Palo Alto Medical Foundation Newsroom

PAMF and Covered California

Beginning Oct. 1, legal residents of California who do not have health insurance from their job or from another government program will be able to buy insurance through the state’s new “exchange” called Covered California. On Jan. 1, 2014, most people will be required by the Patient Protection and Affordable Care Act (Affordable Care Act) to have health insurance. covered california logo

All health plans purchased through Covered California must cover certain services called essential health benefits. These include doctor visits, hospital stays, emergency care, maternity care, children’s care, prescriptions, medical tests and mental health care. They also must cover preventive care services, such as mammograms and colonoscopies.

If you buy coverage through Covered California, you may qualify for federal tax credits or subsidies. Tax credits are available to people who make up to 400 percent of the federal poverty level, or $46,000 a year for an individual and $94,200 for a family of four.

The plan options vary by location and are available at four different levels: bronze, silver, gold and platinum. A bronze plan will have the lowest monthly premium, and the insurance company will pay 60 percent of the cost of services and you will pay 40 percent. In a platinum plan, the insurance company pays 90 percent of the cost of services but you will pay a much higher premium.

PAMF’s Participation in Covered California

The Palo Alto Medical Foundation (PAMF) is participating in Covered California with several different Blue Shield individual/family plans and the Blue Shield small business health options program (SHOP). Blue Shield’s website has a tool you can use to get a health insurance quote providing specific information on plan benefits, premiums and health provider networks available to you – visit the Get a Quote Tool. You may also call 888-568-3560 to speak with a Blue Shield representative about selecting a Covered California health plan that allows you to receive care from PAMF.

For a list of Covered California health plans that include PAMF, visit our participating health plans page.

Health Care Reform

In 2010, the federal government passed the Affordable Care Act to increase the number of Americans with health insurance and decrease the cost of health care.

The law provides access to insurance for many people who have not had it – including people with pre-existing health conditions and those who cannot afford insurance.

A video from the Kaiser Family Foundation provides a brief overview of the Affordable Care Act.