This is part of a series of updates from Mayor Mark Stodola addressing various topics of interest to the citizens of Little Rock.
Message from theMayor
Patient Protection and Affordable Care Act
As you know, the federal healthcare reform law, known as the Patient Protection and Affordable Care Act (ACA), goes fully into effect on January 1, 2014, although many of the law’s consumer protection provisions have been implemented over the last several years. The time for enrollment in the law’s newly available insurance programs begins tomorrow, October 1, 2013. I’m sure many citizens have questions about what this change to the healthcare system means to them and their families. It’s important to get answers to all of these questions as soon as possible, so you can make informed healthcare decisions for your family.
The Arkansas Insurance Department has created some very informative websites and publications that seek to answer many of these questions. Below I have provided links to some of these resources. First, I would like to provide you with some basic questions and answers that you may find helpful.
What parts of the ACA are already in place?
· Children can stay on their parents’ health insurance policy until age 26.
· Insurance companies can no longer deny coverage of a child under age 19 due to pre-existing health conditions.
· Lifetime benefit payment limits are eliminated, and annual limits are regulated until 2014.
· Rescinding coverage by insurance companies is prohibited unless due to fraud.
· Coverage is available for early retirees (age 55-64).
· Many Arkansans have received rebates on paid premiums when insurers did not use at least 80% of paid premiums toward medical costs.
· Arkansans who are covered by Medicare have received preventive care with no out-of-pocket costs and have seen a shrinking of the “donut hole” through rebates and discounts on prescription drugs
How will the ACA help consumers in the future?
· Coverage can’t be denied to anyone who has a pre-existing condition, such as cancer, diabetes or heart trouble.
· No insurance policy for anyone in America can have annual or lifetime caps on benefit payments.
· Premiums cannot be increased due to gender, health conditions or personal health history; premiums can only be increased due to age, geography and tobacco use.
· Preventive care will covered at no out-of-pocket costs for consumers.
My family is already insured through my employer. Will I be affected?
All health insurance policies, including those through an employer, will be affected by some of the changes resulting from the ACA. For instance, many insurance policies now cap a person’s lifetime benefit payments; ACA says they can no longer be capped. The law also removes the annual limits on benefits that your insurance may now impose. Also, your insurance will no longer be able to stop your coverage or raise your premium because of a pre-existing condition and your children now can be kept on your insurance until they are 26 years old. Another change that may affect you is that your insurance company must give rebates if it fails to spend a certain percentage (80-85%) of the premiums on healthcare each year.
I am currently insured through an individual policy, which is expensive. Can I switch plans?
Yes, you may switch plans. In fact, you may be eligible for financial support to help pay for available health insurance plans in Arkansas through the Health Insurance Marketplace created by the ACA. You may keep your plan in 2014 if you re-enroll in it before January 1, but be aware that your current plan may not meet minimum essential coverage required by the law, which could subject you to a tax penalty.
I do not have insurance through my work, and I cannot afford to buy an individual policy for my family or myself. How will the Marketplace help me?
On October 1, the new Health Insurance Marketplace will give you a choice among an array of insurance plans that fit your family’s needs and your pocketbook – with immediately available financial assistance to help pay premiums if you meet income eligibility.
I have no health insurance, but my family and I are in good health. I don’t want to buy insurance. Do I have to?
You can choose not to buy insurance. Instead, you will pay a penalty to the federal government each year that you and your family are not insured.
I have military insurance (either VA or active military); will the ACA affect me?
Your insurance provides the required coverage. The same is true of nearly all government employee insurance programs.
Who can purchase a plan through the Marketplace?
Any individual or family may buy coverage through the Marketplace, although only those who meet income eligibility will qualify for financial assistance. Small employers (employers with 50 or fewer employees) may also purchase health insurance for their employees through the Marketplace.
How much will plans on the Marketplace cost?
A wide variety of plans intended to fit different budgets will be offered. In addition, many people will qualify for the new premium tax credits to help people afford coverage. To see specific costs of plans for you or your family and to determine whether you qualify for financial assistance to help pay for coverage, go toARHealthConnector.orgor call 800-318-2596 to talk with a guide.
What about Medicaid expansion under the ACA; did Arkansas do that?
Rather than expanding the traditional Medicaid program for very low-income individuals, Arkansas instead decided to use the federal funding to allow those individuals to purchase private health care coverage through the Health Insurance Marketplace. The Health Care Independence Program—sometimes called the “Private Option”—will pay premiums (and for some individuals all cost sharing—copays, coinsurance) for plans offered through the Marketplace.
What key dates are coming up?
October 1, 2013: Open enrollment in the new Health Insurance Marketplace begins for individuals and small businesses shopping for health insurance coverage. If you sign up for coverage between October 1 and December 15, 2013, your coverage will become effective January 1, 2014.
To learn more about the Health Insurance Marketplace, the Health Care Independence Program, and the ACA, you can reference the following websites and publications from the Arkansas Insurance Department:
You can also call the Arkansas Insurance Department at 855-283-3483.
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