HCR 101: Your Guide to Understanding Healthcare Reform

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1 HCR 101: Your Guide to Understanding Healthcare Reform

2 Are You Ready for Healthcare Reform? By now, you ve probably been hearing a lot about the Affordable Care Act (also known as healthcare reform or Obamacare). It s a topic that s been getting a lot of attention, and there s no doubt that it brings changes to healthcare for both consumers and insurers. But don t worry, Blue Cross and Blue Shield of Alabama is here to help you make sense of it. We ve developed this guide to give you an overview of what healthcare reform is, how it will work and what it may mean for you. How the Affordable Care Act is Making a Difference for Alabamians The Affordable Care Act creates a new opportunity for Alabamians to find health coverage that fits their needs. For the Alabamians who don t have health insurance, many will likely qualify for a subsidy or tax credit to help pay for their healthcare expenses. The new law also eliminates medical underwriting which means insurance companies cannot discriminate and must accept everyone regardless of their current health status. HCRAlabamaBlue.com provides even more details and information about healthcare reform. 2

3 Key Highlights of the Affordable Care Act: The Individual Mandate One of the components of the Affordable Care Act that has received a lot of attention is the Individual Mandate. This is the part that goes into effect on January 1, 2014 and states that most everyone will need to have basic health insurance. If not, you may be subject to a tax penalty as imposed by the Affordable Care Act. Coverage Options for Young Adults Under the Affordable Care Act, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision which went into effect in 2010, over 49,000 young adults in Alabama have gained coverage. Pre-existing Conditions Beginning in 2014, health insurance companies will no longer be able to deny coverage to anyone because of a pre-existing condition. Better Value: The 80/20 Rule Health insurance companies now have to spend at least 80% of your premium dollar on healthcare or improvements to care, or provide you a refund. The Affordable Care Act rebate requirements went into effect last year and Blue Cross and Blue Shield of Alabama is proud to announce that for the second year in a row we will not have to issue rebates. Over 90 cents of every premium dollar we receive is used to pay healthcare claims to doctors, hospitals or other healthcare professionals. Removing Lifetime Limits on Essential Health Benefits The new law prevents insurance companies from imposing lifetime dollar limits on most health benefits, and also bans annual limits completely in Better Health: Covering preventive services with no deductible or copay The Affordable Care Act requires many insurance companies to provide coverage without cost sharing to enrollees for a variety of preventive health services such as colonoscopy screenings for colon cancer, pap smears and mammograms for women, well-child visits and flu shots for children and adults. 3

4 10 Essential Health Benefits All of our plans include 10 Essential Health Benefits. This ensures that people who purchase new plans will be getting access to a minimum standard of healthcare benefits. These include: Ambulatory patient services: Care you receive without being admitted to a hospital for example, at a clinic, physician s office or same-day surgery center. Emergency services: Care for conditions which, if not immediately treated, could lead to serious disability or death. Hospitalization: Care you receive as a patient in a hospital, such as room and board, care from doctors and nurses, and tests and drugs administered during your stay. Maternity and newborn care: Care provided to women during pregnancy as well as during and after labor; care for newly born children. Mental health and substance abuse disorder services: Care to evaluate, diagnose and treat mental health and substance abuse issues. Prescription drug coverage: Drugs prescribed by a doctor to treat an acute illness, like an infection, or an ongoing condition, like high blood pressure. Rehabilitation services and devices: Services and devices to help people with injuries, disabilities or chronic conditions gain or recover mental and physical skills. Laboratory services: Testing blood, tissues, etc. from a patient to help a doctor diagnose a medical condition and monitor the effectiveness of treatment. Preventive and wellness services and chronic disease management: These services include routine physicals, screenings, and immunizations. Chronic disease management is an integrated approach to manage an ongoing condition, like asthma or diabetes. Pediatric services, including oral and vision care: All plans include benefits for pediatric eye exams, glasses, dental exams, cleanings, fluoride treatment, fillings and oral surgery. 4

