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Will Insurance Plans Sold By Obamacare’s New Marketplace Meet Your Needs?

Q: I’m currently on Medicare but pay out of pocket for a Blue Cross supplement policy. Will insurance companies offer Medicare supplement policies and prescription drug policies on the new health insurance exchange?

A: I’ve gotten in the bad habit of starting my columns with questions that don’t have simple answers. So much for easing you into Obamacare.

But it isn’t entirely my fault. There’s a caveat or exception for just about everything in the Affordable Care Act.

Today, I’m going to celebrate the rare combination of a good question that has a simple answer by tackling it first. However, it may not be the answer that Ann of Los Osos wants to hear.

No, Ann, you won’t be able to buy Medicare plans through Covered California, the state’s health insurance exchange.

Covered California specializes in private insurance policies for individuals, families and small businesses. It does not sell plans for government-sponsored health programs like Medi-Cal or Medicare.

In a few weeks – Oct. 1 to be exact – Covered California will begin offering 12 health plans across the state (not all in each region), with coverage to begin on Jan. 1.

(UPDATE: Covered California ended up offering 11 health plans in 2014.)

Individuals and families who earn between 138 percent and 400 percent of the federal poverty level will be eligible for sliding-scale tax credits to purchase those plans.

Medicare recipients will have to look outside the exchange for policies, much as you do now.

Elaine Wong Eakin, executive director of the Medicare advocacy and education group California Health Advocates, has some tips. She suggests searching the “plan finder” on if you’re looking for Medicare Advantage or prescription policies. If you want Medicare supplement insurance – also called Medigap – she points to California’s Department of Insurance website:

Medicare open enrollment runs from Oct. 15 through Dec. 7.

Q: Will Covered California offer plans for dental and vision for adults? I’m 25, and I’m thankfully on my parents’ health insurance for another year, but I’m currently without dental or vision coverage through my job.

A: Now back to our regular, less-straightforward programming.

Under the new health law, all health plans sold to individuals and small businesses must include coverage for 10 categories of services, including emergency care, hospitalization and prescription drugs. These categories are known as “essential health benefits.”

I’m sorry to tell Helen of Temple City that vision and dental care for adults are not among them.

As a result, Covered California will not be offering dental and vision coverage for adults. That also means you cannot receive tax credit assistance for dental and vision coverage, even if your income qualifies, says Covered California spokeswoman Anne Gonzales.

Covered California may consider linking Californians who shop for its medical plans to adult vision and dental plans elsewhere, but that idea, Gonzales says, is still just that.

So, Helen, if you really want dental and vision coverage, you’ll have to buy the policies separately and off the exchange.

Q: What about dental and vision coverage for children?

A: For children, on the other hand, dental and vision coverage are considered “essential.” That means they must be offered by Covered California.

Children’s vision services will be embedded in medical plans sold by Covered California, Gonzales says.

Dental is another matter and has been the subject of significant debate. I won’t get into the drama here, but suffice it to say that many children’s advocates are frustrated.

In short, Covered California decided that children’s dental plans will not be embedded in medical plans. They will be sold separately by the exchange and will be offered by five insurance companies.

Depending on the plan and your region, premiums will range from $10 to $30 a month per child. The rate maxes out at three times the single premium, so if you have more than three kids, that’s the most you will pay, Gonzales says.

And even though they’re considered essential health benefits for kids up to age 19, families won’t be required to buy them.

Theoretically, some families may have tax credit dollars left over from buying medical plans to apply toward children’s dental plans, but that’s not likely to happen often, Gonzales says.

Eileen Espejo, health policy director for Children Now, says the children’s dental contracts only last a year and that she and other advocates will push for dental plans to be embedded in medical plans in the future.

“There will be changes coming in 2015,” she says.

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

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