Ask Kathy …

We’ve all heard it … “There are no dumb questions.” Well, when it comes to health insurance that’s really true. And when it comes to the Affordable Care Act and all the changes we’re seeing today, that’s especially true. So here are some questions that people often ask. Click on the question to find the answer.

Answers to Common Questions

Where do Americans get their health insurance?
 Health insurance funding in the US has three major sources: employers, government and private insurers. Read more …
What is a pre-existing condition?

A pre-existing condition is any current health issue: 1)  for which a person has received treatment in the past or 2) for which a prudent person would have sought treatment. Pre-existing conditions may be anything as minor as a mild allergic reaction to dust or as serious as brain cancer or heart attack. Read more …

Can I be denied coverage because of a pre-existing condition?

Under the terms of the Affordable Care Act, no one can be denied coverage because of a pre-existing condition. This is known as Guaranteed Issue. However, outside of Open Enrollment periods (brief once-yearly periods), it will not be possible to purchase individual or family insurance policies, regardless of need.The restriction of access to purchase insurance policies is a way of controlling for adverse selection: the phenomenon of purchase of insurance only by those who are currently experiencing the loss against which the policy is designed to protect them.

Do the provisions regarding pre-existing conditions apply to Medicare?

The Affordable Care Act’s provisions regarding pre-existing conditions apply only to people in the under-65 insurance market. Medicare Supplements and Advantage plans follow different rules. During the Initial Enrollment Period, pre-existing conditions are not grounds for denial of coverage. After that time, underwriting is allowed except in the case of a few exceptions.

What is a Copay?
 A Copay is a small, fixed sum that must be paid by the insured for each prescription or medical service at the time the service is accessed. Another name for this fee is Copayment. Read more … 
Why do insurers cancel health policies?
Health care insurers phase out policies regularly. A long-standing practice, health insurance companies continuously evaluate the profitability of their products and stop selling them to new customers when they become unprofitable. Read more …
How do I get a new policy
Application for a new insurance policy through state or federal marketplaces can be done using paper applications, contacting call centers, or using the marketplace websites. Certified agents and enrollment counselors or navigators are ready to help. Read more …
Do people who get insurance through their employers qualify for a subsidy?
People who get their insurance through their employers do not qualify for an Advanced Premium Tax Credit (subsidy). If employers include coverage for dependents in their offering to employees, dependents cannot get a subsidy if they purchase a policy through the insurance marketplaces either. However, if dependents are specifically excluded from coverage under employer-sponsored insurance plans, they may qualify for a subsidy to help pay for their coverage. Standard income level guidelines apply.
Why can't I get a subsidy to help pay for my employer-sponsored health insurance?
Employer-sponsored coverage has been subsidized by the federal government since it was first established during World War II as a way that employers could increase employee compensation without increasing wages. Employers generally pay at least half the cost of the insurance for their employees. Read more …
Who set up the regulations for implementation of the Affordable Care Act?
The regulations for implementation of the Affordable Care Act have been developed in a cooperative process that includes the Department of Health and Human Services, the National Association of Insurance Commissioners, state officials, insurance companies, and providers of care. Read more …
Isn't the Affordable Care Act going to be too expensive?
The Affordable Care Act was set up in such a way that it has the potential to decrease the federal deficit over the ten year period by decreasing the cost of providing care and increasing the number of persons covered by private health insurers. Read more …
My policy is being cancelled and I'm afraid I won't be able to use the website. How can I get coverage?
There are three ways to apply for coverage. 1) Use a paper application and send it to Covered California (or your state’s marketplace exchange), 2) Work with a certified insurance agent, counselor or navigator, 3) Apply on your own through the websites.  Read more …
Where can I get a paper application?
All state exchanges offer paper applications, as does the federal site, A list of links is available here.
I live in California and have enrolled in a policy from Anthem Blue Cross. How will I get my bill?
Your bill from Anthem will come in a letter-size window envelop with the words IMPORTANT PLAN INFORMATION on the front of it. The letter will include your Application ID number. Please note, this ID number is not necessarily the same as the number on your Covered California application.

Your payment can be made by Bank Draft, Check/Money Order, eCheck, or Credit Card. Online payments may be set up at

Alternatively, you may send a check or money order to Anthem at:

Anthem Blue Cross
Individual Services
P.O. Box 9041
Oxnard, CA  93031-9041

Your insurance premium must be paid to complete your enrollment in your new health insurance plan.

Is health insurance from Costco less expensive?
Costco is working with a brokerage firm out of Nevada that has agents licensed in California. It offers plans from Blue Shield, Anthem, Health Net, and Assurant Health Plans. The Blue Shield, Anthem, and Health Net plans offer the possibility of subsidy, because they are the ones offered by Covered California, our state Affordable Care Act (ACA) marketplace. Read more …

How do I use my new policy?
Now that you have your new policy, it’s time to use it. Covered California has some good suggestions and we add a few others. Read more …