HEALTH CARE TIP: Adult Dental Benefits


Adult dental benefits were fully restored to Midi-Cal recipients effective January 1, 2018, as part of the 2017-2018 Budget Act. Now major services such as partial dentures, root canals on back teeth and gum treatment are covered. Along with an array of general maintenance services such as cleanings, x-rays and fillings and more, Western Center on Law & Poverty has a one-page fact sheet on the restored adult dental benefits.

Still, ongoing access to Denti-Cal services and providers is an issue in California. In 2015, the state appointed a State Dental Director to address Denti-Cal access. To access Denti-Cal and take advantage of these adult dental benefits enroll in Medi-Cal through Covered CA.

Reminder: Covered CA open enrollment ends Wednesday, January 31, 2018.


Importance of the First Premium Payment for 2018 Health Coverage


First, the deadline to enroll for 2018 health coverage is Wednesday, January 31, 2018, so enroll now.

Once signed up for a 2018 health plan through the marketplace, it is very important to pay the first month’s premium on time to activate coverage. If there are issues paying the first month’s premium payment in full, the Health Insurance Premium Payment Program may be able to provide financial assistance. Also, consider reaching out to the insurance company to understand payment options and/or grace periods. Once again, the first premium payment needs to be paid, or there is a chance of losing 2018 coverage.

If enrollment is not complete by January 31, 2018, there will not be another opportunity to enroll unless you qualify for a Special Enrollment Period. If you or someone you know is HIV+ and a San Francisco resident, PRC may be able to help with problems accessing health coverage.

Open Enrollment Is Still On!

Open Enrollment is Still On!

Open Enrollment Is Still On!

Despite numerous attempts this year at repealing the Affordable Care Act, open enrollment is still on! This year’s health insurance enrollment cycle begins on November 1, 2017 and ends on January 31, 2018. Enrolling is easy and may be done through Covered CA online, by phone (1-877-453-9198), or in-person with one of San Francisco’s many enrollment workers.

Covered CA Basics

Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.

Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including prescription drugs, mental health care, and emergency services.

This Years’ Changes

  • The federal government has eliminated cost-sharing reductions (CSRs) payments to insurance companies. CSRs help people enrolled in Enhanced Silver tier plans pay for out-of-pocket costs like deductibles and co-pays. Covered CA has taken steps to minimize the impact of the loss of CSR funding by adding a premium surcharge to silver-level plans only. The surcharge will be offset by an increase in advance premium tax credit, so most consumers will see their monthly premiums stay the same or decrease.
  • Anthem Blue Cross will no longer offer coverage options in San Francisco County. Affected members will receive an official notice that their plan is ending. The notice will contain information on new carrier options and how to switch carriers. Members may choose a new plan within 30 days of the date of the notice. If they do not, they will be automatically placed in the lowest cost plan that is in the same metal tier as their current plan.

Need help paying for health insurance costs?

Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) and the AIDS Drug Assistance Program (ADAP) help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.

Get Help

Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident, you can contact PRC for additional help and information:  415-777-0333.