Healthcare & YOU

The Affordable Care Act is the nation’s health reform law enacted in March 2010. It contains numerous provisions that will expand health coverage to 30 million Americans, increase benefits and lower costs for consumers, provide new funding for public health and prevention, bolster our health care and public health workforce and infrastructure, foster innovation and quality in our system, and more.

Learn more about how healthcare reform specifically impacts colorectal cancer.


What is “guaranteed issue”?

Guaranteed issue is the most popular part of health reform:  Health plans must make coverage available to everyone, regardless of pre-existing conditions. The plans cannot charge more based on health or gender.


How are the healthcare exchanges set up?

Exchanges may be established either by the state itself as a “state exchange” or by the Secretary of Health and Human Services (HHS) as a “federally-facilitated exchange.” The new exchanges are called the “Marketplace.”

A federally-facilitated exchange may be operated solely by the federal government, or it may be operated by the federal government in conjunction with the state, as a “partnership” exchange.

ACA and regulations require exchanges to carry out a number of different functions. The primary ones include:

  • Determining eligibility
  • Plan management, enrolling individuals in appropriate plans
  • Consumer assistance and accountability
  • Financial management
  • ACA gives various federal agencies, primarily HHS, responsibilities relating to the general operation of exchanges

If an individual consumer or small business needs financial assistance or tax credits to make plans affordable, the exchange website can to calculate what benefits are applicable to each individual situation. This will allow the individual consumer or small business to make a decision on a plan with the “real” financial cost of the plan; or the cost minus any financial support.

Starting in January 2014, the Marketplace will allow individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.


What will the health care exchanges offer in terms of coverage?

Each plan will cover a list of Essential Health Benefits (EHB) that have been defined by the Secretary of the Department of Health and Human Services.  Each plan must cover at least the following 10 general categories:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitation services
  8. Laboratory services
  9. Preventative and wellness services
  10. Pediatric services, including oral and vision care

What if I am already insured?

You do not have to buy into the new Marketplace if you already have insurance.


What if I’ve never had insurance?

Financial help is available to many uninsured consumers with low income through tax credits and cost-sharing reductions, Medicaid, or the Children’s Health Insurance Program (CHIP).


What are the effects on pre-existing conditions?

No one will be penalized and denied coverage for pre-existing conditions.  There are no questions in the application for coverage about pre-existing conditions.


What will penalties look like if I do not sign up for coverage?

If you choose not to carry health insurance, you’ll have to pay a tax penalty starting at $95 per individual, $285 per family, or 1% of your annual income, whichever is greater, for 2014.

Note:  In 2016, that penalty will rise to $695 per individual, $2,085 per family, or 2.5 % of your annual income.


How do I pay the penalty?

If you choose not to carry health insurance, the penalty will be deducted from your federal tax return for that year.


What are the key dates for the Marketplace that I should keep in mind?

  • October 1, 2013 begins the Open Enrollment Period
  • Open enrollment ends March 2014
  • January 2014 is when coverage begins
  • Last day of enrollment is March 31, 2014

 


What are the different levels of assistance that will be available?

Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for a tax credit subsidy available through state-based exchanges.


Where do I turn to get more information as a consumer?

Please visit Marketplace.cms.gov or call our Answer Line to be pointed in the right direction.


Where do I turn to get more information as a professional?

Please visit Healthcare.gov or call our Answer Line to be pointed in the right direction.


Who can help me?

There are navigators and assistors available to help you learn more.  The navigators will walk you through the process of enrollment, and explain to you your options.  The assistors are there to provide you more information to enable you to make the right choices for you and your family.

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