2 | LIVING WELL A-Z | WEDNESDAY, December 4, 2013
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Q&A: Affordable Care Act (ACA) A
If you are purchasing insurance through the Marketplace, you must enroll in a new health plan by Dec. 23, 2013 (recently changed from Dec. 15, 2013) in order to have coverage that starts Jan. 1, 2014. If you enroll after Dec. 23, your coverage can start no earlier than Feb. 1, 2014.
nswers provided by Cheryl O’Donnell, Arizona state director at Enroll America, a nonprofit group educating consumers about the ACA, and Allen Gjersvig, Director of Health Innovations, Arizona Association of Community Health Centers.
Q
How can I figure out what a health insurance plan through the Health Insurance Marketplace will cost me?
A (O’Donnell): Get Covered America has a calculation tool available online at GetCoveredAmerica.org/calculator; there is also a calculator on the Kaiser Family Foundation website (kff.org). F These calculators provide an estimate T of how much you may be able to qualify for in subsidies, reducing the cost of any premium. We estimate that up to 90 percent of the nearly one million eligible uninsured in Arizona will qualify for some type of tax break or subsidy in the Marketplace, which they can then apply directly to the cost of their premium.
Q
My employer-insurance rates went up again. Is this because of the ACA?
A (O’Donnell): Insurance rates have risen steadily for a variety of reasons over the past 20 years, well before the ACA went into effect. Eventually, higher levels of insured individuals will mean more consumers will get better care and healthcare facilities will be paid for services, a situation that will help minimize cost spikes in the future.
Q
I’ve heard that the ACA makes employer-offered healthcare better. Is that true, and if so, how? A (Gjersvig): Simply put, both individual plans and employer-sponsored plans that begin on January 1, 2014 offer broader coverage than many old policies. As part of the ACA, employers who offer coverage
— Source: healthcare.gov to their employees are required to include these 10 essential benefits: 1. ambulatory patient services 2. emergency services 3. hospitalization 4. maternity and newborn care 5. mental health and substance use disorder services, including behavioral health treatment 6. prescription drugs 7. rehabilitative and habilitative services and devices 8. laboratory services 9. preventive and wellness services and chronic disease management 10. pediatric services, including oral and vision care.
Q
What are the insurance company rebates I’ve heard about?A (Gjersvig): One part
of the ACA requires insurance companies to spend a minimum of 80-85 percent of premium income on medical benefits. Called the Medical Loss Ratio, or MLR, this reform was designed to assure consumers that most of their premium expenses were in fact spent on providing medical care to policy-holders. If an insurance company does not meet the required MLR, the insurance company must refund premiums to policy-holders.
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Q
How does the ACA impact veterans?
A (O’Donnell): Since Veterans Administration (VA) care meets the standard for healthcare coverage, veterans would not be eligible for assistance to lower their cost of health insurance premiums if they chose to purchase additional healthcare coverage outside of the VA. However, veterans may still purchase private health insurance on or off the Marketplace to complement VA healthcare coverage.
Q
What is the deadline for signing up for health insurance to avoid having to pay a penalty?
A (O’Donnell): Recently, the U.S. Department of Health and Human Services clarified that people who want to avoid a penalty for not signing up for 2014 coverage have until March 31, 2014 to enroll in a health plan. March 31 is also the day the Open Enrollment period for 2014 ends. — REPORTED BY DEBRA GELBART
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Enrollment help is available: Along with the healthcare.gov website, you can enroll by phone and by paper application. You can seek the assistance of free, professional help through a Navigator or you can download and print a copy of the application from the healthcare.gov website and mail it in. Websites and phone numbers for help: Enroll America – Arizona: EnrollAmerica.org/states/Arizona; 480-779-0239 Get Covered America: GetCoveredAmerica.org; 800-318-2596 Local help page of Healthcare.gov: localhelp.healthcare.gov; 800-318-2596 The bottom line: If you have not enrolled in a health insurance plan by March 31, 2014, you will owe a penalty when you file your 2014 income tax return — either $95 per uninsured adult and $47.50 per child, up to $285 for a family, or one percent of family income, whichever is greater.