Today’s post comes from Kaiser Permanente’s health care reform website.
Q: What is health care reform?
A: The term “health care reform” refers to the federal Affordable Care Act (ACA), as well as any state laws passed to put it in place. These laws are intended to help more people get affordable health care coverage and receive better medical care.
Q: What do I need to do now?
A: You may want to learn all you can about health care reform, and how it might affect your health coverage. If you are a Kaiser Permanente member, there’s nothing you need to do right now. We’ll be in touch with you to let you know of anything that affects you and your coverage.
Q: What are the Health Insurance Marketplaces?
A: Marketplaces, sometimes called “exchanges”, are state- or federal-run places where people can buy health care coverage. They include websites, call centers, and physical locations, so you can get coverage online, over the phone, or in person. You can compare and choose health plans offered by private companies, get answers to questions, and find out if they are eligible for financial assistance or special programs.
Marketplaces will also operate a Small Business Health Options Program (SHOP). There, small-business employers can purchase coverage for their employees. SHOP Marketplaces will be open for enrollment this fall, and coverage purchased there will be effective January 1, 2014, or later, depending on the employer’s renewal date and application date. (Exception: Maryland SHOP opens January 1, 2014, and coverage can begin after March 1, 2014.)
Q: Do I have to buy from the Marketplace?
A: No. A Marketplace is just one of the ways people can shop for health coverage. However, you can only get financial assistance from the government if you buy coverage through a Marketplace. (Exception: Residents of Washington, D.C., purchasing health coverage on their own must buy coverage from the Marketplace.)
Q: Who has to buy health insurance?
A: Beginning January 1, 2014, the Affordable Care Act requires most U.S. citizens and legal residents in the U.S. to have minimum essential health coverage.
Some people will have coverage through their employer or through Medicaid or Medicare. If not, most will be required to purchase coverage from a health plan or through the Marketplace unless they are not required by the ACA to buy coverage.
Link directly to your state’s Health Insurance Marketplace here.
| State | URL |
|---|---|
| California | coveredca.com |
| Colorado | connectforhealthco.com |
| District of Columbia | dchealthlink.com |
| Georgia | healthcare.gov |
| Hawaii | hawaiihealthconnector.com |
| Maryland | marylandhealthconnection.gov |
| Oregon | coveroregon.com |
| Virginia | healthcare.gov |
| Washington | wahbexchange.org |
Q: What if I can’t afford to buy health care coverage?
A: There are two types of federal financial help from the government that may be available to you. One kind helps pay your monthly health insurance 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. Or, the ACA may not require that you buy coverage.
You will be able to find out if you qualify for reduced premiums and reduced cost-sharing when the Health Insurance Marketplaces launch in October. But here are some general income guidelines that might be used by the government to see if you qualify and how much help you would receive.
- If you’re single, you could qualify if you make less than $45,960 (or if you live in Hawaii, less than $52,920).
- For couples, you could qualify if you make less than $62,040 (or if you live in Hawaii, less than $71,400).
- For a family of four, you could qualify if you make less than $94,200 (or if you live in Hawaii, less than $108,360).
Q: What if I don’t buy health care coverage in 2014?
A: If you’re required to have coverage, you may have to pay a tax penalty if you go without insurance for 3 months or longer. You won’t owe a tax penalty if you are uninsured for less than 3 months (or one month or longer if you already had a coverage gap during the year).
Q: Can anyone get health care coverage?
A: Insurance companies can no longer deny coverage because you have a medical condition, and you don’t have to pass a medical exam to qualify for coverage.
Q: What services will be covered?
A: In general, for individual and small-group insured health plans, 10 broad categories of medically necessary services will be covered. This includes preventive care visits, immunizations, and screenings (such as mammograms and other cancer screenings). Maternity, newborn, and pediatric care will be covered, as well as emergency and hospital care. Laboratory services, prescriptions, and mental health (including substance abuse) services will also be covered. Some large-employer plans that were in effect before the Affordable Care Act was passed in March 2010 may not be required to cover all these services. Specific services and supplies, terms of coverage, and exclusions vary by state.
Q: What does a “grandfathered” plan mean?
A: A group health plan that’s had at least one person enrolled in it at all times since March 23, 2010, or that a subscriber had purchased on or before March 23, 2010, and meets other regulatory requirements. Grandfathered plans are subject to some ACA requirements and exempt from others. The plan’s issuer may make changes to the coverage as long as they are within certain limits.
For more information about the ACA, visit healthcare.gov.
