Covering All Americans

A heart attack or stroke can cost as much as $100,000, among the many reasons why it’s so important to have health insurance.



A heart attack or stroke can cost as much as $100,000, among the many reasons why it’s so important to have health insurance.

Under the health care law, America has an unprecedented opportunity to expand insurance coverage to millions, helping protect them financially and enabling them to get the preventive care they need to avoid serious illnesses. Among those eligible for coverage are more than 7 million people with a history of heart disease or stroke who are currently uninsured.

Health Insurance Marketplaces opened in every state plus the District of Columbia in October. These Marketplaces provide a single location in each state where individuals and small businesses can shop for private health insurance that fits their budgets. For the first time in our nation’s history, people will not be turned down or charged higher premiums for pre-existing medical conditions. Financial assistance will be available to help make premiums affordable for people who don’t get health insurance through their workplace.

THE MARKETPLACES — THE PLACE TO START

The Marketplaces — sometimes referred to as exchanges — provide a new, easier way to shop for and buy health insurance. Through the Marketplaces, you can choose a private health plan that best meets your family’s needs and budget. You can see all of your choices in one place, determine your premium, deductibles and out-of-pocket costs up front and compare health insurance plans before you decide to enroll. Depending on where you live, your Marketplace could be run by your state or by the U.S. Department of Health and Human Services. You’re eligible to buy coverage through the Marketplaces if you’re a U.S. citizen or lawfully residing in this country and are not incarcerated. Small employers with 50 or fewer full-time workers can use the Marketplaces to shop for coverage for their employees.

If you already have health insurance through your employer, as most Americans do, you’ll still be eligible for coverage under your employer’s plan and won’t need to use the Marketplace. Your coverage also will continue if you’re covered through a public program like Medicare, Medicaid or another government plan.

PENALTY FOR NOT BEING COVERED

As of Jan. 1, everyone will be required to have some type of health insurance coverage, unless no affordable insurance is available. Individuals have until March 31, 2014, to obtain coverage and still be in compliance with the requirement.

Those who can afford coverage but don’t obtain it will be subject to a tax penalty. In 2014, this penalty will be $95 per adult or 1 percent of your taxable income, whichever is greater.

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FINANCIAL ASSISTANCE AVAILABLE

The new Health Insurance Premium Tax Credit will help make the premiums affordable to qualified individuals and families buying health insurance coverage through the Marketplaces. The amount of the tax credit will depend on income and family size. Those with the lowest incomes may be eligible for a health plan with no premium.

Qualified individuals can choose how they receive their tax credit. They can take it right away and pay a lower monthly premium, take it at the end of the year by subtracting it from the taxes they owe or use it to get a bigger refund.

COVERAGE AND BENEFITS

Every health insurance plan sold through the Marketplaces is required to offer ten categories of Essential Health Benefits, covering services important to heart disease and stroke patients. They include hospital care, doctor’s office visits, emergency services, prescription drugs, lab tests, rehabilitative care, and preventive screenings and services. The services covered are intended to be similar to the benefits provided by a typical employer plan.

ENROLL SEVERAL WAYS

There are a variety of ways to shop, apply for and enroll in health coverage: online through the Marketplace website (healthcare.gov), in person, by mail, or by phone (1-800-318-2596).

Every Marketplace is required to have available trained, certified counselors called Navigators. Navigators are not insurance agents, but people who can help you understand and complete the application and explain the different insurance options. In addition, licensed insurance agents and brokers can help you apply and enroll.

A three-page application will allow individuals to find out whether they qualify for the premium tax credit or for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program.

The Marketplace website and application are available in Spanish. The toll-free number can also help people in Spanish and up to 150 other languages.

Some consumers using the website to shop and apply for coverage have experienced difficulties. Although changes are being made to improve the website, remember that you can also apply by phone or in-person through Navigators and insurance agents.

ENROLLMENT AND COVERAGE

The initial open enrollment period for the new Marketplaces is Oct. 1-March 31. For people who sign up after Jan. 1, coverage starts the first day of the month after they enroll, if they enroll before the 15th of the month. If they enroll after the 15th, coverage starts the first day of the second following month.

Once the initial open enrollment period ends, people who are uninsured have to wait until the next open enrollment period to sign up for coverage. However, you may be eligible to enroll outside the open enrollment period in special circumstances, including losing your health insurance coverage, getting married or moving. If you have or adopt a child, that child is immediately eligible to be signed up for coverage.

Finally, individuals who qualify for Medicaid or the Children’s Health Insurance Program can apply and be enrolled at any time throughout the year.

OTHER CHANGES

Starting Jan. 1, individuals with pre-existing medical conditions can no longer be turned down for coverage or charged a higher premium because of their health status. Also, for most health plans, not just plans sold through the Marketplaces, annual dollar limits on coverage are no longer permitted. Most health plans will now be required to cover the routine costs associated with participating in clinical trials for patients with life-threatening conditions.


PROJECT YOURSELF AGAINST FRAUD
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If someone comes to your home, calls you out of the blue or sends e-mails offering health insurance coverage at a terrific price, how will you know whether the offer is legitimate?

Remember this simple formula: STOP, CALL, CONFIRM.

STOP Ask for identification and a phone number where the person may be reached later. If the person refuses to give this information for any reason, or tries to pressure you into signing any document, you should immediately hang up, close the door or walk away.

Do NOT volunteer your Social Security number or a credit/debit card number to anyone offering insurance unless you personally know them. Likewise, do NOT sign any paperwork or write a check.

CALL Contact your state department of insurance or your state Marketplace. The insurance company or agent or broker, as well as the Navigator, must be registered or licensed in your state before they can sell coverage or counsel consumers through your state’s Marketplace.

CONFIRM Before giving personal information or signing any documents, confirm the authorization status of any insurance company, agent or broker, or Navigator trying to provide assistance.

From National Association of Insurance Commissioners website

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