services and drugs. Consumers enter information and the calculators calculate the patient's costs in real time. The calculator results are personalized, calculating how much the patient still has to pay for the annual deductible and what out-of-pocket spending limit applies to their coverage. It should also show the amount the insurer would have paid if the service had been provided out-of-network.
There is no guarantee that the exact final cost will be quoted. During the course of treatment, unforeseen circumstances may arise, including the need for additional services. But consumers will at least have more information than before to make informed decisions about their health.
Out-of-network medical bills are no surprise
The No Surprises Act of 2022 was enacted to protect health insurance consumers from costly and unexpected out-of-network medical bills. These charges typically arise in emergency situations where a patient needs quick medical attention and does not think about who is in their network or whether they have prior authorization from their health insurance. In these situations, out-of-network providers were allowed to bill patients for any portion not covered by the patient's insurance - a practice known as balance billing. The No Surprises Act is a federal law that protects people from being billed for costs associated with emergency room visits, ambulance services, etc. More information can be found here .
Beginning in 2024, ground ambulances in California will be banned from using the practice, thanks to a new law signed by Governor Newsom. California became the 14th state to protect ground ambulances from balance billing, but a federal committee is seeking to address the issue nationally as part of the "No Surprises" law.
New maximum amounts for out-of-pocket expenses for 2024
The spending maximum is the upper limit on the amount you must pay for covered services in one year. It applies to copayments, deductibles, and coinsurance for in-network care and services. Once you reach this amount, your health plan will pay 100 percent of the costs for covered services. In 2024, the spending cap is $9,450 for an individual and $18,900 for a family - up from $9,100 and $18,200, respectively, in 2023.
Increase in tax penalties for not having health insurance
In California, people are required to have insurance or pay a tax penalty (unless they qualify for an exemption). Penalties for not having insurance typically increase each year to account for inflation. In 2023, Californians without insurance for an entire year will likely pay a minimum penalty of $900 per adult and $450 per dependent child under the age of 18. A family of four without insurance for the entire year could end up owing at least $2,700. You can use a tax penalty calculator to estimate how much you may owe if you don't have health insurance.
Street medicine approved to treat the homeless
From riverside encampments to freeway underpasses, the Biden administration has made it easier for doctors, nurses, and other health care providers to help the homeless - marking a fundamental shift in how and where health care is delivered. For the first time, the federal government has recognized the streets as a legitimate place to provide health care to the homeless, low-income, disabled, and elderly.
This expansion of medical care will have a significant impact on the more than 170,000 California residents who are homeless, who often lack the means and mobility to visit or even find a doctor who will see them. On average, these people die three decades earlier than their peers, and usually from preventable and treatable diseases. Meanwhile, health care costs for the homeless are five times the national average, due to an over-reliance on the emergency department for routine care. This policy change removes these barriers and makes health care fully patient-centered, with doctors and nurses coming to them.
Street medicine is different from mobile clinics with a parked trailer and a team that performs procedures such as HIV testing. Street medicine meets people without housing right where they live.
Employees have access to more affordable health care coverage
Employees who do not have affordable health insurance at their workplace can get financial assistance for insurance by enrolling in Covered California. The level of affordable health insurance is set by the IRS and changes each year. In 2023, the rate was 9.12% of a worker's family income, and in calendar year 2024, the rate will be 8.39% - the lowest rate since the Affordable Care Act was enacted. This means that in 2024, if the lowest-cost plan offered to you by your employer exceeds 8.39% of your family income, you can apply for a plan with financial assistance through Covered California. Furthermore, if the same plan meets the affordability threshold for an employee, but its cost to additional family members exceeds 8.39%, those family members may qualify for financial assistance with a plan through Covered California.
