Below are frequently asked questions about the new health care law. Become familiar with it and learn about your health insurance choices. You must enroll in a plan by December 15, 2013 for coverage that becomes effective on January 1, 2014.
The health care law — the Affordable Care Act — was passed in 2010. It expands health care coverage to include more benefits for more people and is aimed at making coverage more affordable and available to millions who are uninsured. Some of its changes to health insurance are in place now and others are being phased in over time — many on January 1, 2014. One of the biggest changes is that many Americans who have been uninsured will now be able to get health insurance.
The law is changing the way some Americans get health coverage. Some changes are happening now. The biggest change comes in 2014, when almost everyone in the U.S. will be required to have health insurance.
The first open enrollment period for buying insurance on the new Health Insurance Marketplace began on October 1. You can now go online or call, and shop for the different insurance plans available to you. The site also offers a calculator to help you figure out what your monthly premium will be, and to see if you qualify for help with the cost of premiums in the form of a tax credit, depending on your situation. The extended enrollment closes on March 31, 2013. Coverage for these plans begins January 1, 2014.
The Affordable Care Act created online marketplaces where you can shop, compare and enroll in health insurance. You can go to the Marketplace to see what choices of plans are offered by participating insurance carriers in your state, get details on the plans to decide which one is best for your needs, and learn more about all the options available.
You can compare your insurance options based on price, benefits, quality and other features that may be important to you — all in plain language. You can also get answers to your questions, check on financial assistance, see if you're eligible for government health program and enroll in a plan that meets your health and financial needs. You can visit the Health Insurance Marketplace from your computer, phone, iPad or Android tablet. You can also call the Marketplace to get information and sign up for a plan.
All plans on the marketplaces (offered by private health insurance companies such as BCBSTX) will have a comprehensive package of items and services, known as essential health benefits. These benefits will be covered in qualified health plans whether bought on or off the marketplaces. One of the biggest places they differ is on how the costs of the benefits are applied.
These plans are divided into four different levels — Bronze, Silver, Gold and Platinum.
Lower monthly payments
Higher monthly payment than a Bronze plan
Higher monthly payment than a Silver plan
Highest monthly payments
The Affordable Care Act is based on more people buying health insurance from private insurance companies — not from the government. The government's role includes making sure these private plans meet standards for coverage and service, providing financial assistance for people who need it to buy insurance, broadening eligibility for public insurance programs in some states, and encouraging efforts to improve quality and control costs.
If you haven't been able to afford insurance in the past, the law makes it possible to find more affordable coverage and may help pay for it through premium tax credits and cost-sharing assistance. If you haven't been able to qualify for insurance because of a health condition, it makes coverage available to you. And, if you've had insurance with restrictions that made it hard to cover all your health care needs, new rules remove some of the limits that may have been included in health coverage in the past.
In the past, insurance companies were able to decline or offer adjusted rates to individuals based on certain medical conditions. Beginning in January 2014, coverage will be available to all who apply for it. Adults with pre-existing conditions will get coverage and can't be charged more than others for the same health benefits.
Under the new health care law, you are already able to cover your adult children on your plan up to the age of 26. Most limits to keeping your young adult son or daughter on your coverage have been removed, meaning they don't have to be a full-time student, live with you, have a disability or be a tax dependent. Some states may allow you to cover your adult children past 26.
Immunizations are on the list of medical care considered a preventive service. Most preventive care will be covered and will be paid in full by your premium. This means you won't have to pay a copay, coinsurance or deductible when you or others in your family have an annual physical examination, immunizations and certain preventive screenings to check for conditions, such as diabetes or high cholesterol.
In general, most U.S. citizens and legal residents will be required to have coverage beginning January 1, 2014, or may face a penalty. If you are retired but not yet eligible for Medicare, you will still be required to have coverage. One of your options would be to purchase health insurance on the Marketplace.
Yes, if you do not have a grandfathered health plan. You can choose your primary care physician or your child's pediatrician from your health plan's network of doctors. You also will not need a referral to visit an OB-GYN.
In addition, your health plan cannot require you to get prior approval before visiting an emergency room. The new law also prevents plans from charging higher copayments or coinsurance for out-of-network emergency room visits.
Tobacco use is a reason why health insurance providers can adjust your rates. Other reasons include: where you live, the size of your family and your age. This applies only to individual plans and small groups plans unless large group coverage is offered through the Health Insurance Marketplace.
The Affordable Care Act did not eliminate the Consolidated Omnibus Budget Reconciliation Act (COBRA) or change the COBRA rules.
Like any insurance, the cost of health insurance depends on the level of coverage you choose. What you pay can vary based on the percentage of health care costs the plan covers, how many people you'll have on your plan, your age and if you use tobacco. The new health care law established levels to help people get affordable health insurance coverage.
You can expect to see more choices in health plans in 2014 that may allow you to find coverage that meets your needs and stays within your budget. You also may be able to get a new kind of premium tax credit that lowers your monthly premium. Depending on your situation, you may even be eligible for a $0 premium plan. You can see what your premium, deductibles and out-of-pocket costs will be before you make a decision to enroll.
A premium tax credit under the new law will help many people afford the cost of having insurance. These funds were set aside to help individuals and families who do not qualify for Medicare or Medicaid, but still need help with the cost of buying and keeping insurance coverage. By buying your health care covered on the new Health Insurance Marketplace, you can calculate your costs and find out if you qualify for financial assistance in paying insurance premiums.
Starting in 2014, almost everyone will need to have health care coverage. That requirement won't be based on your income. People with lower income may qualify for premium tax credits or cost-sharing assistance to help pay for their coverage. All but those who get coverage through an employer can buy insurance through a marketplace.
If you don't have health insurance in 2014, you may have to pay a penalty on your federal income tax. In 2014, the penalty for individuals is the higher of two amounts — $95 or 1% of income. These penalties increase each year. Learn more about the health care penalty and who is exempt.
Starting in 2014, almost every U.S. citizen and legal resident will need to have health care coverage. Coverage is not required if you are not a documented resident, are incarcerated or are an American Indian. You may also be able to claim a religious exemption or be given and exemption based on financial hardship or other circumstances.
No. According to a proposed rule from the U.S. Department of Health & Human Services (HHS), short gaps in coverage won't trigger the coverage requirement. In other words, if you are temporarily unemployed, you won't be fined for losing your health coverage between jobs.
For more information, view this fact sheet on the proposed rule from HHS and the Internal Revenue Service.
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