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.
|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 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.
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.