Expanding health care options for veterans
The Promise to Address Comprehensive Toxics Act (or PACT Act) was passed in 2022 to help veterans exposed to toxic materials and other harmful substances during the Vietnam War, Gulf War, and post-9/11 by increasing their access to health care. The law expanded the list of suspected illnesses associated with burn pits, Agent Orange, and other toxic exposures, such as male breast cancer, urethral cancer, and paraurethral gland cancer. The full list is available here. In addition, the law requires the Department of Veterans Affairs to conduct a toxic exposure screening for every veteran enrolled in health care. A presumptive illness is an illness for which VA presumes it was caused by military service. In November 2023, the White House announced that it would expedite the enrollment of all veterans exposed to these chemicals.
The VA has also expanded services to World War II veterans. They can now receive health care services for free. This means no co-payments or monthly premiums and even includes nursing home care.
The Department of Veterans Affairs has also expanded access to in vitro fertilization (IVF). Unmarried veterans and veterans in same-sex marriages can now utilize IVF services at VA medical facilities. Previously, VA only provided IVF services to legally married veterans who were able to produce their own eggs and sperm. As part of this expansion, VA will now provide IVF benefits to eligible veterans regardless of marital status and, for the first time, will allow the use of donor eggs, sperm, and embryos. Veterans enrolled in VA health care are eligible for a wide range of reproductive health care services, including obstetrical care, gynecological care, access to contraceptives, cervical cancer screening, menopause care, and more. They also have the right to screening, management and elective treatment of infertility-related conditions.
In addition, there is a new exception to copayments for mental health visits. VA beneficiaries will not be paid for the first three such visits per year. The exemption is extended through June 27, 2023, and the benefit will continue through December 29, 2027. Patients who paid the copayment for these appointments will be reimbursed automatically. The copayment exemption applies to outpatient visits for mental health and substance use disorder treatment. To qualify for the exemption, a mental health or substance use disorder treatment visit must be conducted through the Veterans Administration itself or through one of the providers in the Administration's community.
For the first time in more than 50 years, California's conservatorship laws have been updated to allow even more residents in need of life-saving assistance to qualify, while preserving important civil liberty protections for those at risk. The law updates the definition of conservatorship to include those who are unable to provide for their personal safety or necessary medical care, as well as food, clothing, or shelter because of a severe substance use disorder or serious mental illness. In addition to new options for when intervention may be considered, the new law increases transparency between county mental health departments, courts, clinics, family members, and other organizations to improve the outcomes of such care.
Get HIV prevention drugs without a prescription
Two life-saving drugs used to prevent HIV are now available to California residents without a prescription. The new law allows pharmacists to provide a longer course of pre-exposure prophylaxis, commonly known as PrEP, a drug that helps prevent HIV infection before exposure. PrEP is taken regularly and, if taken as prescribed, significantly reduces the likelihood of infection. Studies have shown it to be 99% effective. Pharmacists can also provide a post-exposure prophylaxis drug known as PEP, which is used to treat patients who have been exposed to HIV. PEP must be taken within 72 hours of exposure and taken for 28 consecutive days to be effective. By law, the cost of these drugs, as well as any related services and tests, must be fully covered by health insurance.
New law keeps pharmacies safe
Medication errors are a serious problem that can lead to illness, disability or even death, and 91% of pharmacists believe their pharmacies are understaffed to prevent such errors. Millions of errors are made in California pharmacies each year, and until now, there was no requirement to report them. Under a new law, the Stop Dangerous Pharmacies Act, chain pharmacies are now required to report all medication errors. The new law also gives the chief pharmacist the authority to make decisions about staffing and safety - historically left to the store's general manager, who typically does not have a medical background - and requires that every pharmacy have at least one employee fully dedicated to pharmacy services. This is a big win, as nearly 46% of patients report not understanding the information on prescription drug labels. California is the first state to attempt to address this problem.
The services of a Doula are now covered
In 2023, the Medi-Cal program expanded its benefits to include the important work done by doulas. Later that year, a new law was passed to further expand coverage of these services by the state's health insurers. Why. The U.S. has a high maternal mortality rate, and three out of five deaths could have been prevented. Doulas are non-medical professionals who provide care and support to people during pregnancy, such as prenatal care, childbirth, breastfeeding, and specialize in helping with infertility, miscarriage, and abortion.