With additional health plans to choose from, increased access to care, and even more financial help available, getting health insurance has never been this affordable.
Buying health insurance for 2024? It’s a good idea to get up to speed on the new rules and regulations, and how to get or stay covered. So, 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 brand-name plans for you and your family. The Inland Empire Health Plan joined Covered California, bringing more choices to consumers in the Riverside and San Bernardino counties. Aetna CVS Health, which first joined us in 2023, will begin offering plans in Contra Costa and Alameda counties. Similarly, Health Net will start offering coverage to residents in Imperial County. As a result, we will have a total of 12 health insurance companies across the state to choose from. All residents will have at least two options with over 90% of consumers having four or more insurance providers to pick from.
More Financial Help Through Covered California
Beginning 2024, California state taxes collected under the individual mandate will be used to help lower the cost of health insurance for those enrolling through Covered California. These state subsidies are in addition to the existing federal financial help that together make getting covered more affordable than ever before!
Approximately 650,000 Californians will qualify for these new subsidies (known as cost sharing reductions). This financial help will not only eliminate their deductibles but also decrease their costs on prescriptions, emergency care, and doctors visits. And these state subsidies are expected to increase in subsequent years.
Medi-Cal for All, Regardless of Immigration Status
Starting 2024, all Californians, regardless of immigration status, can enroll in Medi-Cal if their income qualifies. Over the last few years Medi-Cal has been expanding coverage to include undocumented adult immigrants. Californians under the age of 26 have received this coverage since 2020. Starting January 1st of 2023, these benefits became available to eligible adults ages 26 to 49. And starting this year, Medi-Cal is extended to all qualifying low-income adults 50 years and older. This is just one of many ways the state continues to invest in the overall health equity of its residents.
Medi-Cal Ends Asset Limit Reporting
When determining your eligibility for certain Medi-Cal programs, such as Medi-Cal for people aged 65 or older or for people with disability, it used to be that both your income and your assets were considered as part of your application. This included such things as your bank accounts, property, vehicles, and more. Beginning in July of 2022, the state of California began phasing out the asset test and starting this year eliminated it all together. Historically, this qualifier required people to spend down their assets – sell their car or house – before accessing care through Medi-Cal’s Aged and Disabled program, Medicare Savings Programs, and Long-Term Care programs. Now income-eligible people will be able to access these life-saving benefits regardless of assets owned. Keep in mind, while owning property itself will not be considered, any income paid to you for the use of your property, such as rent, still counts.
More Access to Healthcare Services
Consumers affected by limited access to providers, and the unanticipated out-of-network costs associated with that, will soon have more options. Beginning in 2024, health plans must offer at least one treatment center for substance use disorders and one mental health facility in every county within the health plan’s service area. These are known as Essential Community Providers, which already include free clinics, children’s hospitals, family planning clinics, facilities run by Indian tribes, rural medical centers, and centers dedicated to chronic conditions such as HIV/AIDS or cancer. It also includes providers that serve low-income consumers or those in underserved areas. The addition of these behavioral health care centers not only further expands what consumers have access to but also the choices they have when picking a provider.
Expanded Access to Abortion Care
California is enabling more medical practitioners to perform certain abortion procedures. A new law that took effect on January 1, 2024 allows physician assistants, also known as physician associates, who have completed training and achieved the clinical competency required by law, to perform first-trimester abortions without a supervising physician present. This puts physician assistants on par with nurse practitioners and nurse midwives when it comes to performing an abortion without a doctor present. The new law means fewer barriers and shorter wait times for this care.
More Time to Get Covered After Losing Medi-Cal, CHIP
Starting January 1st, Californians who lose their coverage through Medi-Cal or the Children’s Health Insurance Program (CHIP) will have more time to enroll in Covered California. The special enrollment period to apply is now 60 days before the loss of coverage and up to 90 days after that coverage has ended. If you lost your Medi-Cal, you can learn more about staying covered here.