5 The Health Insurance Marketplace To help you compare plans and find one that best fits your needs, the new law calls for each state, or the federal government to create an online Health Insurance Marketplace. Starting on October 1, 2013, you will be able to go online and search for plans and clearly see each health insurance provider s benefits and costs on the Health Insurance Marketplace. Beginning October 1, visit to shop and compare all of our plans. Metal Levels An Easy Way to Compare Plans The Affordable Care Act recommends that all health insurance companies provide coverage at one or more of the following metal levels: Platinum, Gold, Silver and Bronze. Plans within each metal level will have similar benefit levels and meet the same guidelines. Plan pays:* Platinum 90 % You pay:* 10 % Gold 80 % 20 % Silver 70 % 30 % Bronze 60 % 40 % *On Average 5

6 Are you eligible for a subsidy or tax credit that could lower your health insurance expenses? Find out on October 1. Beginning in 2014, you may be eligible for financial assistance from the federal government to help lower your health insurance expenses. Known as subsidies, these are tax credits that you can use to offset the cost of your health insurance. Depending on your annual income, marital status, family size and other factors, you may be eligible for a subsidy. Save Time: You can find out if you qualify for a subsidy or tax credit faster by having these items ready when you call or go online. You will need: Identification: Your Social Security Number (or document number for legal immigrants) Wages: Employer and income information for everyone in your family (for example: pay stubs, W-2 forms, or wage and tax statements) Current Coverage: Policy numbers for any current health insurance you have Information about any jobrelated health insurance available to your family 6 Beginning October 1, see if you re eligible for a subsidy or tax credit by visiting: Or by calling a.m. to 8 p.m., 7 days a week

7 A Glossary of Terms Here are some of the important terms to understand when reviewing your options under the Affordable Care Act. Affordable Care Act: Legislation that requires most Americans to have health insurance. It also enacts new regulations for insurers, employers and providers, and requires them to offer consumers new coverage options, new ways to purchase insurance and even new financial tax credits to help pay for a plan s monthly premium. Copayment: A copay is the fixed dollar amount you pay for certain medical services or doctor visits at the time you receive care. It varies by plan and company. Cost Sharing: This refers to the portion of costs that are covered by your insurance that you share by paying out of your pocket. It doesn t include your monthly premium, but does include things like copayments and deductibles. Essential Health Benefits: This is the heart of the Affordable Care Act. It mandates a set of 10 benefits that all plans must now include as a way of ensuring that everyone has access to a minimum standard of benefits. Individual Mandate: A statute of the Affordable Care Act that requires most Americans to have health insurance. It goes into effect on January 1, If you don t have health insurance in 2014, you may be subject to a tax penalty. Metal Levels: A way of grouping health insurance plans by the percentage of costs that the plans cover. For example, all Platinum level plans will cover 90 percent of costs, all Gold level plans will cover 80 percent, and so on. Grouping plans this way makes it easier for buyers to compare a plan s benefits and costs. Subsidy (Tax Credit): Financial assistance that is available to help people pay for their health insurance. Eligibility is based on income level, marital status, family size and other factors. Qualified Health Plan: Also referred to as QHPs, these are plans that meet the criteria and provide the benefits required under the new law. Health Insurance Marketplace: A new way to compare and purchase health insurance. Available online and over the phone, Blue Cross and Blue Shield of Alabama will offer plans for sale on the Health Insurance Marketplace. 7

8 Choose Blue. Strong. Dependable. Local. When it comes to the quality you want in your health plan, look to Blue Cross and Blue Shield of Alabama and our more than 75 years of experience in serving Alabamians. We re proud to provide coverage to over 2 million Alabamians in our group, individual and senior market. HCR101_14 An Independent Licensee of the Blue Cross and Blue Shield Association For questions, call: Or visit HCRAlabamaBlue.com

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