HEALTH CARE R E F O R M

Transcription

1 HEALTH CARE

2 What does the Affordable Care Act mean to you? HEALTH CARE On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law. This marked the beginning of health care reform. Though many changes have already taken place since then, more significant ones will come as we approach 2014 and beyond. If you already have insurance You may not have to do anything if you already have insurance. But, it s a good idea to check with the person in charge of benefits at your company or your broker to see if your specific plan is affected. The health care reform law doesn t require you to get health insurance coverage differently than you do today, unless you qualify for financial assistance from the government to help you pay for coverage. Chances are that you may not need to switch plans in 2014 if you have coverage through your employer and are happy with your existing coverage. If your job has an open enrollment period, you could change your plan then, if you like. However, some individual and small employer plans may require changes. You may already benefit Depending on your specific plan, you may have already used some of the benefits that have begun as a result of the ACA. For example: t Children under age 26 years can stay on a parent s health plan. t People with pre-existing conditions can get coverage. t Preventive care benefits have been expanded. t Annual and lifetime dollar limits on essential health benefits have been eliminated. If you know someone who needs insurance People can shop for health insurance on the Health Insurance Marketplace, which opened on October 1, 2013, based on price and what s right for them. They ll see side-by-side comparisons of different plans to help make their decision easier. They can also sign up for a plan and pay for it. Based on their income, they may be able to get premium tax credits to help pay for their coverage. People who buy coverage on the Health Insurance Marketplace can start using their health insurance benefits on January 1, Individuals can also continue to buy insurance through buy.horizonblue.com and take advantage of the tax credits if they qualify. Paying for Coverage Tax credit Income 25.7 million people will be eligible for premium tax credits based on their income. 40% of people who currently purchase coverage on their own will not be eligible for tax credits. Source: Families USA, 2013, familiesusa.org 2

3 The Health Insurance Marketplace HEALTH CARE The health care reform law doesn t require you to get health insurance coverage differently than you do today. However, it will provide consumers with more ways to buy insurance. The Health Insurance Marketplace (originally called the individual exchange ) is one way individuals can shop for health insurance. Whether you need to buy health insurance through the Health Insurance Marketplace or want to help a family member who needs to, it helps to know how the Health Insurance Marketplace works. How does the Health Insurance Marketplace work? If you ve ever shopped for car insurance or flights online, you ll be familiar with the process. The Health Insurance Marketplace will work a lot like those websites. On the Health Insurance Marketplace, and on HorizonBlue.com, you can shop for health insurance based on price and your individual insurance needs. You ll see side-by-side comparisons of different plans to help make your decision easier. And, you can sign up for a plan and pay for it. Health insurance benefits purchased on the Health Insurance Marketplace are effective starting January 1, Horizon Blue Cross Blue Shield of New Jersey intends to offer plans on the Health Insurance Marketplace and on HorizonBlue.com. Individuals can use tax credits to buy plans from both places. Remember, the health care reform law does not require you to get health insurance coverage differently than you do today. 3

4 Using preventive care services for a healthier life HEALTH CARE Horizon Blue Cross Blue Shield of New Jersey is dedicated to helping you get and stay healthy. That s why we encourage you to use preventive care services to help you avoid illness and improve your health. We give you the tools, resources and support you need. Under the Affordable Care Act, beginning January 1, 2014, you and your family enrolled in non-grandfathered* health plans may be eligible for some preventive care services at no added cost to you when you stay in network. Plus, there are more preventive care benefits for women. Preventive care services include: t Blood pressure, diabetes and cholesterol screenings. t Cancer screenings, including mammograms and colonoscopies. t Counseling on such topics as quitting smoking, losing weight, eating healthy, treating depression and reducing alcohol use. t Regular well-baby and well-child visits from birth to age 21 years. t Routine shots against diseases such as measles, polio and meningitis. t Counseling, screenings and shots to ensure healthy pregnancies. t Flu and pneumonia shots. t Osteoporosis screening (age 60 years and older). Visit healthcare.gov/prevention for a full list of preventive care services. All new 2014 individual and small employer policies must generally cover 10 categories of benefits, many of which may not be included in the coverage individuals purchase today. 10 categories Source: Health and Human Services 4 4 things to know about preventive care services: 1. Availability: These benefits may not be available to all plans. Please check with the person in charge of benefits at your company. 2. Network doctors, hospitals and other health care professionals: You can receive preventive and wellness services through an in-network doctor, hospital or other health care professional for no additional out-of-pocket costs or copayments. 3. Office visit costs: Your plan can require you to pay some costs for office visits. This can happen if the preventive services are not the primary reason for your visit, or if your doctor bills for the preventive services separately from the office visit. 4. What s right for you: Talk to your doctor to know which covered preventive and wellness services are right for you based on your age, gender and health status. *Grandfathered health care plans are insurance plans that are not required to meet all the policies dictated in the Affordable Care Act (ACA). Most health care plans established before the passing of the ACA in March 2010 are eligible for grandfathered status.

