Your guide to reform

Having health benefits from work is great

Many health care reform changes that affect your health plan may be in place. If there are additional changes that will affect your plan, you should get more details at your annual open enrollment period.

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Greater peace of mind for you and your family

If you currently have health insurance through your employer, you may be enjoying some of the added benefits from health care reform. For example, the following benefit changes are in effect for some plans.*

  • Expanded no-cost preventive care. This includes immunizations, diabetes and cancer screenings, counseling for smoking and alcohol abuse, and more.
  • No annual or lifetime dollar limits on essential health benefits.
  • Your kids can stay on your plan until they turn 26 years old.
  • Children with pre-existing health problems can be covered.

*Some of these benefit changes do not apply to “grandfathered” health plans. Your employer and your insurer should let you know if your plan is grandfathered.

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If you work for a large company

You should get more details from your employer about changes that may affect your plan in 2014. You can get coverage through your employer or through the Health Insurance Marketplace. In certain cases (such as if your employer’s coverage doesn’t meet ACA standards and you qualify), you may be eligible for federal financial help. To do so, you would need to apply and get your coverage through the Marketplace.

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If you work for a small business

You should get more details from your employer about changes that may affect your plan in 2014. You can purchase your coverage through your employer, buy it through the Marketplace, or purchase directly from Kaiser Permanente. (Exception: Residents of Washington, D.C., purchasing health coverage on their own must buy coverage from the Marketplace.) You may be able to get federal financial help if you qualify. To do so, you would need to apply and get your coverage through the Marketplace.

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It feels good to know you’re covered

For 2014, insurance companies will have to update many of their health plans to include all of the protections from the health care law. If you already have coverage on your own, you may be able to keep your current plan. Contact your current health plan for more details.

If you are a Kaiser Permanente member, we’ll continue to keep you informed about your options or anything that affects your coverage.

Keep in mind the value of staying with Kaiser Permanente — including the care and providers you know and trust, and the convenient services you’ve come to rely on.

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Greater peace of mind for you and your family

If you currently have individual or family health insurance, you may be enjoying some of the added benefits from health care reform. For example, the following benefit changes are in effect for some plans.*

  • Expanded no-cost preventive care. This includes immunizations, diabetes and cancer screenings, counseling for smoking and alcohol abuse, and more.
  • No annual or lifetime dollar limits on essential health benefits.
  • Your kids can stay on your plan until they turn 26 years old.
  • Children with pre-existing health problems can be covered.

If you keep your existing plan, nothing else changes in 2014. However, the following significant change applies to all new plans for 2014*:

  • You can’t be denied coverage because you have a medical problem.

*Some of these benefit changes do not apply to “grandfathered” health plans. You can find out if your insurance is grandfathered by reviewing your health plan documents.

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More options for how you get and pay for coverage

Financial help from the federal government

There are 2 types of federal financial help that may be available to you. One kind helps pay your monthly health insurance premium. The other helps with your out-of-pocket expenses for care. You may qualify for one or both, and the federal government can pay your health plan directly.

  • Qualification is based on your income and family size, where you live, other coverage that is available to you, and if you are a U.S. citizen or legal resident in the U.S.
  • You can apply for federal financial help through your state or federal Health Insurance Marketplace.
  • You can only get financial help when you buy coverage through the Marketplace.

Here are some general income guidelines that might be used by the government to see if you qualify for federal financial help. The amounts below are based on 2013 numbers, and are likely to be slightly higher for 2014.

  • If you’re single, you could qualify if you make less than $45,960 (or if you live in Hawaii, less than $52,920).
  • For couples, you could qualify if you make less than $62,040 (or if you live in Hawaii, less than $71,400).
  • For a family of 4, you could qualify if you make less than $94,200 (or if you live in Hawaii, less than $108,360).

Health Insurance Marketplaces

Marketplaces are state- or federally run markets where you can shop, compare, and buy individual or family health care coverage. They are sometimes called “Exchanges.”

  • You can choose a plan based on price, benefits, quality, and other features that are important to you.
  • Kaiser Permanente plans will be available in the Marketplace.

You don’t have to buy from the Marketplace. You can still buy directly from Kaiser Permanente. (Exception: Residents of Washington, D.C., must buy coverage from the Marketplace.)

Kaiser Permanente members, link directly to the Health Insurance Marketplace for your state here.

State URL
California coveredca.com
Colorado connectforhealthco.com
District of Columbia dchealthlink.com
Georgia healthcare.gov
Hawaii hawaiihealthconnector.com
Maryland marylandhealthconnection.gov
Oregon coveroregon.com
Virginia healthcare.gov
Washington wahealthplanfinder.org

Levels of coverage

Marketplaces will have several levels of coverage offered by different insurers. You can choose among the plans according to your personal situation and needs.

  • All plans will offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
  • All plans will be grouped into several levels of coverage. These levels (referred to as Metal tiers) were set up by the federal government to make it easier for people to compare plans offered by different insurance companies.
  • The most affordable level would generally offer lower premiums but higher copayments, coinsurance, and deductibles. The other levels would generally have higher premiums but lower deductibles, coinsurance, and copays.
  • If you qualify, you will have the additional option of a Catastrophic Plan, which is usually a high-deductible plan with low monthly premiums.

You may change or apply for health care coverage during an annual open enrollment period. Outside of the open enrollment period, you can enroll or change your coverage only if you have experienced a situation known as a triggering event. See your state guidelines on special enrollment periods:
California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington.

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Kaiser Permanente is committed to the Medicare program and to providing high quality care and service to our members at the best possible value.