No More Surprise Out-of-Pocket Costs
Navigating the cost of health insurance can be a tricky process. It often leaves consumers guessing how much a medical procedure, test, or treatment will cost them after co-pays and deductibles. But now health insurers and employers that offer health plans must provide online calculators for a range of services and drugs. Consumers will enter the information and the calculators produce real-time estimates of a patient’s out-of-pocket cost. And the results are personalized, computing how much of an annual deductible patients still owe and the out-of-pocket limit that applies to their coverage. The amount the insurer would pay if the service were out of network must also be shown.
That said, there is no guarantee the exact final cost will be shown. There can be unforeseen factors during the course of treatment which may include the need for additional services. But consumers will have at least more information than before to make informed decisions about their health.
No Surprise Out-Of-Network Medical Bills
Back in 2022, the No Surprises Act was enacted to help protect consumers with health insurance from costly and unexpected out-of-network medical bills. These expenses typically occur during an emergency when a patient needs care quickly without worrying about who’s in their network or whether they have prior authorization from their health insurance. In these situations, providers that are out-of-network had been permitted 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 balance billing expenses related to emergency room visits, air ambulance services, and more. You can find more info here.
Starting in 2024, ground ambulances in California will be barred from this practice, thanks to a new law signed by Gov. Newsom. California is the 14th state to provide protections against balance billing for ground ambulances but a federal committee under the No Surprise Act is looking to address it nationally.
Prior Authorization Process Gets Updated
Health insurers participating in Medicare Advantage, Medicaid and Medi-Cal, and the Affordable Care Act (ACA) health insurance marketplaces, like Covered California, now must respond to prior authorization requests within 72 hours for expedited (i.e., urgent) requests and seven calendar days for standard (i.e., non-urgent) requests. Prior authorization is used by insurers to approve medical procedures and treatments. Under this new rule from the Biden administration, health insurance companies are required to provide a specific reason for denying any prior authorization request. Companies must also publicly report their prior authorization metrics. Not only will this new rule shorten wait times but will streamline the approval process by digitizing it. The new rules don’t apply to veterans who receive their care through the Department of Veterans Affairs or the estimated 153 million Americans covered by private, employer-sponsored plans.
New Out-of-Pocket Maximums for 2024
The out-of-pocket maximum is the upper limit of how much you have to pay for covered services in one year. It applies to copayments, deductibles, and coinsurance for in-network care and services. Once you meet this amount, your health plan will pay 100 percent of the costs for covered benefits. For 2024, the out-of-pocket limit is $9,450 for an individual and $18,900 for a family — up from $9,100 and $18,200, respectively, in 2023.
Tax Penalties Increase for Not Having Health Insurance
In California, people must have coverage or pay a tax penalty (unless they qualify for an exemption). The penalties for not being insured generally increase each year adjusted for inflation. For tax year 2023, Californians without coverage for the 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 who goes the whole year with no coverage could owe a minimum of $2,700 come tax time. You can use the tax penalty calculator to estimate what you may owe if you don’t have health insurance.
Street Medicine Approved for Treating the Homeless
The Biden administration has made it easier for doctors, nurses, and other providers to treat the unhoused, from creekside encampments to freeway underpasses, marking a fundamental shift in how — and where — healthcare is delivered. This is the first time the federal government has recognized the streets as a legitimate place to provide care, affecting the homeless, low-income, disabled, and older populations.
This expansion of care will greatly impact California’s more than 170,000 unhoused residents who often lack the means and mobility to visit – or even locate – a doctor who will accept them. On average, this population dies three decades earlier than their peers, and usually from preventable and treatable conditions. Meanwhile, the healthcare costs for the homeless are five times the national average, due to an over reliance on the emergency room for routine care. This change in policy removes those hurdles and makes healthcare completely patient-centered, with doctors and nurses coming to them.