5 HEALTH CARE Improving access The Affordable Care Act will expand access to insurance and broaden member benefits. These changes may give you access to new services at lower costs. Beginning in January 2014, every health plan sold within the individual and small group markets must generally include essential health benefits that cover 10 categories of services: t Outpatient services. t Emergency services. t Hospitalization. t Maternity and newborn care. t Mental health and substance abuse disorder services, including behavioral health treatment. t Prescription drugs. t Rehabilitative and habilitative services and devices. t Laboratory services. t Preventive and wellness services and chronic disease management. t Pediatric services, including oral and vision care. New benefits, new costs The health care reform law will expand access to insurance and broaden member benefits. Individuals can sign up for coverage, including those with pre-existing medical conditions. These new benefits bring new costs. Government assistance will be available to help qualifying individuals and families pay for coverage when they buy it through the Health Insurance Marketplace. Even with this new assistance, the new benefits will cause some people who currently have insurance to pay more than they do today. Individuals who receive coverage from a large employer are unlikely to see big changes, but many who purchase coverage on their own or get it through a small employer will see significant changes to their benefits and costs. Those changes will affect people differently, depending on where they live, what coverage they have today, their age, health, gender and income. For more information visit: Timeforaffordability.org 5

6 How your health care dollar pays for health care HEALTH CARE Under the Affordable Care Act (ACA), a health insurance company must meet a Medical Loss Ratio (MLR) requirement. MLR is a basic financial measurement used in the health care reform law. It requires health plans to spend a certain percentage of premium dollars to pay for customers' medical benefits, as opposed to expenses like company overhead or profit. The ACA sets the minimum required MLR at 80 percent for the individual and small group markets and at 85 percent for the large group market. In general, the higher the MLR, the more value customers receive for their premium payment. If an insurance company does not spend at least 80 or 85 percent of its annual premiums on health care costs, then it must give rebates to individuals and employer groups. If an insurance company spends more than 80 or 85 percent of its annual premiums on health care costs, then it does not need to give rebates. Your health care dollar pays for a lot of care Other Medical Services: Insurer Profits: Administrative Services: Physician Services: 28 Inpatient Costs: 19 Outpatient Costs: 19 Prescription Drugs: of every health care dollar goes directly to pay for medical care, 10 goes to administrative costs, and only 2 is profit. 2 Based on 2012 year-end data. Please note: The MLR rule does not apply to employers who operate what is called a self-insured plan. If you re not sure whether your plan is self-insured, ask your employer or check your plan materials. 6

7 HEALTH CARE Myths and about the Affordable Care Act Myths The ACA replaces private coverage with a new government-run insurance plan. Facts The ACA makes existing plans more accessible to people. New Jersey s Governor Christie vetoed legislation to have a state Health Insurance Marketplace (originally called an exchange ) so New Jersey does not have to meet many of the ACA s rules. No state is exempt from the ACA. The federal government will create a Health Insurance Marketplace for those states that choose not to create one. Horizon BCBSNJ plans will be available through the Health Insurance Marketplace as well as on HorizonBlue.com. Starting in 2014, everyone will need to have health insurance or pay a fine. Not entirely true. Some people are exempt from the fine, including those with religious reasons for not having health insurance, members of federally recognized Indian tribes and people who don t need to file taxes because their income is too low. If I don t have health insurance today, then the ACA does not affect me. In 2014, most people will need to have health care coverage. The ACA provides added protection for everyone, including the removal of lifetime limits from plans and access to in-network, preventive care for non-grandfathered* health plans with no cost sharing. People with pre-existing health conditions cannot get coverage. Starting in 2014, pre-existing health condition restrictions are eliminated. People with pre-existing conditions will be able to get coverage. Visit HorizonBlue.com/reform or healthcare.gov for more facts about health care reform. *Grandfathered health care plans are insurance plans that are not required to meet all the policies dictated in the Affordable Care Act (ACA). Most health care plans established before the passing of the ACA in March 2010 are eligible for grandfathered status. 7

8 HEALTH CARE 3 ways the Affordable Care Act (ACA) adds up to higher costs Still have questions about health care reform? As your health insurance company, we re here to help. This special newsletter will help you understand health care reform and what it could mean to you. You can also visit the following websites for more information: HorizonBlue.com/reform Healthcare.gov Askbluereform.com Timeforaffordability.org The information included in this document may be subject to change at any time as laws and regulations and related guidance are issued by state and federal agencies. This document is for educational purposes only. Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Horizon name, symbols and Making Healthcare Work are registered marks of Horizon Blue Cross Blue Shield of New Jersey Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey