Health care reform

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Your Guide to the
Health Care Reform Law

I’m covered by my employer

Greater peace of mind for you and your family

If you currently have health care coverage through your employer, you may be enjoying some of the added benefits from health care reform. For example, the following benefits are in effect for plans that must comply with the requirements of the Affordable Care Act (ACA).*

• Expanded no-cost preventive care. This includes certain immunizations, diabetes and cancer screenings, and more.
• No annual or lifetime dollar limits on essential health benefits.
• Your kids turning 26 can stay on your Kaiser Permanente Individual and Family plan until the end of the plan year during which they turn 26 instead of the end of the birth month.
• You and members of your family with pre-existing health problems can be covered.

*Some of these benefit changes don't apply to “grandfathered” health plans. Your employer and your issuer should let you know if your plan is grandfathered.

If you work for a large company

You can get coverage through your employer or through the Health Benefit Exchanges (also known as the marketplaces). Check with your employer for more information during your next annual open enrollment period.

If you work for a small business

Check with your employer for information on how to get coverage. You may be able to select coverage through your employer, the Small Business Health Options Program (SHOP), through your local health benefit exchange, or through us. In the District of Columbia, you can only apply through DC Health Link.

Visit healthcare.gov to review SHOP options for each state (federal vs. state-based health benefit exchange). If your employer doesn't offer health coverage, you may be able to get federal financial assistance. Visit your local health benefit exchange to find out if you qualify.

I’m covered on my own

It feels good to know you’re covered

Our health plans include all the protections of the health care law.

If you decide to change plans, you can visit the health benefit exchange to compare health plans. If you find a plan that better meets your needs, you can buy it through the health benefit exchange or purchase a plan directly from us during the annual open enrollment period or when you have a qualifying life event. Qualifying life events open up a special enrollment period.

You may be able to get federal financial help if you qualify. To do so, you need to apply and get your coverage through the health benefit exchange. You may also qualify for additional state financial assistance, even if you haven't qualified for federal financial assistance in prior years.

If you're a Kaiser Permanente member, we’ll continue to have information to help 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 issuers you know and trust, and the convenient services you’ve come to rely on.

Greater peace of mind for you and your family

If you currently have individual or family health care coverage, you may be enjoying some of the added benefits from health care reform. For example, the following benefits are in effect for plans that must comply with the requirements of the Affordable Care Act (ACA).*

• Expanded no-cost preventive care. This includes certain immunizations, diabetes and cancer screenings, and more.
• No annual or lifetime dollar limits on essential health benefits.
• Your kids turning 26 can stay on your Kaiser Permanente Individual and Family plan until the end of the plan year during which they turn 26 instead of the end of the birth month.
• You and members of your family with pre-existing health problems can be covered.

*Some of these benefit changes don't apply to “grandfathered” health plans. Your employer and your issuer should let you know if your plan is grandfathered.

More options for how you get and pay for coverage

Financial help from the federal or state government

There are 2 kinds of federal financial help that may be available to you. One kind helps pay your monthly health plan 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 financial help through your state or federal marketplace.
• You can only get financial help when you buy coverage through the marketplaces.
• In California, you may qualify for additional state financial assistance even if you haven't qualified for federal financial assistance in prior years.

For some general income guidelines and to see if you qualify for federal financial help, visit buykp.org. You can also compare plans, calculate your rate, or apply online.

Health Benefit Exchanges

Health benefit exchanges are federally or state-run exchanges where you can shop, compare, and buy individual, family, or group health care coverage. They are sometimes called “marketplaces.”

• You can choose a plan based on price, benefits, quality, and other features that are important to you.
• You can purchase Kaiser Permanente plans directly through us, and they are also available through the health benefit exchanges. To qualify for financial assistance from the federal government, you must purchase a plan through your exchange.

(Exception: Residents of the District of Columbia who are purchasing health care coverage on their own must buy coverage through DC Health Link.)

Levels of coverage

Health benefit exchanges offer health plans from different companies and several levels of coverage. You can choose a plan that meets your personal situation and needs.

All plans are grouped into several levels of coverage. These levels (referred to as metal plans) make it easier for people to compare plans offered by different insurance companies.

