FAQs

ACA Frequently Asked Questions -Updated 10/01/13

1. What is the Affordable Care Act (ACA), also known as Health Care Reform?
2. What services are covered through the Affordable Care Act?
3. How can I find out my eligibility for healthcare coverage?
4. What documents to I need to enroll?
5. When can I enroll for healthcare coverage?
6. How do I enroll for healthcare coverage? 
7. When does Healthcare coverage begin?
8. Am I required to enroll if I do not have health insurance?
9. How much does it cost to get insurance through Covered California? What if I can’t afford it? Are there tax credits or cost sharing subsidies?
10. Am I still eligible if I have a pre-existing condition?
11. Do I need to be a citizen or legal resident to qualify for new ACA health coverage options?
12. Do I need to apply for Medi-Cal?
13. I am currently on MediCal, do I need to do anything?
14. I am currently in the SF PATH (LIHP) program, do I need to do anything to continue my health coverage?
15. I am currently receiving CalWORKs, will I qualify for one of the new ACA health coverage options?
16. I am currently receiving CalFresh (Food Stamps), will I qualify for one of the new ACA health coverage options?
17. I am currently enrolled in Healthy San Francisco, am I impacted?
18. I have private insurance, how does Health Care Reform impact me?
19. I have health insurance through my employer, do I need to do anything?
20. What is Covered California?
21. What is Medi-Cal?
22. What is Healthy San Francisco?

What is the Affordable care Act (ACA), also known as Health Care Reform?

The Affordable Care Act was passed by Congress and signed into law by President Obama on March 23, 2010. It provides access to quality and affordable health care for all Americans through state-run Health Insurance Exchanges. In California, Covered California was created, providing a marketplace for affordable health insurance: https://www.coveredca.com
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What services are covered through the Affordable Care Act?

The ACA requires that insurance plans offer ten Essential Health Benefits.
• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventative and wellness services and chronic disease management 
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How can I find out my eligibility for healthcare coverage?

You may be eligible for new free or affordable health insurance options through Medi-Cal or Covered California. The amount of financial help you qualify for depends on your income.

Certain US citizens and legal residents who do not have health insurance through an employer or governmental program, regardless of income level, can purchase health insurance through Covered California.

If you are a family with children, a senior, are disabled, or your income level is below 138% of the Federal Poverty Level (FPL) then you may qualify for Medi-Cal, a free governmental health insurance program. In 2013 138% of FPL is $15,856 for a single person or $32,499 for a family of four.
If you do not qualify for Medi-Cal and your income level is below 400% of the Federal Poverty Level (FPL) then you may qualify for subsidies to help pay for health insurance purchased through Covered California. In 2013 400% FPL is $45,960 for a single person or $94,200 for a family of four.
If you do not qualify for Covered California or Medi-Cal, then you may qualify for Healthy San Francisco. (See question “What is Healthy San Francisco?”)
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What documents will be verified for enrollment into Covered California?

https://www.coveredca.com/FAQs/#faq-18

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What information will I need to enroll in Medi-Cal?

When you apply for Medi-Cal you will be asked to provide only information needed to determine your eligibility.

• Residency
• Identity
• Citizenship
• Age (Date of Birth)
• SSN (if you have one)
• Household composition
• Income
• Pregnancy
• Immigration status
• Other health coverage

Note* Asset information may be needed for seniors (age 65+) and in some cases persons with disabilities.

The county will attempt to verify most of your eligibility components electronically, if we are unable to verify your eligibility, we may ask you to provide documentation.

The list below provides some examples of documents that can help us verify your eligibility (for a complete list of verifications, contact the Human Services Agency SF BenefitsNet Center at 855-355-5757).

