FAQ

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Health Care Reform FAQ

Below are frequently asked questions about the new health care law. Become familiar with it and learn about your health insurance choices. Enrollment starts in October 2013 for coverage that becomes effective on January 1, 2014.

 

What is the new health care law?

Health care reform is an ongoing process to help our country's health care and insurance system work better. The reform effort you're hearing more about now is the Affordable Care Act, which became law in 2010. Some of its changes to health insurance are in place now and others are being phased in over time — many in 2014. One of the biggest changes of the new law is that many Americans who have been uninsured will now be able to get health insurance. In fact, most people will be required to get coverage or may have to pay a penalty.

What’s happening in 2014?

The new health care law expands health insurance to include more benefits for more people and is aimed at making coverage more affordable and available to uninsured people. 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.

I have heard that October is important. What is so important about October?

The first open enrollment period for buying insurance on the new health insurance exchange begins October 1. At that time you will be able to go online or call, and shop for the different insurance plans available to you. The site will also offer 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 first open enrollment will last through March of 2014. Coverage begins January 1, so the sooner you enroll, the sooner you'll be covered.

How do the new health insurance exchanges work?

Beginning in October, you'll be able to go online to look at insurance plans available in your area, or get that information with a phone call. Most health insurance plans on the exchange will offer comprehensive coverage, from doctors to medications to hospital visits. You can compare all your insurance options based on price, benefits, quality and other features that may be important to you.

What coverage options will be available on the exchange?

All plans on the exchange will have similar types of benefits, and all will include essential health benefits. One of the biggest places they differ is on how the costs of the benefits are applied.

Exchange plans will be divided into four different levels — Bronze, Silver, Gold and Platinum.

           

Bronze

Lower monthly payments
Higher cost when you receive medical care

Silver

Higher monthly payment than a Bronze plan
Lower cost than a Bronze plan when you receive medical care

Gold

Higher monthly payment than a Silver plan
Lower cost than a Silver plan when you receive medical care

Platinum

Highest monthly payments
Lowest cost when you receive medical care

Am I buying insurance from the government?

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.

How does the new health care law help me today?

The Affordable Care Act adds benefits that help a lot of people with insurance. If you haven't been able to afford insurance in the past, it makes it possible for most people to find more affordable coverage. You also may get help paying for it through tax credits. 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.

My mom got turned down for insurance because of her diabetes. Will she be able to get covered under the new law?

In the past, insurance companies were able to decline or offer adjusted rates to individuals based on certain medical conditions. Beginning in January 2014, anyone who buys a new plan or renews their current plan will be guaranteed issue. This means that they'll be able to get insurance that includes coverage for their medical conditions. (If a plan is purchased or renewed before January, 2014 they will not be guaranteed issue.)

My 22-year old son just graduated from college, but doesn’t have a job. Will the new health care law give him coverage?

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.

I am retired but not yet eligible for Medicare. Can I get a policy on the exchange?

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 exchange.

Under the new law, will I be able to pick my own doctors and hospitals?

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.

Will my rates be adjusted if I smoke?

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 exchange.

How will the Affordable Care Act affect COBRA?

The Affordable Care Act did not eliminate the Consolidated Omnibus Budget Reconciliation Act (COBRA) or change the COBRA rules.

What if I can’t afford health insurance?

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 tax credit that lowers your monthly premium. Depending on your situation, you may even be eligible for a $0 premium plan. You'll be able to see what your premium, deductibles and out-of-pocket costs will be before you make a decision to enroll. In some states, if you cannot afford health insurance and you meet certain requirements, you will not be required to pay a penalty.

What is this penalty I keep hearing about if I don’t sign up for health insurance by 2014?

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.

If I am unemployed and don’t have coverage for a few months during a year, will I have to pay this penalty?

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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