Brenda Goodman, Massachusetts
WebMD Health News
Review by Sarah Goodell
For example, you may have received a refund check from your health insurance company.Or maybe you weren’t charged for some preventive services, such as when you last visited your doctor: vaccination, identification Cancer screening Test, and test Heart disease When Diabetes mellitus..
And more changes are coming.
This fall, many will begin buying enhanced health insurance through a new online marketplace, also known as Exchange. The new insurance will come into effect in January and may be penalized for taxes filed in 2015 if sufficient insurance is not covered in 2014.
Are you wondering what this means to you? According to a recent survey by the Kaiser Family Foundation, just over half (51%) of all Americans say they still don’t know what. Healthcare reform The law makes sense to them. Four in ten do not know if the law is still in force. (that’s right.)
If you count yourself in the mess, don’t worry. This article describes seven amazing things you need to know about this brave new world of health insurance you need.
1. Most people do not pay a penalty.
The new law requires most people to take out health insurance or pay a fine when filing a tax return. The 2014 penalty will be $ 95 per adult, $ 47.50 per child, or 1% of your income, whichever is greater. The maximum family penalty is $ 285.
But what you may not know is that most people are already insured to comply with the law or have not earned enough money to be fined, so of the working age of 10 people. This means that nine out of adults are not subject to fines. To an expert.
2. October 1st is not your deadline, but a government deadline.
You may have heard that everyone is struggling to meet the October 1st deadline of the law. Take a break. You don’t have to do anything by October 1st. But the federal government (or your state) is at stake, and your employer is probably at stake.
October 1st is the day the new insurance marketplace is set to open in all states. The Marketplace has a website that offers one-stop shopping for new health insurance. Fill out the three-page form to see if you are eligible for financial assistance and what insurance policies you can buy. Open registration runs from October 2013 to March 2014. Some states have chosen to operate their own marketplaces. Others left it to the federal government. There are also “navigators” trained in your community to help you understand and sign up for insurance.
3. Most uninsured people are eligible for financial assistance to purchase new insurance.
Main goal of Affordable care method If they don’t have it yet, it’s about helping people get good and affordable health insurance. Therefore, the government will support payment of new policies if people are less than 400% of federal poverty levels, or $ 45,960 for individuals and less than $ 94,200 for families of four.
Approximately 26 million uninsured adults under the age of 65 will either purchase insurance or be fined. According to the non-profit Urban Institute, two-thirds can be covered for free or at low cost.This includes 11 million people eligible for government subsidies (a type of financial assistance) and Medicaid or Child health Insurance program (CHIP).
“Most people, most uninsured people, and about half of those who already have personal insurance are eligible for tax credits,” says Larry Levitt, senior vice president of the Kaiser Family Foundation.
However, you must purchase the policy from one of the new state marketplaces to get the new tax credit.
The less income you have, the less you pay.
“I think many people will be happy and surprised that they are eligible for help … and they have a selection of plans that will help them,” says Cheryl Fish-Parcham. She is the Deputy Director of Health Policy for Family USA, a non-profit organization.
4. Women receive significant new benefits and are not charged more than men.
The Affordable Care Act extends the coverage of health insurance for everyone, but women will undoubtedly see some of the greatest benefits from the law.
Many are already valid. For example, if you meet the age requirements, certain health checks will be provided to the patient free of charge and will not be out-of-pocket.These include mammograms, bone scintigraphy osteoporosis, Papanicolaou smear and pelvic examination Cervical cancer,Colonoscopy Colorectal cancer, And many other health checks. contraception As with any type of doctor’s consultation, women are now free to use. contraception You may need it.
After January, women will not be able to get health insurance more than men. According to a 2012 report by National Women’s, 36 states now allow insurers to charge women further. 92% of popular plans in these states charge women 20% to 40% more than men of the same age. Low center.
“This creates a new world where women don’t have to pay more for the same insurance policy than men,” says Lauren Birchfield Kennedy.she is Senior health Policy Council for National Partnerships for Women and Families.
