Now that the new health insurance marketplace is up and running, Mainers across the state have the opportunity to take a fresh look at their health insurance needs and choose a plan that works for them and their family. As with most new programs, there are bound to be many questions.
While the open enrollment for the Health Insurance Marketplace runs from October 1, 2013 through March 31, 2014, it is best to seek answers to your questions now so you and your family can make an informed decision without being under the pressure of a looming deadline. There’s another reason to start taking a look sooner rather than later: There could be a tax penalty for those who miss this deadline and I’m sure no one wants to pay a penalty!
Thanks to the Affordable Care Act or “Obamacare,” health care in America is on the road to being more accessible and more affordable. In the past, consumers could be denied coverage if they had a pre-existing condition. Others might be dropped in the middle of an illness if they hit a cap on how much insurers might pay for needed treatment. These and other negative scenarios are now a thing of the past.
Even if you are already insured, the health care law provides critical new benefits and protections. For example, did you know that your insurance company can no longer drop your coverage because of an honest error on your application? Believe it or not, that was not uncommon in years past. Nor can insurance companies put lifetime or annual caps on essential medical services. The law also makes it possible to keep your children on your family plan until they reach age 26 – an invaluable protection as this younger generation struggles to find their footing in the new economy.
In addition, all insurance plans are now required to provide more preventive care such as health screenings for certain cancers, diabetes and heart disease.
Many organizations like AARP offer free tools such as HealthLawAnswers.org, and HealthLawFacts.org that can help you better understand the benefits and protections of the health care law for you and your family. We strongly urge you to contact Maine’s Consumers for Affordable Health Care for answers to your specific questions. They have operators ready to help by telephone at 1-800-838-0388 or 1-800-965-7476. You can also use their excellent website at http://www.mainecahc.org
Tips for shopping for health plans in the Marketplace: Keep in mind the three Cs: Coverage, Costs and Compare.
- Coverage. Although all insurance plans offered in the Marketplace are now required to cover important health care services, like emergency care, hospitalization, physician’s services and prescription drugs – there are still other factors you should consider when purchasing health coverage:
ü What services do you and your family need? For example if you need orthopedic care you’ll want to select a plan that offers this coverage.
ü Does the plan limit which doctor or hospital you can use? If you have a favorite doctor, make sure they’re part of the network you select. Otherwise you may have to pay more for those services.
ü What happens if you need health care while away from home? If you spend a lot of time outside of Maine, you’ll want to find a plan that covers health services in other states.
ü Does the plan cover the prescription drugs you need? Prescription drug costs add up fast – especially if you end up needing to take them regularly or for prolonged periods.
- Costs. Most health insurance plans have a monthly premium which is a fee that you pay the insurer for your health insurance coverage. You also need to consider the other costs that a health plan might not cover. Be sure to get a clear picture of your costs before selecting a plan.
ü Is there a deductible? Deductibles – the amount you have to pay for health services each year before your coverage kicks in – vary and have a direct impact on your out-of-pocket costs.
ü Are there coinsurance or copayment requirements? These are the costs you pay each time you visit the doctor or use certain services and they also vary by plan. Be sure to factor in these costs before making a decision.
ü Is there coverage for out-of-network providers? You may have to pay more – sometimes as much as 100 percent of the costs – if you use an out-of-network provider. So if you have a favorite doctor, make sure they participate in the plan you select.
- Comparisons. The Marketplace will allow you to directly compare the costs and coverage of health plans in Maine, find out about financial help, and get your health coverage questions answered.
Remember, open enrollment for the Health Insurance Marketplace runs from October 1, 2013 through March 31, 2014. After that, if you still don’t have coverage in place, you may have to pay a tax penalty. Sign up by December 15 and you can start getting coverage by January 1.
It may feel confusing right now, but all you need to do is take that first step. Go to Consumers for Affordable Health Care or call 1-800-838-0388 or 1-800-965-7476 to get the answers to your questions. The time you invest in researching your options will pay off with the peace of mind that comes with knowing you and your family are covered.
AARP Maine Communications Director
With thanks to AARP’s Office of Education and Outreach who provided excerpts for this column.
Graphic: Courtesy of AARP