Street medicine is different from mobile clinics involving a parked trailer and a team facilitating such things as HIV testing. Street medicine meets unsheltered people right where they are living.
Employees Get Access to More Affordable Healthcare
Employees who aren’t offered affordable health insurance through their job may get financial help for coverage when signing up for a plan through Covered California. What is considered affordable health insurance is set by the IRS and changes every year. For 2023, that rate was set to 9.12% of an employee’s household income, and for calendar year 2024, it will be 8.39% – the lowest it has been since the Affordable Care Act was implemented. That means, for 2024, if the lowest-cost employee-only plan offered to you by your employer is more than 8.39% of your household income, you can apply for a plan with financial help through Covered California. Moreover, if that same plan meets the affordability threshold for the employee but costs more than 8.39% to cover additional family members, those family members may qualify for financial help themselves when they sign up for a plan through Covered California.
Expanded Health Care Options for Veterans
The Promise to Address Comprehensive Toxics Act – or PACT Act – was passed in 2022 to better help veterans exposed to toxic materials and other harmful substances during the Vietnam, Gulf War, and post-9/11 eras by expanding their access to healthcare. The act also expanded the list of presumptive conditions related to burn pits, Agent Orange, and other toxins along with requiring the Department of Veterans Affairs to provide a toxic exposure screening to every veteran enrolled in VA health care. A presumptive condition is one where the VA assumes the condition was caused due to military service and you can find the full list here. In November of 2023, the White House announced they would be accelerating enrollment for all veterans who were exposed to these chemicals.
The VA is also expanding care for Word War II veterans. They can now access health care services at no cost. This means no co-pays or monthly premiums, and even includes nursing home care.
Conservatorship Laws Updated for Mental Illnesses & More
California’s conservatorship laws have been updated for the first time in more than 50 years, now allowing even more residents who need this life-saving help to be eligible, all while maintaining important civil liberty protections for those at-risk individuals. The law updates the definition for conservatorship to include those who are unable to provide for their own personal safety or necessary medical care, in addition to food, clothing, or shelter, due to either severe substance use disorder or serious mental health illnesses. In addition to these new opportunities for when intervention can be considered, the new law increases transparency between county mental health departments, courts, clinics, family members, and more as a way to improve the outcome of this care.
Get HIV Prevention Meds Without a Prescription
Two life-saving medications used in HIV prevention are now available to Californians without requiring a prescription. A new law authorizes pharmacists to furnish a longer course of preexposure prophylaxis, commonly known as PrEP, a drug that helps prevent HIV infection prior to exposure. PrEP is taken regularly, and if taken as prescribed, largely reduces the chances of infection. Studies have shown it to be 99% effective. Pharmacists can also furnish postexposure prophylaxis, commonly known as PEP, a drug used to treat patients who have been exposed to HIV. PEP must be taken within 72 hours of exposure and for 28 consecutive days to be effective. The law requires the costs of these drugs, along with any related services and testing, to be fully covered by health insurance.
New Law Ensures Pharmacy Safety
Medication errors are a serious problem that can lead to illness, disability, or even death and 91% of pharmacists feel their pharmacies are not property staffed to prevent these errors. Millions of mistakes are made every year across California pharmacies and up until now, there has been no requirement for reporting them. Under a new law, the Stop Dangerous Pharmacies Act, chain pharmacies are now required to report all medication-based errors. The new law also empowers the pharmacist-in-charge to make staff and safety decisions – historically left to the store’s general manager who typically has no medical training – and that each location has at least one clerk fully dedicated to pharmacy-related services. A big win as nearly 46% of patients report not understanding the information listed on their prescription drug labels. California is the first state to try to tackle this problem.
We’ve Got You Covered!
Just like buying health insurance, your life and your family’s needs may change year to year. We are here to help. Find out quickly and easily just how much financial help you could get to pay for health insurance. Explore your options now and get the coverage you need — or contact us at any time.
What has changed in health insurance in previous years:
