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Health Care Law -- Answers

Learn how the health care law works for you and your family.

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1)  What U.S. state or territory do you live in?

Health Care Law -- Factsheets
Quick Reference   View | PDF
The Health Care Law: More Choices, More Protections   View | PDF
Choosing a Health Care Plan: Coverage, Cost, Compare   View | PDF
What the Health Care Law Means for Employees of Small Businesses   View | PDF
What the Health Care Law Means for Small Businesses    View | PDF

Health Care Law -- Getting Coverage

There's a new, easy way to shop for health insurance

Every state will have a Health Insurance Marketplace where people looking for coverage can go online to shop for health insurance. The Health Insurance Marketplace will make it easier to shop for health plans in your state starting October 1, 2013.

Here’s how the marketplace will work:

   -- All health plans will be listed in one place, so you can make side-by-side comparisons of the benefits and prices.
   -- Insurance companies are required to describe what’s included in simple language, so there’s no guesswork about what’s covered.
   -- All plans offered in the marketplace are required to cover important benefits, like doctor visits, hospital care, emergency care, prescriptions, preventive care and more.

Financial help is available

Health Care Law -- Medicare Coverage
The health care law means you'll get more from your Medicare

New protections and benefits in the health care law strengthen Medicare, protecting the benefits you’ve earned and providing more care from your coverage.  

Your guaranteed benefits are protected

You've earned your Medicare over a lifetime of work. The health care law protects the benefits you were promised to ensure you can always get the care you need when you need it. The law also adds resources to fight fraud, scams and waste, and helps the Medicare program save money.

More preventive care is covered

Lower prescription drug costs

Health Care Law -- Timeline -- AARP

Health Care Law -- Facts -- AARP

Take the time to understand the Law.  Afterall, it was Supreme Court approved.

NOW you have some Health Care Law answers too.  Many thanks to the AARP -- The American Association of Retired Persons.

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Comment Preferences

  •  AARP H/C Resources (5+ / 0-)

    Notice: This Comment © 2013 ROGNM UID 2547

    by ROGNM on Tue Sep 24, 2013 at 06:17:05 AM PDT

  •  I'm looking at employer mandates for my job. (20+ / 0-)

    Please note that there is a hole if both spouses work for different employers.

    ACA mandates that each employer offer insurance to the employee and their children, but does not mandate coverage for a spouse. If the spouse also works, you may have to pay up to 9.5% * 2 to get coverage for the entire family and the employers are meeting the mandate.

    For employees, it is going to be very important to read the materials given out when it comes time to sign up again for insurance. There are many things that the insurance coverage can't change, but dropping spousal coverage is the one thing that can be done and be within the law.

    Also of note, if your employer offers multiple plans, only one of the plans has to meet the guidelines of the employer mandate, so the other plans might not have the coverage that you need.

    "A teacher affects eternity; he can never tell where his influence stops." Henry Adams.

    by glendaw271 on Tue Sep 24, 2013 at 06:40:24 AM PDT

  •  Other Sources also help (2+ / 0-)
    Recommended by:
    Nance, quill

    Get the full picture...

    That's an old, familiar way to keep profits high, or raise prices without anybody noticing; people who don't read the fine print and check the weight think they're getting the same value for
    a "box of cereal" when they're not. Candy manufacturers use the same play: They shrink the size of the bar, and leave the size of the wrapper the same.

    And so, to ObamaCare. ObamaCare apologists consistently make the argument that ObamaCare is "affordable" because the prices are low* or at least not too high, but they always talk about price and not about value.** And they can't talk about value because ObamaCare's insurance policies have not yet been revealed! In any case, the value story isn't looking good for ObamaCare's Exchanges:

    WASHINGTON — Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

    “That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” [Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group] said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

    If I were the super-paranoid and cynical type, I'd feel like I were being lured into the trap by the cheese of low price, only
    to have the jaws of poor value close on me later.

    •  Repeating right wing hysteria? (6+ / 0-)

      Where is the proof that ACA exchange plans have more limited networks than non-exchange plans?

      Also- pretty much every employer sponsored plan out there has networks. This is not anything new. The right wing hacks make it sound like this is a new concept. Out-of-network and in-network have different charges! Imagine that!

      •  NH for starters. (0+ / 0-)

        A Shocker (Watch Video)

        That whole “you can keep your plan – you can keep your doctor” foundation that was used to “sell” the Affordable Care Act to the American People? To me, that’s a pretty important foundation for this reform: the whole point is to add options for those who need it, while maintaining current choices for those who don’t wish to make a change.

        Well guess what – I’m finding out in a hurry that this core foundation of my support for Obamacare was a fantasy. I – the individual healthcare purchaser (in New Hampshire) – am about to get royally screwed. New Hampshire residents who purchase their own health insurance basically have one option: Anthem. The Marketplace under the Affordable Care Act will also only have one provider option: Anthem. One might think that if there is only one provider, that the Government might go to great lengths to make sure that this one provider isn’t going to hose their subscribers – but one would be mistaken.