• All metal plans offer essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include certain preventive services at no cost.
• The most affordable level generally offers lower premiums but higher copays, coinsurance, and deductibles. The other levels generally have higher premiums but lower copays, coinsurance, and deductibles.
• If you qualify, you'll have the additional option of a Catastrophic plan (known as Minimum Coverage in California) which is usually a high-deductible plan with low monthly premiums. (The Hawaii region doesn't offer a Catastrophic plan.)
• In general, you can only change or apply for health care coverage during the annual open enrollment period. But if you have a qualifying life event, you may be able to change or apply for coverage for a limited time before or after this event occurs. This is called a special enrollment period.

For more information on special enrollment periods and qualifying life events, visit kp.org/specialenrollment.

Kaiser Permanente members

Link directly to the health benefit exchange for your region here.

I’m a Medicare beneficiary

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're a Kaiser Permanente Medicare health plan member, you don’t need to take any action to maintain your Medicare health plan.

If you're covered on your own, you can get information about Medicare health plans available to you by visiting medicare.gov. Information about our 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.

I’m not covered

Take control of your health and your care

The Affordable Care Act (ACA) provides options for how you get and pay for coverage.

• You and your family members can be covered, even if you have pre-existing health problems. You can apply for financial assistance from the federal government to help pay for premiums and out-of-pocket costs when you purchase coverage through the health benefit exchange.
• Federally and state-run health benefit exchanges are available to help you shop, compare, and buy health care coverage.
• Our plans are available through the health benefit exchanges. Or, you can get your coverage directly from us (unless you live in the District of Columbia). 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 federal or state exchange.
• In California, you may qualify for additional state financial assistance, even if you haven't qualified for federal financial assistance in prior years.

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.

What all metal health plans have in common

Here are the added protections from health care reform that every metal plan includes.

• Expanded no-cost preventive care, including certain immunizations, diabetes and cancer screenings, and more.
• No annual or lifetime dollar limits on essential health benefits.
• Your kids turning 26 can stay on your Kaiser Permanente Individual and Family plan until the end of the plan year during which they turn 26 instead of the end of the birth month.
• You and your family members with pre-existing health problems can be covered without any exclusion periods.

More options for how you get and pay for coverage

Financial help from the federal government

There are 2 kinds of federal financial help that may be available to you. One kind helps pay your monthly health coverage premium. The other helps with your out-of-pocket expenses for care. You may qualify for 1 or both, and the federal government can pay your health plan directly.

• Qualification is based on your income and family size, where you live, and if you're a U.S. citizen or legal resident in the U.S.
• You can apply for federal financial help through your federal or state health benefit exchanges.
• You can only get financial help when you buy coverage through an exchange.

For some general income guidelines and to see if you qualify for federal financial help, visit buykp.org. Here you can also compare plans, calculate your rate, or apply online.

Health Benefit Exchanges

Health benefit exchanges are federally or state-run exchanges where you can shop, compare, and buy individual, family, or group health care coverage. They are sometimes called “marketplaces.”

• You can choose a plan based on price, benefits, quality, and other features that are important to you.Our plans are available through the exchanges.

Or, you can get your coverage directly from us (unless you live in the District of Columbia). 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 federal or state health benefit exchange.

Levels of coverage

Health benefit exchanges offer plans from different companies with several levels of coverage. You can choose the plan that's the best fit for your personal situation and needs.

• All plans offer essential health benefits (such as doctor visits, hospital care, prescriptions, and maternity care). They also include certain preventive services at no cost.
• All plans are grouped into several levels of coverage. These levels (referred to as metal) make it easier for people to compare metal plans offered by different companies.
• The most affordable level generally offers lower premiums but higher copays, coinsurance, and deductibles. The other levels generally have higher premiums but lower copays, coinsurance, and deductibles.
• If you qualify, you'll have the additional option of a Catastrophic plan (known as Minimum Coverage in California), which is usually a high-deductible plan with low monthly premiums. (Hawaii doesn't offer a Catastrophic plan.)
• In general, you can only change or apply for health care coverage during the annual open enrollment period. But if you have a qualifying life event, you may be able to change or apply for coverage for a limited time before or after this event occurs. This is called a special enrollment period.

For more information on qualifying life events and special enrollment periods, visit kp.org/specialenrollment.