• SecondsCount Guide to the Affordable Care Act
    (ACA or “ObamaCare")

     
     
     
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    4/21/2014

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    Learn more about healthcare reform and what it means for you and your family. Dr. Peter L. Duffy, Director of the Cardiovascular Service Line at Reid Heart Cent/FirstHealth of the Carolinas in Pinehurst, North Carolina

    If you are confused and overwhelmed by everything you’ve heard about healthcare reform and the Affordable Care Act (ACA or “Obamacare”) and how it might affect you and your family, you are not alone. Good health care is critical to living a quality life and it doesn’t come cheap, so it’s not surprising that it inspires lively discussion and strong opinions. But when you need the best care for you or your family, you need facts, not opinions. This purpose of this guide is to help you understand key provisions of the ACA that may have an impact on your health care. A good place to begin is to understand the coverage you have now or the coverage you would like to have. One of the primary goals of healthcare reform from the beginning was to make sure that all U.S. citizens have health insurance.

    If you already have health insurance…
    It will benefit you to understand what it covers and how much it costs. You are probably responsible for part, if not all, of your premiums as well as out-of-pocket costs, such as deductibles and copayments. Click here to learn more about how health insurance works.

    If you do not have health insurance…
    You have a variety of options for getting coverage. The ACA requires that everyone has at least minimum essential coverage (see “Minimum essential coverage”) in 2014. With few exceptions, such as homelessness and bankruptcy, people without health insurance are required to pay a penalty. Click here to learn more about how you can get health insurance.

    How Has the ACA Changed Our Health Care?

    In addition to requiring that everyone have health insurance, the ACA has also changed health care in other ways by:

    Giving you more rights and protections -The ACA attempts to protect consumers by:

    • requiring insurance companies to provide a summary of your benefits in plain and simple language
    • allowing you to choose your doctor and use any emergency room
    • eliminating pre-existing conditions as a reason to deny coverage and raise premiums
    • eliminating annual and lifetime limits on your coverage
    • outlawing the retroactive cancellation of insurance policies
    • giving you the right to appeal coverage decisions by your insurance company
    • providing a process for independent, third-party review of denied claims,
    • regulating how your premium is spent

    Some exceptions do apply. Click here to learn more about your rights and protections under the ACA.

    Expanding coverage - The ACA made more people eligible for health insurance coverage by changing the income requirements for Medicaid, creating a marketplace for comparing and buying coverage, and raising the age limit to 26 for adult children covered by their parents' insurance plans. Click here to learn more.

    Creating a health insurance marketplace - The ACA provides a venue for comparing and buying health insurance coverage from private companies. When you visit healthcare.gov to shop for a plan, you will also learn if you qualify for free or low-cost coverage through Medicaid or Children’s Health Insurance Program (CHIP) Click here to learn more about the federal and state marketplaces.

    Encouraging preventive care - Many of us don’t get the care we need to prevent serious illnesses, such as cardiovascular disease. The ACA provides funding for prevention and public health programs and eliminates deductibles, co-pays, and co-insurance for employer-sponsored health plans or individual health insurance policies. Click here to learn more.

    Improving quality of care - The ACA requires insurers to spend 80 to 85 percent of your health insurance premium dollars on health care and quality improvement or give you a rebate. It also lays out a plan for strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources. Click here to learn more.

    Improving Medicare - The ACA calls for extending the life of Medicare and improving coverage by attempting to eliminate waste, fraud, and inefficiency; reducing annual payment increases to insurance companies, hospitals, and nursing homes from Medicare; and eliminating the “doughnut hole” in prescription drug coverage. Click here to learn more about changes to Medicare.

    Other Important Considerations

    The ACA is a complex piece of legislation that has an impact on many aspects of health care. Its implementation spans years, it encompasses many exceptions, and it is always changing. Read on to learn more these key aspects of this law.

    Implementation of ACA
    The ACA was passed in 2010 with a timeline for implementing its provisions over the course of eight years. Click here to see the history of the law’s implementation and find dates and deadlines that may be significant to you given the nature of your coverage.

    Grandfathered Plans: Be Aware of Exceptions to the Law
    As you read about specific provisions of the ACA, pay close attention to exceptions that may apply to your coverage. Special rules apply to grandfathered plans, which are job-based and individually purchased plans in effect before the ACA became law on March 23, 2010. Click here to learn more about grandfathered plans and exceptions to coverage.

    Tracking Changes in Federal and State Healthcare Law
    The implementation of ACA has already brought about a lot of change, but more change will come. Protect yourself and your family by knowing the details of your healthcare coverage and be prepared for changes in the federal and state laws that could affect your coverage. The following websites can help you track these changes and learn more about ongoing healthcare reform.

    The Henry J. Kaiser Family Foundation State Health Insurance Marketplace Profiles 
    This site tracks and reports on the progress of healthcare reform in your state

    The Henry J. Kaiser Family Foundation Health Reform Site
    This site from the Henry J. Kaiser Family Foundation provides news and information at both the state and federal level along with public opinion poll results, information on assistance and subsidies (e.g., a subsidy calculator, implementation milestones, and other resources for both insured and uninsured consumers.

    Medicare.gov
    Medicare.gov provides updates, tools, and information about Medicare. For example, one resource is a tool for finding and comparing hospitals in your area for specific medical conditions, such as heart attack. The site’s other many features include news

    The Center for Consumer Information & Insurance Oversight (CCIIO)
    CCIIO is the arm of the U.S. Department of Health and Human Services responsible for implementing the Affordable Care Act. This site provides consumer support and information on its programs and initiatives, such as its work with state and local governments to comply with new regulations and protect consumers.

