Affordable Care Act is Working: Families Report Quality Care at Affordable Prices

Paying nearly $600 every month for health insurance was a heavy burden for Alfredo and Tayhesha Madrid of Riverside.

The couple had insurance coverage through Tayhesha’s employer, a window frame manufacturer. Although they looked for more affordable insurance, there were few plans that would take them because of Alfredo’s pre-existing condition as a diabetic.

Things changed in March 2014 when the couple discovered Covered California and the insurance companies that sell coverage through the exchange under the Patient Protection and Affordable Care Act.

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The Madrids chose an Anthem Blue Cross of California Silver plan and saw their premium fall to $230 per month, aided by a federal subsidy. The decrease in premium cost was a life-altering surprise for the 45-year-old notary public and his wife.

“I was floored,” said Alfredo. “My insulin now costs $30 as opposed to $180 under our old plan. We are free to see whatever doctor we want to see. It was a huge weight lifted from our shoulders.”

According to Covered California, of the consumers receiving subsidies to help them pay for insurance, the majority pay less than $150 per month, and more than 120,000 enrollees are paying less than $10 per month for coverage.

Covered California estimates that in 2014 it provided more than $5,200 in subsidies per household per year, or about $436 per month. Savings for 2015 are still being calculated.

Covered California is approaching the third year of helping millions of Californians gain health insurance through the Affordable Care Act. Open enrollment is Nov. 1, 2015, through Jan. 31, 2016. More than 2 million consumers have been enrolled at one time or another since coverage began in January 2014. Currently more than 1.3 million members have active health insurance. Millions more have received care through low-cost or no-cost Medi-Cal.

Despite this monumental progress, California still has millions of people who are eligible for health insurance through either Covered California or Medi-Cal but remain uninsured, Covered California Executive Director Peter V. Lee said.

The Affordable Care Act is working in California, Lee said, offering affordable plans and quality medical care. Those are the messages his agency relentlessly delivers to consumers.

“You can get health insurance for a lower cost through Covered California,” Lee said. “Four out of five people who enrolled through our agency got help paying for their coverage.”

The total amount of subsidies, or Advanced Premium Tax Credits, was $3.2 billion paid to health insurance companies in 2014 on behalf of Covered California enrollees. Consumers themselves paid $1.1 billion toward those policies in 2014, meaning that for every dollar a subsidized Covered California consumer spent on premiums, the federal government paid another $3.

For 2016 coverage, Covered California is launching another robust community outreach and enrollment campaign, with an emphasis on African-Americans, Latinos and young adults.

Key to that effort will be insurance agents and enrollment counselors trained to help consumers shop around and look at their options among 12 insurance carriers. Those professionals, along with a trained customer service staff, will help consumers decide whether to stay with their current plan or find another option that better suits their financial needs.

It was an enrollment counselor with the Riverside County Black Chamber of Commerce who helped the Madrids — Alfredo, who is Latino and Tayhesha, who is African-American.

“We didn’t know that we qualified to enroll,” Alfredo said. “Through a counselor we learned we were able to switch, because we were paying 9.5 percent of our income through our employer coverage. If your employer-sponsored plan costs that much, the law allows you to switch to a Covered California plan.”

That bit of good news — plus lower cost and better care — is something the Madrids are sharing with friends.

“I found it to be awesome, and now I can help people,” Alfredo said.