 Eligibility Factor                     Example of Documentation
 Residency
  • Rent receipt
  • Utility Bill
  • Child’s school records
  • Can use proof of income from California as proof of residency
 Identity
  • California driver license/ ID
  • Photo ID
Citizenship       
  • U.S. Passport
  • U.S. Birth Certificate
  • A certificate of U.S. citizenship
  • Certificate of naturalization
 SSN (if you have one)             
  • Social security card                                                                                                       
 Income
  • Copy of most recent paystub
  • Signed statement from employer
  • Copy of last year’s federal income tax return
  • If self-employed last year’s federal tax return, include Schedule C or F, or last 3 months of profit and loss statements
  • Copies of award letters or bank statements showing disability or retirement income
  • Copies of checks received or statements from the District Attorney’s Family support division for last month for Child support and/or alimony or spousal support
  • Copies of award letters or loan papers for student loans or grants
 Immigration Status
  •  A copy of immigration documentation or card (if card, a copy of both sides) 
 Assets
  • Vehicle registration
  • Most recent bank statements for all accounts
  • Copy of life insurance policy, stocks, bonds, retirement account statement

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What documents do I need to enroll into Healthy SF?

http://healthysanfrancisco.org/visitors/necessary-documents-to-enroll/ 

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When can I enroll for healthcare coverage?

New ACA healthcare coverage options (Covered California and newly expanded Medi-Cal) will take effect on January 1, 2014. Open enrollment will be for an extended 6 month period from October 1, 2013 – March 31, 2014. During this time, families and individuals will be able to apply for and enroll in new ACA healthcare coverage options (Covered California and newly expanded Medi-Cal). From October 1, 2013 – December 31, 2013 this period is considered “pre-enrollment” because healthcare coverage will not take effect until January 1, 2014. During the pre-enrollment period, if you are found to be eligible under current Medi-Cal rules, your healthcare coverage will begin right away. 
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How do I enroll for healthcare coverage?

Beginning on October 1, 2013 you can apply
• Online (https://apply.coveredca.com)
• Over the phone at Covered California’s Enrollment line (800) 300-1506. Business hours are Monday through Friday 8am to 8pm and Saturday 8am to 6pm.
• Low income San Franciscans can also call the SF BenefitsNet Service center at 855-355-5757. Business hours are Monday through Friday 8am-5pm.
• In-person at the SF BenefitsNet Service Center (1440 Harrison St, San Francisco, CA) Business hours are Monday through Friday 8am-5pm

You may also apply at one of many Community Partners participating in the Certified Enrollment Entities Program. The most up to date information on the locations of Certified Enrollment Entities will be posted to http://www.sfgov.org/healthreform as it becomes available.
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When does Healthcare coverage begin?

New ACA healthcare coverage options (Covered California and newly expanded Medi-Cal) will take effect on January 1, 2014. Open enrollment will be for an extended 6 month period from October 1, 2013 – March 31, 2014. During this time, families and individuals will be able to apply for and enroll in new ACA healthcare coverage options (Covered California and newly expanded Medi-Cal). From October 1, 2013 – December 31, 2013 this period is considered “pre-enrollment” because healthcare coverage will not take effect until January 1, 2014. During the pre-enrollment period, if you are found to be eligible under current Medi-Cal rules, your healthcare coverage will begin right away.

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Am I required to enroll if I do not have health insurance?

Starting in January 2014, most people will be required to have health insurance or pay a penalty if they don’t. Some exceptions apply.

The penalty phases in over three years and becomes increasingly severe.

Health Insurance Penalty Phase-In Schedule
Pay the greater of the two amounts

 Year   

 Percentage of Income 

 Set Dollar Amount   

 2014  1%  $95
 2015  2%  $325
 2016  2.50%  $695

Several groups are exempt from the requirement to obtain coverage or pay the penalty, including:
• People who would have to pay more than 8 percent of their income for health insurance
• People with incomes below the threshold required for filing taxes 
    o In 2012, $9750 for a single person and $27,100 for a married couple with two children
• People who qualify for religious exemptions
• Undocumented immigrants
• People who are incarcerated
• Members of Native American tribes

If you do not have insurance and do not fit into one of these categories, then you may have to pay a penalty.
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How much does it cost to get insurance through Covered California? What if I can’t afford it? Are there tax credits or cost sharing subsidies?

