Minor and Hunter received workshop training on the general facts and structures of the health care law and serve Bradley County as volunteer liaisons for Patient Protection Affordable Care Act education and outreach.
For information about your specific questions, please visit HealthCare.gov.
Q: What is the Affordable Care Act?
A: The Patient Protection and Affordable Care Act (ACA) became law in 2010 and has already improved current healthcare policies in the following ways:
1) Ban on lifetime limits — Your coverage won’t run out because insurance companies can no longer set a dollar limit on how much they will pay over the course of your life.
2) Expanded coverage for your children — You can now keep your children covered on your policy until they are 26 years of age.
3) Free preventive care and annual checkups — New plans must now cover cancer screenings, annual checkups and immunizations at no cost to you. There are additional free services for women.
4) Rebates from insurance companies — If they spend less than 80 percent of premiums they collect (85 percent for large employer policies) on medical care and quality improvements, insurance companies must send you a premium rebate.
ACA also includes these improvements:
1) No more pre-existing conditions — It is now illegal for insurance companies to turn you down or charge you more if you have a pre-existing condition.
2) Help with paying premiums — You may qualify for a new tax credit that will go immediately to the insurance company and lower the cost of your premiums.
3) Women cannot be charged more than men for the exact same coverage.
4) Benefits and coverage have to be explained in a concise and understandable manner.
5) Policy protection — It is now illegal for health insurance companies to arbitrarily cancel your insurance because you get sick.
Q: Who in Bradley County can apply for insurance under the ACA law?
A: If you live in Tennessee; are a U.S. citizen or national; are a non-citizen but lawfully present in the U.S. through 2014 (student visa or contracting with a U.S. company, for example); are not on Medicare; and do not have access to insurance at work, then you can apply. Also, if your insurance is ending soon; you have a private insurance plan you purchase yourself; have COBRA that is too expensive or expires soon; cannot afford your employer plan; or simply want to shop for comparable and/or more affordable plans, then you can apply.
Q: How can you apply for health insurance?
A: You can apply online at HealthCare.gov or call 1-800-318-2596 anytime. This is called the Health Insurance Marketplace where you will create an account, enter your information and be presented with plans you’re eligible to purchase. You will also find out if you qualify for premium assistance to lower the monthly costs and/or reduce out-of-pocket expenses.
Q: What benefits do you get with these plans?
A: Prior to health reform, insurance companies sold plans that may or may not cover certain services — for example, a benefit rider excluding coverage for specific medical conditions based on a pre-existing condition. Now, all plans in the marketplace are required by law to offer “essential health benefits.” These include outpatient and office visits, hospitalization, emergency services, laboratory tests, prescription drugs, maternity and newborn care, pediatric services including dental and vision, preventive and wellness, rehabilitation and habilitation services, mental health and substance abuse treatment and management of chronic diseases.
Q: Is this “government” health insurance?
A: No. The marketplace is a portal or one-stop-shop where traditional insurance companies offer you a choice of plans for health insurance. It’s like a virtual insurance store where you can compare, side-by-side, private insurance plans from these companies. And, there are no questions about your medical history or pre-existing conditions. Also, preliminary studies show that 79 percent of Tennesseans who apply will qualify for the premium tax credit that will pay part of their premium costs directly to the insurance companies (Dr. Mary Headrick). This assistance is available only if you purchase a plan through the marketplace.
Q: When can you apply?
A: Open enrollment for everyone is from Oct. 1, 2013 through March 31, 2014. It is strongly suggested that you enroll by Dec. 1, 2013 for your benefits to begin on Jan. 1, 2014. After this date, you should enroll by the 15th of each month in order to start benefits on the 1st of the following month. For example, if you enroll between January 1 and January 15, 2014, then benefits should begin February 1, 2014, and so forth.
Q: When do benefits begin?
A: The start date is Jan. 1, 2014 per the above guidelines and if your premium is paid.
Q: Can you apply for health insurance through the Health Insurance Marketplace if you already have insurance at work?
A: Yes. If your employer is canceling your plan for 2014, it doesn’t meet minimum requirements or it is considered unaffordable, then it might benefit you to go to the marketplace, fill out your information and look at the plans and pricing options. There are several variables to consider, such as employer contributions, which should be investigated prior to making a decision.
To assist with this, you should have received a form “New Health Insurance Marketplace Coverage Options and Your Health Coverage” (or something similar) from your employer by Oct. 1.
For additional information or if you wish to participate in outreach efforts, you may contact Angela Minor, county coordinator, at Minor.BCDP@gmail.com or Deb Hunter, team leader, at Hunter.BCDP@gmail.com.