If you are a Kaiser Permanente Medicare health plan member, you don’t need to take any action to maintain your Senior Advantage (HMO) or Medicare Plus (Cost) health plan coverage.

If you are insured on your own, you can get information about Medicare health plans available to you by visiting medicare.gov. Information about Kaiser Permanente Medicare health plans is available on kp.org/medicare.

If you receive your coverage through an employer or trust fund, contact your group for information about your health care options.

Kaiser Permanente is an HMO plan with a Medicare contract. Kaiser Permanente is a Cost plan with a Medicare contract. Enrollment in Kaiser Permanente depends on contract renewal.

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Take control of your health and your care

The Affordable Care Act provides more options than ever for how you get and pay for coverage.

  • As of January 2014, insurance companies can no longer deny coverage if you have a medical condition, and you don’t have to pass a medical exam to qualify for coverage.
  • You can apply for financial assistance from the federal government to help pay for care and coverage in 2014 purchased through the Marketplace.
  • State- and federally run Health Insurance Marketplaces are available to help you shop, compare, and buy health care coverage.
  • Our great Kaiser Permanente plans are available through the Marketplaces. Or, you can get your coverage directly from us (unless you live in Washington, D.C.). We’ll help you explore all your options and choose a plan that works best for you and your family. Federal financial help is only available when you buy coverage through your state or federal Health Insurance Marketplace.

Why Kaiser Permanente?

There are many advantages to having health care coverage. And many more to having Kaiser Permanente. As a Kaiser Permanente member, you’ll get doctors, facilities, and health plans that work together as one. This makes your care more coordinated, convenient, and connected.

Learn more

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What all 2014 health plans have in common

Here are the added protections from health care reform that any of your health plan choices will include.

  • Expanded no-cost preventive care, including immunizations, diabetes and cancer screenings, counseling for smoking and alcohol abuse, and more.
  • No annual or lifetime dollar limits on essential health benefits.
  • Your kids can stay on your plan until they turn 26 years old.
  • You and your children can be covered if you have pre-existing health problems.

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More options for how you get and pay for coverage

Financial help from the federal government

There are 2 types of federal financial help that may be available to you. One kind helps pay your monthly health insurance premium. The other helps with your out-of-pocket expenses for care. You may qualify for one or both, and the federal government can pay your health plan directly.

  • Qualification is based on your income and family size, where you live, other coverage that is available to you, and if you are a U.S. citizen or legal resident in the U.S.
  • You can apply for federal financial help through your state or federal Health Insurance Marketplace.
  • You can only get financial help when you buy coverage through the Marketplace.

Here are some general income guidelines that might be used by the government to see if you qualify for federal financial help. The amounts below are based on 2013 numbers, and are likely to be slightly higher for 2014.

  • If you’re single, you could qualify if you make less than $45,960 (or if you live in Hawaii, less than $52,920).
  • For couples, you could qualify if you make less than $62,040 (or if you live in Hawaii, less than $71,400).
  • For a family of 4, you could qualify if you make less than $94,200 (or if you live in Hawaii, less than $108,360).

Health Insurance Marketplaces

Marketplaces are state- or federally run markets where you can shop, compare, and buy individual or family health care coverage. They are sometimes called “Exchanges.”

  • You can choose a plan based on price, benefits, quality, and other features that are important to you.
  • Kaiser Permanente plans will be available in the Marketplace.

You don’t have to buy from the Marketplace. You can still buy directly from Kaiser Permanente. (Exception: Residents of Washington, DC, must buy coverage from the Marketplace.)

Kaiser Permanente members, link directly to the Health Insurance Marketplace for your state here.

State URL
California coveredca.com
Colorado connectforhealthco.com
District of Columbia dchealthlink.com
Georgia healthcare.gov
Hawaii hawaiihealthconnector.com
Maryland marylandhealthconnection.gov
Oregon coveroregon.com
Virginia healthcare.gov
Washington wahealthplanfinder.org

Levels of coverage

Marketplaces will have several levels of coverage offered by different insurers. You can choose among the plans according to your personal situation and needs.

  • All plans will offer the same essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care), and include certain preventive services at no cost.
  • All plans will be grouped into several levels of coverage. These levels (referred to as Metal tiers) were set up by the federal government to make it easier for people to compare plans offered by different insurance companies.
  • The most affordable level would generally offer lower premiums but higher copayments, coinsurance, and deductibles. The other levels would generally have higher premiums but lower deductibles, coinsurance, and copays.
  • If you qualify, you will have the additional option of a Catastrophic Plan, which is usually a high-deductible plan with low monthly premiums.

You may change or apply for health care coverage during an annual open enrollment period. Outside of the open enrollment period, you can enroll or change your coverage only if you have experienced a situation known as a triggering event. See your state guidelines on special enrollment periods:
California, Colorado, District of Columbia, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington.

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Medicaid & Charitable Health Coverage Programs

Kaiser Permanente is committed to providing high-quality, affordable health care services to all the communities we serve. This includes Medicaid recipients and low-income individuals who have no access to government or private health care coverage.

To learn how to enroll in Kaiser Permanente's Medicaid plan or Charitable Health Coverage:

Kaiser Permanente members or individuals who have been a member within the last 12 months, or have an immediate family member who is a member of Kaiser Permanente ─ call your local Member Services Department.

Nonmembers ─ contact your state or local Medicaid agency to see if you are eligible for Medicaid and if a Kaiser Permanente Medicaid plan is available in your area.

Individuals interested in Charitable Health Coverage ─ visit kp.org/charity-care.