Visit www.coveredca.com or call 800-300-1506 Monday through Friday, 8am-8pm or Saturday 8am-6pm to learn more about your new options.

You may be eligible for tax credits or cost sharing subsidies.

Tax credits are available for individuals and families who meet certain income requirements and do not have access to affordable health insurance through their employer or a government program such as Medi-Cal. Advanced Premium Tax Credits (APTC) are only available for those who purchase health insurance through Covered California. Individuals can choose to apply the estimated tax credit to their health insurance premiums each month to reduce the monthly cost of the health insurance. These credits are paid directly to a health plan by Covered CA and may be adjusted at the end of the year based after comparing your actual income to your anticipated yearly income.

Cost sharing subsidies (CSR) are available for individuals and families who meet certain income requirements and do not have access to affordable health insurance through their employer or a government program such as Medi-Cal. CSR are only available for those who purchase health insurance through Covered California. Cost-sharing subsidies reduce the amount of money you have to pay for healthcare expenses such as co-payments and deductibles when you visit your doctor.
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Am I still eligible if I have a pre-existing condition?

Under the ACA, a person cannot be denied health insurance coverage for a pre-existing health condition. You can purchase health insurance regardless of any current or past health conditions, and insurance companies cannot charge you a different premium.
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Do I need to be a citizen or legal resident to qualify for new ACA health coverage options?

Legal permanent residents are eligible to purchase insurance through Covered CA, regardless of income. Some legal permanent residents who meet the income criteria are also eligible for Medi-Cal.

If you do not qualify for Medi-Cal or Covered CA, you may be eligible for Healthy San Francisco. Healthy San Francisco is a health access program, not health insurance.

To find out what you qualify for insurance, visit www.coveredca.com or call 800-300-1506, Monday through Friday 8 am to 8 pm or Saturday 8 am to 6pm. For more information about Healthy San Francisco, visit www.healthysanfrancisco.org or call 415-615-4555 Monday through Friday 8:30am-5:30pm.

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Am I eligible for Medi-Cal?
The current Medi-Cal coverage is for families with children, pregnant women, and aged, blind and disabled individuals. To be eligible for the current Medi-Cal program, applicants also need to meet certain other criteria regarding income and property. Families with children, pregnant women, and aged, blinded and disabled individuals will continue to be eligible for Medi-Cal after January 1, 2014.

Starting January 1, 2014, more people will be eligible for Medi-Cal. Medi-Cal will be expanded to cover low income adults (ages 19-64). Eligibility for the expanded Medi-Cal program will be based on income as calculated on your tax return. If you are an individual with an income of less than $15,856 or a family of four making less than $32,500 per year, you likely are eligible for Medi-Cal.

If your income exceeds the Medi-Cal eligibility limit, your family may qualify for financial help with buying health insurance coverage from https://www.coveredca.com starting January 1, 2014. Open enrollment for Covered California begins October 1, 2013 through March 31, 2014.
 

How do I apply for Medi-Cal?

You can apply:
• Online at https://www.mybenefitscalwin.org/
• Over the phone - toll free 855-355-5757 – M-F 8am-5pm
• In Person - 1440 Harrison Street, San Francisco, CA 94103 – M-F 8am-5pm
• By Mail – Human Services Agency – PO Box 7988, San Francisco, CA 94188 

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I am currently on Medi-Cal, do I need to do anything?

Persons who are currently eligible to Medi-Cal will still be eligible for Medi-Cal after January; you don’t need to complete a new application for health coverage. When you have a change to report or when your renewal is due in 2014, you will need to provide additional information about your tax household and your consent for electronic verification to determine which health coverage program and/or financial assistance you are eligible to receive.
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I am currently in the SF PATH (LIHP) program, do I need to do anything to continue my health coverage?

