Question 1

Is gender-affirming surgery covered by health insurance in Los Angeles?

Accepted Answer

Gender-affirming medical treatments are generally included in transgender health benefits provided by health insurance plans in Los Angeles. Contact your health insurance provider for more details, as coverage for gender-affirming care varies based on location and your specific health plan. You might also be required to make an upfront co-payment, either a flat fee or a percentage of the procedure cost.

Question 2

What is the bronze health insurance plan in Los Angeles?

Accepted Answer

The bronze health insurance plan in Los Angeles usually offers the lowest monthly premium. However, when medical attention is needed, it often involves high costs and a substantial deductible amounting to thousands of dollars annually. People seeking coverage for serious medical situations, such as severe diseases or injuries, should generally consider bronze health insurance.

Question 3

Who is eligible for Medi-Cal in Los Angeles?

Accepted Answer

You could qualify for Medi-Cal in Los Angeles if you're under 19 and your income is equal to or less than 266% of the federal poverty level, or if you're 65 years or older with a disability and your income is at 138% or below. You may also be eligible if your income falls within 138% of the FPL for your household size, or if you're pregnant with an income equal to or less than 213%.

Question 4

What costs and services are covered by Medi-Cal in Los Angeles?

Accepted Answer

Medi-Cal in Los Angeles covers essential healthcare services deemed "medically necessary," including the following:

X-rays and lab tests.
Hospital and nursing home care.
Doctor's appointments.
Home healthcare.
Prosthetic and orthopedic devices.
Hearing aids.
Some prescription drugs that are not covered by Medicare Part D.
Ambulance services.
Medical equipment.
Dental services through the Denti-Cal program.
Hospice care. These expenses and services would only be covered if you receive them from providers who accept Medi-Cal.

Question 5

What does the Health Incentive Account refer to in Los Angeles?

Accepted Answer

A health incentive account in Los Angeles is a health fund established by your employer's health plan. When you engage in particular activities to improve your health, funds will be added to this account. These funds can offset your share of healthcare expenses, such as coinsurance or deductibles. Any unused funds can roll over to the next year as long as you stay employed.

Question 6

How can you find affordable health insurance?

Accepted Answer

Affordable insurance is available through employers, Medicare, Medicaid, and the federal Health Insurance Marketplace, which offers subsidies in the form of tax credits. You can also purchase coverage through private insurance companies and independent agents. Nearly half of all Americans have employer-sponsored health insurance, and about 10% of the population is uninsured.

Question 7

What is health insurance?

Accepted Answer

Health insurance policies are contracts that require an insurer to pay some or all of a beneficiary's health care expenses in exchange for a premium and deductible. Plans cover preventive care and emergency medical services arising from an injury or illness. They may also offer optional coverage for dental and vision.

Question 8

How do health insurance companies make money?

Accepted Answer

Health insurance companies make money by collecting premiums from consumers and reinvesting the funds. Federal law requires insurers to put approximately 80-85% of collected funds toward claims, and 15-20% is used to pay for administrative expenses.

Question 9

What is subsidized health insurance?

Accepted Answer

Subsidized health insurance is available exclusively through the Health Insurance Marketplace. This system applies federal tax credits that can reduce or eliminate premiums. Tax credits are available to consumers who earn up to 400% of the federal poverty level based on household size.

Question 10

What is a health insurance deductible?

Accepted Answer

A deductible is a fixed amount you must pay out-of-pocket before normal copays or coinsurance rates apply. Under the Affordable Care Act, some services, such as annual physicals and wellness screenings, must be covered at no charge.

Question 11

Is it illegal to not have health insurance?

Accepted Answer

No. Starting in 2019, the federal government eliminated the penalty that applied to individuals who could afford health insurance but chose not to purchase it. Financial penalties still apply in California, Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C.

Question 12

Does health insurance cover therapy?

Accepted Answer

All Marketplace plans must cover behavioral health care services, including counseling, inpatient care, and substance abuse treatments. However, there are coverage limits, and preauthorization may be required.

Question 13

What is a copay?

Accepted Answer

A copay is a fixed price that you pay at the time of service after your deductible is satisfied. Insurance companies set specific rates for primary and specialty care and other services, such as emergency room visits and X-rays. Alternatively, plans may have coinsurance rates that require beneficiaries to pay a certain percentage of covered charges.

Question 14

What is the Health Insurance Marketplace?

Accepted Answer

The Health Insurance Marketplace is a federal service designed to help consumers compare and purchase subsidized health insurance plans that comply with the Affordable Care Act. A number of states operate their own insurance marketplaces, including California, Colorado, New York, and Pennsylvania.

Question 15

How can you find health insurance without a job?

Accepted Answer

Individuals who don't have access to health insurance through their job can purchase ACA-compliant plans through the Health Insurance Marketplace. Off-exchange plans are also available through private insurers and independent agents. The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives certain individuals who are losing their coverage the right to maintain the same plan for a limited time period.

Question 16

Can you cancel health insurance at any time?

Accepted Answer

Consumers can cancel their health coverage at any time. Cancellations may be effective immediately or at a specified date. However, you must wait until Open Enrollment to sign up for a new plan unless you qualify for a Special Enrollment period.

Question 17

Can you have more than one health insurance policy?

Accepted Answer

It's possible to have primary and secondary health insurance. This is most common with Medicare and Medicaid beneficiaries, including dual enrollees and individuals who purchase supplemental plans. Secondary plans can cover some additional expenses, but you're still responsible for premiums and deductibles.

Question 18

Is health insurance pretax?

Accepted Answer

Premiums for employer-sponsored health plans are generally deducted from the worker's pretax income. The same is true for voluntary contributions made to Flexible Spending Accounts and Health Savings Accounts that are paired with a qualifying high-deductible health plan.

Question 19

How long can a child stay on a parent\'s health insurance policy?

Accepted Answer

Children can stay on their parents' health insurance plan until their 26th birthday. There's a 60-day special enrollment period following this date. Exemptions allow disabled adult children to remain on their parents' policy beyond this age.

Question 20

Do you have to pay a health insurance deductible upfront?

Accepted Answer

In most cases, out-of-pocket expenses for approved services count toward your deductible. However, it's increasingly common for hospitals to request all or part of the deductible upfront when scheduling major services, such as CT scans and surgeries.

Question 21

Do employers have to offer health insurance?

Accepted Answer

The Affordable Care Act requires companies with at least 50 full-time employees to make essential health benefits available to 95% of their workforce. Companies that choose not to offer such benefits may have to pay a penalty.

Question 22

Is there a tax credit for having health insurance?

Accepted Answer

The Advance Premium Tax Credit is a federal tax rebate designed to lower the cost of health insurance plans purchased through the Marketplace. Eligibility is based on income and household size. Consumers can decide how much of their tax credit to put toward their premiums.

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Frequently Asked Questions

Introduction

Is gender-affirming surgery covered by health insurance in Los Angeles?

What is the bronze health insurance plan in Los Angeles?

Who is eligible for Medi-Cal in Los Angeles?

What costs and services are covered by Medi-Cal in Los Angeles?

What does the Health Incentive Account refer to in Los Angeles?

How can you find affordable health insurance?