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Game Changer: Obamacare’s New Coverage Rules And Costs

Q: I had colon cancer and have had trouble buying health insurance ever since. Under Obamacare, will insurance companies still be allowed to refuse me because of my medical history?

A. Finally, an Obamacare question with a simple answer, and the answer is NO.

Starting on January 1, health plans no longer can deny anyone coverage because of health status or previous diagnoses. Nor can they charge more because of pre-existing conditions. Period.

Q: What can health plans charge more for?

A: Thankfully, this is another pretty simple answer. Plans will be able to charge families more than individuals, and older people – who generally have more health problems – can be charged up to three times more than younger ones. Premiums also will vary based on medical costs in your geographic region.

Premium amounts also will depend on the level of coverage you choose. You will pay more for lower out-of-pocket costs.

To be clear, these rules will apply to those who buy individual, family or small group coverage from the state’s new health insurance marketplace, called Covered California, or on the open market. (To learn more about Covered California, link to my previous column here.)

One final note: Obamacare allows states to charge smokers more. But that won’t happen in California, where lawmakers recently approved a law preventing a surcharge on tobacco users.

Q: So how much will insurance actually cost me?

A: That’s the $10,000 question.

I’m hearing from readers across California who desperately want to know how much their insurance premiums will set them back under health care reform.

We don’t have all the details yet, but I can provide some guidance now, especially to those readers who earn between 138 percent and 400 percent of the federal poverty level. This year, 400 percent equals $45,960 for an individual or $94,200 for a family of four. (Click here for federal poverty level guidelines.)

Californians who are within that range may qualify for sliding-scale tax credits to offset the cost of health insurance premiums.

If you make under 138 percent of the poverty level, you will qualify for Medi-Cal, the state’s version of the federal Medicaid program. If you make more than 400 percent, you won’t qualify for the tax credits.

But for those who fall between 138 and 400, here are some examples:

A single person making approximately $11,000 to $17,000 per year would pay between $19 and $57 in monthly premiums, with the balance of the premium paid by federal tax credits. That same person would pay between $193 and $364 monthly if she made between $29,000 and $46,000.

A family of four making $24,000 to $35,000 would pay between $39 and $118 in monthly premiums. The family would pay between $395 and $746 if it earned $59,000 to $94,000.

By mid-July, we’ll know for sure which health plans will offer coverage on the exchange and at what price, said Dana Howard, a Covered California spokesman.

Until then, Covered California has a calculator that can help you estimate your insurance cost. Try it here.

UPDATE: After this column was published, Covered California released specifics on which plans would be offered around the state. To find out how much you would pay for a plan in your region, use the Covered California calculator

Provided by the Center for Health Reporting at the University of Southern California.