There are also significant benefits for self-employed women in 2014. In the past, most insurance policies available to individuals, not through their employers, did not cover obstetric care. With insurance, women, on average, pay about $ 2,000 to $ 3,000 at their own expense to give birth to a baby. childbirth Connection.Without insurance, the cost of a healthy childbirth can be several times higher, and the complex costs are pregnancy It can reach tens of thousands to hundreds of thousands of dollars.
All insurance plans sold to individuals in January should cover maternity care.They also bear the cost Breastfeeding Consumables such as breast pumps.
“We are delighted and very excited to see these services included in the new law and firmly implemented,” says Birchfield Kennedy. “I think making these available to women under health insurance will be a game changer.”
5. You can get health insurance even if you are already ill. And you will pay the same coverage price as a healthy person of the same age.
In the past, insurance companies have been able to refuse compensation for people with health problems.
As part of the application process, the company examined the patient’s medical records for signs of possible illness.
And there was plenty of room to define these existing conditions. This can extend to serious and ongoing problems such as: Diabetes mellitus Also cancerFor long-forgotten illnesses, such as old sports injuries.
Companies may reject coverage altogether or offer limited or more expensive policies that prevent many from using coverage. According to a recent report from Family USA, one in five adults under the age of 65 has an existing condition that could result in disqualification from health insurance under old rules.
The new law will abolish this rating system. Insurance companies need to cover everyone, regardless of their health status. And if you are ill or you were once treated for an illness or injury, they cannot charge you any further.
Prices are based on three things: age, where you live, and whether you smoke.
6. Your employer will contact you shortly.
By October 1, many will receive a letter from their employer. Companies that do business for at least $ 500,000 each year need to send these letters.
The letter is intended to inform employees that the state marketplace is offering new insurance options to qualified people. It also has important information needed to determine if you are eligible to purchase insurance on the marketplace. This includes whether the employer offers coverage and whether it is offered to dependents. It also includes whether the plan meets the “minimum value standards” stipulated by law. The plan should cover at least 60% of your medical expenses to meet the criteria.
If your work insurance is too high or does not cover your health costs well, you may be eligible to shop at your marketplace and be eligible for financial assistance.
7. Available health insurance should improve regardless of whether you purchase a new plan from the marketplace.
For most people, the best deals come from health insurance policies that are part of a benefits package at work or purchased through a new marketplace. The marketplace is the only place where you can use tax credits to pay for your plans.
But if you’re a self-employed person and you’re making a lot of money to be tax deductible, it might be worth looking for coverage outside the marketplace, says Kaiser Family Foundation Levitt.
Under the law, every new plan sold in an individual market must meet a set of minimum requirements. These requirements vary slightly from state to state, but all new plans need to cover 10 key benefits, including those that were often missing from plans purchased individually in the past. mental health problem, Substance abuse, And obstetric care.
Why do you look out of your marketplace? You might find the same insurer, but “they offer slightly different plans, perhaps with different providers’ networks and cost-sharing structures,” says Levitt. Or you might find a plan from a company that has decided not to join the marketplace.
However, keep in mind that Marketplace plans may have lower management costs than plans purchased through an insurance broker. So far, the management costs added to the marketplace plan range from about 1.5% in the following states: running In states where the federal government operates marketplaces, Levitt says he will have 3.5% of his own marketplaces. On the other hand, he says, the commissions to brokers added to the premium have historically been double digits.
Source: Kaiser Family Foundation: “Health Tracking Poll” Urban.org: “Individual Mandate in Perspective” White House Blog: “Affordable Care Act: Speaking to Women’s Unique Health Needs.” HealthCare.gov: “What Are My Preventive Effects?” “Open Registration Period. Childbirth: “The cost of having a baby in the United States.” Family in the United States: “How affordable care makes health insurance more affordable.” US Department of Labor, Model Letter: “New Health Insurance Market Place coverage options and your health insurance. “
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7 Amazing Things About Affordable Care Act
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