; CONSUMERconnection
LIKE IT OR NOT, under the Affordable Care Act
(ACA) there will be a new way to get health insurance coverage in America—the Health Insurance
Marketplace (HIM;
www.healthcare.gov). Here is a
general overview of what you should know.
How the ACA works
Whether you need health coverage or have it
already, when key parts of the ACA take effect in
2014, there will be new procedures. Some of these
apply to plans in the HIM or other individual
insurance, some apply to job-based plans and some
apply to all health coverage. The HIM, created by
the healthcare law, changes the search for health
coverage by allowing you to compare plans and
explore programs that you may qualify for with one
application.
The new law also requires insurance companies
to cover people with preexisting health conditions,
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, ends lifetime and yearly
dollar limits on coverage of essential health benefits,
provides free preventive care and guarantees your
right to appeal a health plan’s decision to deny your
claim or end your coverage.
You can read the ACA at the U.S. Department
of Health and Human Services’ site,
www.hhs.gov.
Understanding HIM
The HIM allows you to fill out a single application, compare and explore options for health insurance coverage in your area, find out if you can get
lower costs for premiums for private insurance
plans and learn if you qualify for lower out-of-pocket costs. With an application, you learn if you
and your family qualify for Medicaid or the
Children’s Health Insurance Program (CHIP).
Applying for Marketplace coverage
You can apply for Marketplace coverage online,
by mail or in person. Telephone help will be available at 1-800-318-2596 (TTY: 1-855-889-4325) 24
Beware of healthcare
enrollment scams
THE FEDERAL Trade
Commission, the nation’s
consumer protection agency,
has reported incidents of
scammers trying to capitalize on healthcare enrollment.
Beware of false enrollment
websites trying to swindle
you into buying fake health
insurance. The only official
site of the Health Insurance
Marketplace is www.health
care.gov.
Don’t take a call from out
of the blue from people who
offer to help you navigate
the new healthcare market
or say they’re issuing mandatory new national medical
cards. The same rule applies
to receiving an unsolicited
email, letter or text.
If you are asked for personal or bank account information so a caller can
determine whether you meet
the financial threshold for
Affordable Care Act benefits,
you’re being swindled. C
HIM and your health
hours a day, seven days a week. Online chat help will
be available at
www.healthcare.gov.
Navigators, in-person assisters, certified application counselors, and agents and brokers will all be
able to help you complete your application, analyze
the coverage available in your state and select the
coverage that is right for you. The U.S. Department
of Health and Human Services will provide training
to assisters so they are knowledgeable about the
Marketplace and the coverage available through it.
Enrollment periods
You can enroll in the exchange only during
enrollment periods. For 2014, the six-month enrollment period starts October 1, 2013, and ends in
March 2014. In year two and beyond, open enrollment will begin on October 15 and end on
December 7. All 50 states will be able to access the
Marketplace during the enrollment periods.
Health benefits
All private health insurance plans in the
Marketplace are required to offer minimum essential
health benefits, which include the following items
and services:
■ Ambulatory patient services (outpatient care
you get without being admitted to a hospital)
■ Emergency services
■ Hospitalization
■ 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
Grandfathered plans
A group health plan that was created on or
before March 23, 2010, or an individual health insurance policy that was purchased on or before March
23, 2010, is considered a “grandfathered plan.” These
plans are exempted from some changes required
under the ACA. That means the rights and protections offered by other plans will not be available to
those with a grandfathered plan. A health plan must
disclose whether it considers itself to be a grandfathered plan and must advise you how to contact the
U.S. Department of Labor or the U.S. Department of
Health and Human Services with questions. C
©
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David Horowitz is
a leading consumer
advocate. David’s
daughter Amanda
Horowitz is the
CEO of Fight Back!
and co-founder of
FightBack.com.
Email David and
Amanda at info@
fightback.com.
Back!
Have a question for Fight Back?
Just log on to
www.fightback.com or email
info@fightback.com. Questions and
answers of the greatest interest to Costco members will be used in this column
(with the permission of the contributor) and will be posted on
www.fightback.com.
© 2013 AMANDA HOROWITZ MEDIA, LLC ALL RIGHTS RESERVED
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