    Foundation for Health Coverage Education
    This site provides assistance in finding affordable health insurance coverage.

    Gaining an understanding of ACA provisions and healthcare practices in your own state gives you important perspective on how to ensure quality care for you and your family at a price you can afford. Click here if you need assistance finding affordable coverage.

  • More About the Affordable Care Act (ACA or “Obamacare”)

     
     
     
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    Expansion of Coverage Under the Affordable Care Act

    Access to quality health care for you and your family is influenced by a number of factors that include your insurance status, income, race, gender, age, and where you live. The Affordable Care Act (ACA) attempts to address inequities or special considerations in these areas to make comprehensive and affordable health insurance coverage available to more people.

    Financial and Health Insurance Information for Patients with Congenital Heart Disease

    If you or your child was born with a heart defect (congenital heart disease), paying for treatment will usually involve using different types of resources - whether those resources are private insurance, government programs, or out-of-pocket payments. Complicated medical tests or procedures can be expensive, so it is particularly important that patients who will need treatment and follow-up throughout their lives maintain some form of active medical coverage. It is crucial to avoid gaps in medical coverage during the transition from childhood to adult care. Once insurance coverage is lost, it can lead to long delays in coverage and can be very difficult to get back. Talk to your healthcare providers specifically about how to prevent gaps in coverage.

    Grandfathered Health Insurance Plans

    If you were enrolled in an individual plan from a private insurance companies before March 23, 2010, or if you participate in an employer-sponsored health insurance plan that has been in place since before the Affordable Care Act (ACA) became law on March 23, 2010 (even if you enrolled after that date), and it has not changed substantially in terms of costs and benefits provided, it is possible that your plan is grandfathered. Grandfathered plans may not be subject to some of the ACA’s requirements for health insurance plans.

    Health Insurance Basics and FAQs

    We all complain about the rising cost of health care and health insurance, and yet many of us don’t really know what we’re paying for or if we’re paying the right amount. According to a study by George Loewenstein and his colleagues, only 14 percent of a group of people with employer-sponsored health insurance could define basic health insurance terms such as deductible, copay, and coinsurance. Can you? You might be surprised.

    Health Insurance Resources

    Don’t be embarrassed if you need help understanding your health insurance coverage. It is complicated, and for most of us, just as difficult as preparing our taxes. But you don’t have to tackle it alone. Ask a friend or relative to help. Or, if you have the resources, hire a consultant.

    Health Insurance Shopping List

    Consider asking these questions before buying health insurance coverage.

    How Does the Affordable Care Act Affect My Quality of Care

    We would like to think that we’re getting quality care every time we see a doctor or go to the hospital for an emergency. But that may not always be the case. The United States spent $2.5 trillion on health care in 2009 - more than any other country - and yet the outcomes of our care weren’t as good as those in other countries, according to the Institute of Medicine (IOM), a branch of the National Academy of Sciences that provides nonpartisan advice on health issues.

    How to Afford Your Medications

    The high cost of medications for cardiovascular disease is one of the most common reasons patients give for not taking their medicine. But when you consider what is at stake—your health and possibly your life—you must find a way to afford them. Don’t wait to fill your prescriptions until you can afford them. You need them now. If you are already taking medication but are thinking about stopping, skipping, or dividing up your doses to make your medication more affordable, don’t do it until you talk with your doctor. Your doctor and others can help you get the medication you need.

    Important Health Insurance Terms to Know

    Insurance policies are legally binding documents, written to protect the rights of both you and the insurance provider. Unfortunately, the language they used to do that can also make policies and benefit information difficult to understand.

    Medicare and the Affordable Care Act

    Medicare provides health care for over 48 million Americans. So it’s not surprising that strengthening and improving that program is a major goal of healthcare reform in the Affordable Care Act (ACA) passed in March 2010. According to Kathleen Sebelius, then-Secretary of Health & Human Services, rather than change or diminish your current Medicare benefits, the ACA is designed to improve Medicare by introducing new benefits and savings with an emphasis on delivering quality care.

    Questions to Ask before Participating in a Clinical Trial

    Before choosing to participate in a clinical trial, it is often helpful to talk to a physician, family members, or friends. Here are some questions you may have about joining a clinical trial.

    SecondsCount Guide to Health Insurance

    Back in the early 1900s it didn’t cost much to see a doctor and your doctor would even make house calls! But as good as that sounds, in many cases, the doctor couldn’t do very much to help. Since then, advances in science and technology have dramatically improved health care. Unfortunately, the downside is that health care costs much more now than it did then.

    SecondsCount Healthcare Guide

    Managing your healthcare needs and those of your family can be a daunting task. It can require a good deal of time, money, and specialized knowledge, and it involves making decisions that can affect the quality and length of your life and of those you love. The SecondsCount Healthcare Guide is designed to make your job easier and give you the information and tools you need to protect your most valuable asset - your health.

    Tips on Getting the Most from Your Health Insurance

    These tips address common issues and concerns of people trying to understand and use their health insurance. By following these suggestions now you may save money and get more services from your plan.

    Your Guide to New Treatments and Technologies

    Now more than ever, people with cardiovascular disease can be assured there are effective medications, procedures, and other treatments available to treat their conditions. As knowledge of cardiovascular disease has expanded, so has the ability to treat the disease. Yet the medical community is always working toward new innovations to improve patient care, especially considering cardiovascular disease is the leading cause of death in the United States, with nearly 80 million Americans estimated to have a form of the disease.

    Your Rights and Protections Under the
    Affordable Care Act

    The Affordable Care Act (ACA) has provisions designed to protect you from abuses by insurance companies. The insurance industry was regulated by the government before the ACA, but the intent of the law is to take those protections even further by...