There is a lot to learn about the new health care law, also known as the “ACA” or “Obamacare.” But primarily what it does is address the quality and affordability of health insurance in this country, and creates mechanisms called “Heath Insurance Marketplaces” that will help people select plans if they are not already covered by their employer. The good news is that you only need to be concerned with provisions that affect you and your family. Here’s a basic road map to the changes in the law:
New Consumer Protections
Insurance companies can no longer deny coverage to people with pre-existing conditions like asthma, diabetes, high blood pressure, or cancer. And they can’t cut off or cancel someone’s coverage if they hit a certain dollar limit or get sick. There are no annual or lifetime limits on coverage.
Already Have Health Insurance?
Preventive care coverage like flu shots, prostate exams, and mammograms are all covered under the law. This will help catch relatively minor health problems before they become serious.
Many young adults do not have coverage because they cannot afford it because of being in low-paid jobs without insurance coverage, or are still in school and cannot get coverage. Under the law, children can be on their parents’ plan until they turn 26, even if they are married (though the spouse will not be covered by the parents’ plan).
Wellness and preventive services are now covered at no cost to you. If you have prescription Part D, the coverage gap or “doughnut hole” will disappear by 2020. Starting this year, you will get a discount of more than 50% on brand name prescription drugs or more than 20% of generic drugs while in the coverage gap. No other significant changes to Medicare are in the law.
Don’t Have Health Insurance?
Starting October 1, 2013, each state must have a Health Insurance Marketplace to help people shop for plans, and provide ways to compare prices and benefits. Utah will have its own marketplace for small businesses (defined as having two–fifty employees) called “Avenue H,” while individuals will have plans available to them through a marketplace run in the state by the federal government.
All plans must cover essential benefits, such as doctor visits, emergency care, hospital services, prescription drugs, and other basic health care needs.
Everyone is required to have coverage, except for people with a very low income. Financial help is available to get help covering the cost of coverage. For example, a family of four making under $94,200 a year will be able to get financial help.
More information will be available later this summer about where to shop for the plans, how to find help through health care navigators, and how to apply for financial help in Utah. For more information about the law, go to HealthLawAnswers.org.