What is the Affordable Health Care Act (ObamaCare)? Whether you need health coverage or have it already, the health care law offers new rights and protections that make coverage fairer and easier to understand. How the law protects you Creates the Health Insurance Marketplace, a new way for individuals, families, and small businesses to get health coverage Requires insurance companies to cover people with pre-existing health conditions Helps you understand the coverage you re getting Holds insurance companies accountable for rate increases Makes it illegal for health insurance companies to arbitrarily cancel your health insurance just because you get sick Protects your choice of doctors Covers young adults under 26 Provides free preventive care Ends lifetime and yearly dollar limits on coverage of essential health benefits Guarantees your right to appeal What do the plans cover? The Affordable Care Act ensures health plans offered in the individual and small group markets, both inside and outside of the Health Insurance Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits are minimum requirements for all plans in the Marketplace. The essential health benefits include at least the following items and services: Ambulatory patient services (outpatient care you get without being admitted to a hospital) Emergency services Hospitalization (such as surgery) Maternity and newborn care (care before and after your baby is born) Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) Prescription drugs Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) Laboratory services Preventive and wellness services and chronic disease management Pediatric services
How to get health insurance under the Affordable Care Act In order to receive the benefits of the Affordable Care Act you must register through the Health Insurance Marketplace. This marketplace is located at www.healthcare.gov or you can find your state s registration website here. After registration you can compare coverage plans, view if you are qualified for additional coverage, get quotes, and purchase health insurance. You also have the options to go directly to a health insurance company in your area to receive coverage however they may or may not offer coverage under the Essential Health Benefits afforded under the Affordable Care Act. Please thoroughly view any coverage plan before purchasing. Most people must have health coverage in 2014 or pay a fee. If you don t have coverage in 2014, you ll have to pay a penalty of $95 per adult, $47.50 per child, or 1% of your income (whichever is higher). The fee increases every year. Some people may qualify for an exemption to this fee. To avoid the fee, you need coverage that qualifies as minimum essential coverage. For 2014, you will be considered covered (and won t have to pay a fee) if you have any of the following plans: Any employer plan (including COBRA) Any individual insurance plan that you already have Any Marketplace plan Medicaid Medicare Peace Corps Volunteer plans The Children s Health Insurance Program (CHIP) TRICARE (active and retired military, families and survivors) Veterans health care programs If you don t have coverage in 2014 you may not have to pay the fee if you: Are a member of a federally recognized Indian tribe Are insured for at least nine months of the year Don t have to file a tax return because of low income Have a very low income and you cannot afford coverage (you must complete an application on the Marketplace to determine whether your income qualifies you for an exemption) Participate in a health care sharing ministry Would qualify for Medicaid (under the new income limits) but your state has chosen not to expand eligibility Are a member of a recognized religious sect (such as the Amish and some Mennonite sects) that objects to health insurance
I have health insurance, how does the Affordable Care Act affect me? If you have coverage, you gain new protections. You receive coverage of Essential Health Benefits, coverage of services for pre-existing health conditions, and also limits on how much your premiums can vary based on your age. These new protections will take effect starting January 2014. The only individual plans that don t have to provide these protections are grandfathered individual plans. These plans have existed largely unchanged since the health care law was passed. These plans don t have to make any changes, and if you like you can keep the plan for as long as it s offered. To find out if you have a grandfathered plan; Check your plan s materials: Health plans must disclose if they are grandfathered in all materials describing plan benefits. They must offer contact information. Check with your employer or your health plan's benefits administrator. What grandfathered plans do and don't have to cover All health plans must: End lifetime limits on coverage End arbitrary cancellations of health coverage Cover adult children up to age 26 Provide a Summary of Benefits and Coverage (SBC), a short, easy-to-understand summary of what a plan covers and costs Hold insurance companies accountable to spend your premiums on health care, not administrative costs and bonuses Grandfathered plans DON'T have to: Cover preventive care for free Guarantee your right to appeal Protect your choice of doctors and access to emergency care Be held accountable through Rate Review for excessive premium increases In addition to the above, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) don't have to: End yearly limits on coverage Cover you if you have a pre-existing health condition I have health insurance through my employer If you have job-based health insurance you like, you can keep it. You're considered covered. Any job-based health plan you currently have qualifies as minimum essential coverage. You don't need to change to a Marketplace plan in order to avoid the fee that uninsured people may have to pay for 2014.
What are the different types of health insurance? Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs) o HMOs and EPOs may limit coverage to providers inside their networks. A network is a list of doctors, hospitals, and other health care providers that provide medical care to members of a specific health plan. If you use a doctor or facility that isn't in the HMO s network, you may have to pay the full cost of the services provided. Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS) o These insurance plans give you a choice of getting care within or outside of a provider network. With PPO or POS plans, you may use out-of-network providers and facilities, but you ll have to pay more than if you use in-network ones. If you have a PPO plan, you can visit any doctor without a referral. If you have a POS plan, you can visit any in-network provider without a referral, but you ll need one to visit a provider out-of-network. High Deductible Health Plan (HDHP) o High Deductible Health Plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1250 per year for individual coverage and $2500 for family coverage. If you have an HDHP, you can use a health savings account or a health reimbursement arrangement to pay for qualified out-ofpocket medical costs. This can lower the amount of federal tax you owe. Catastrophic Health Insurance Plan o A catastrophic health insurance plan covers essential health benefits but has a very high deductible. This means it provides a kind of "safety net" coverage in case you have an accident or serious illness. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher. This means you must pay thousands of dollars out-of-pocket before full coverage kicks in.
Four health plan categories Bronze, Silver, Gold and Platinum The different levels are intended to meet various health and financial needs, and are based on the percentage that each plan pays towards health care services. The plan levels also indicate the percentage you will pay towards the health care you receive. Your portion of these costs is in the form of: Plan Level What the Plan Spends What you Spend Bronze 60% 40% Silver 70% 30% Gold 80% 20% Platinum 90% 10% The lower the amount of coverage, the lower the premium you must pay to maintain coverage. Bronze level plans have the lowest premiums, but also the lowest level of coverage. As the plan levels increase (from Bronze to Silver to Platinum), your monthly premium increases but so does the level of coverage. For example, you will pay a higher premium for a Platinum plan but you will pay less for each doctor visit, prescription, or health care service that you use. How much will it cost? For any plan, your monthly premium will be based on several factors including Your age Whether or not you smoke (in some states you will pay a surcharge if you are a smoker) Where you live How many people are enrolling with you (spouse and/or child) Your insurance company You may visit any of our health insurance companies for a free online quote.