The SF PATH (LIHP) program ends on December 31, 2013. Your eligibility for health benefits will automatically move to the Medi-Cal program beginning January 1, 2014 if you meet income eligibility. You will not have to do anything to be enrolled into Medi-Cal. You will receive a packet in the near future from the state with more information on the move to Medi-Cal and the Medi-Cal health plans available to you. If you have more questions contact SF PATH customer service at 415-615-4510, M-F 8am-5pm or visit http://www.sfpath.org/
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I am currently receiving CalWORKs, will I qualify for one of the new ACA health coverage options?

If you are receiving cash assistance through the CalWORKs program, you are already receiving health coverage through Medi-Cal. If you would like specific information about a certain household member, call the San Francisco Human Services Agency CalWORKs program at 415-557-5723, M-F 8am-5pm. 
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I am currently receiving CalFresh (Food Stamps), will I qualify for one of the new ACA health coverage options?

You will likely qualify for one of the new ACA health coverage options (Medi-Cal or Covered California), or Healthy San Francisco. To get assistance determining which healthcare program (including financial assistance) you are eligible for contact the SF BenefitsNet Service Center at 855-355-5757, or 1440 Harrison St, M-F 8am-5pm. You may also visit the San Francisco Human Services Agency CalFresh office at 1235 Mission St., M-F 8am-5pm. You can also apply online for new ACA health coverage options (including Covered California and Medi-Cal) via the Covered California website (www.CoveredCA.com).

From October 1, 2013 – December 31, 2013 if you qualify for Medi-Cal under the current rules then your health coverage will begin right away. If you do not qualify for Medi-Cal under the current rules, then health coverage under the new ACA rules will begin January 1, 2014. 
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I am currently enrolled in Healthy San Francisco, am I impacted?

You may qualify for new free or affordable health insurance options through Medi-Cal or Covered CA. If you qualify for Medi-Cal or Covered CA, you will no longer be eligible for Healthy San Francisco. Your Healthy San Francisco Application Assistor can help you understand your options. Visit www.healthysanfrancisco.org or Call (415) 615-4588.

Healthy San Francisco will still be here for San Francisco residents who do not qualify for new options in 2014.
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I have private insurance, how does Health Care Reform impact me?

If you currently have insurance, you do not have to take any action. However, you may qualify for more affordable health insurance options. Visit www.coveredca.com or call (800) 300-1506 M-F 8am-8pm or Saturday 8am-6pm to explore your options.
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I have health insurance through my employer, do I need to do anything?

No you do not need to sign up for any other health insurance coverage if you are already covered through your employer. Open enrollment dates are determined by your employer and may not be the same as the open enrollment time period of the Affordable Care Act.
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What is Covered California?

Covered California is California’s Health Benefit Exchange – a new marketplace for affordable health insurance. 
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What is Medi-Cal?

Medi-Cal is a public health insurance program that offers eligible individuals and families access to free or low-cost health care coverage. 
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What is Healthy San Francisco?

Healthy San Francisco is San Francisco’s local health access program for uninsured adults who do not qualify for one of the new ACA health coverage options. Healthy San Francisco is designed to make health care services available and affordable to uninsured San Francisco residents. It is operated by the San Francisco Department of Public Health (DPH).

After the Affordable Care Act goes into effect, January 1, 2014, the Healthy San Francisco Program will continue to provide health care access to San Francisco residents ages 18-64 with household incomes from 0-500% of the Federal Poverty Level, who do not have health insurance and are ineligible for health insurance through either Medi-Cal or Covered California.

Healthy San Francisco can be reached in the following ways:
Visit www.healthysanfrancisco.org or Customer Service representatives are available Monday through Friday from 8:30am to 5:30pm.
• Participants & Visitors: 415-615-4555
• TDD/TTY for People who are Deaf, Hard-of-Hearing, or have Speech Disabilities: 415-547-7830
• Email: info@healthysanfrancisco.org
• Mail: Healthy San Francisco,201 Third Street, 7th Floor, San Francisco, CA 94103
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