        See, Anthem’s new plans will only include coverage for 14 of the state’s 26 hospitals. “Kid Dynamite,” you say, “you live in the Greater Concord Area. Concord is the capital of New Hampshire. Concord Hospital is one of the major hospitals in New Hampshire. You’d be crazy to think that Anthem could get away with excluding Concord Hospital from their exclusive monopoly coverage that will be offered under the Affordable Care Act.” See, pragmatically, your words would make total sense: it seems impossible that the Government, regulators, New Hampshire Lawmakers, etc would allow Anthem to exclude major hospitals like Concord Hospital from their coverage, right? Yet somehow that is exactly what is happening.

        “But Kid Dynamite,” you say, “forget about the new plans – just keep your current plan and ignore the impact of the Affordable Healthcare Act.” Great idea! I might just have to do that – BUT WAIT – Anthem has informed me that my current plan is ceasing to exist. They’re making it so that I don’t even have the option of keeping my c

        urrent plan.
        14 out of 26!

        RW points indeed.  We are not spozed to discern conflicting information?

        •  Many states may choose to limit--it's state thing (3+ / 0-)
          Recommended by:
          davehouck, createpeace, theBreeze

          and a compromise under the present law in order to get it passed.

          Many states aren't participating at all and costs will skyrocket.

          It's not the fault of the law, per se, as much as the state's implementation of it.

          Weak point, to be sure, but we can't forget all the compromises we had to make to get this passed.

        •  Private insurers change coverage all the time (4+ / 0-)

          Every year... every autumn. I've been booted from one group to another for years. Some years, hospital A is included, other years they're not a preferred provider.  It all depends on the contracts your insurance provider negotiates with various health care providers in your area, and this changes every flipping year.

          I'm not sure how this is any different now... except that instead of blaming insurance companies, people conveniently blame Obamacare.

          Freedom isn't free. That's why we pay taxes.

          by walk2live on Tue Sep 24, 2013 at 09:42:10 AM PDT

          [ Parent ]

          •  Agreed! (0+ / 0-)

            "I'm not sure how this is any different now."  Yes we got nothing.  And the promises about how you could keep your doctor and your coverage were?

            •  Obamacare does not alter current existing plans (0+ / 0-)

              aside from letting 26yo offsprings sign onto their parents' plans and no lifetime coverage cap. My employer-provided plan has not changed. Nor has my wife's.

              Of course, sometimes some plans will change, and/or add/drop providers from their network. This has been happening since time immemorial. This is called 'business as usual'. Nothing to do with Obamacare. Just a capitalist corporation doing what it needs to do to make a buck.

            •  Actually we don't agree... (1+ / 0-)
              Recommended by:

              My point is that the cause of this particular issue isn't Obamacare, it's the insurance companies.

              The promise that you could "keep your doctor" under Obamacare means to me that "Obamacare" doesn't have any provision in it that dictates who provides your health care - your insurance does... same as it's always worked.

              What irks me is that the opponents of Obamacare conveniently shift blame for everything that was wrong with our health care system (high costs, preferred providers, etc) to Obamacare - assuming that problem is not immediately fixed.

              And no system is going to fix everything... at the end of the day, healthcare is a complex thing - treatments and outcomes are not straightforward. People die. Complex treatments are expensive. Choices have to be made.

              Freedom isn't free. That's why we pay taxes.

              by walk2live on Tue Sep 24, 2013 at 03:38:58 PM PDT

              [ Parent ]

        •  traditional health plans all have networks too (0+ / 0-)

          You have not shown that the new ACA plans are any different than traditional health plans, which all have in-network and out-of-network charges. You make it sound like this is something new, with that hysterical right wing video.

          Also- networks are constantly changing. Hospitals which are excluded from a network one year, would renegotiate to join the network the next year. I work for a large corporation, and their health plan in this area (northern CA) started out with a very sparse network. After a bunch of northern CA employees complained, they expanded their network, so that it is fairly useable now.

          •  some of the network law (0+ / 0-)
            §156.230 Network adequacy standards.
            (a) General requirement. A QHP [Qualified Health Plan] issuer must ensure that the provider network of each of its QHPs, as available to all enrollees, meets the following standards –
            (1) Includes essential community providers in accordance with §156.235;
            (2) Maintains a network that is sufficient in number and types of providers, including providers that specialize in mental health and substance abuse services, to assure that all services will be accessible without unreasonable delay; and,
            (3) Is consistent with the network adequacy provisions of section 2702(c) of the PHS Act.
            (b) Access to provider directory. A QHP issuer must make its provider directory for a QHP available to the Exchange for publication online in accordance with guidance from the Exchange and to potential enrollees in hard copy upon request. In the provider directory, a QHP issuer must identify providers that are not accepting new patients.

            §156.235 Essential community providers.
            (a) General requirement. (1) A QHP issuer must have a sufficient number and geographic distribution of essential community providers, where available, to ensure reasonable and timely access to a broad range of such providers for low-income, medically underserved individuals in the QHP’s service area, in accordance with the Exchange’s network adequacy standards.
            (2) A QHP issuer that provides a majority of covered professional services through physicians employed by the issuer or through a single contracted medical group may instead comply with the alternate standard described in paragraph (b) of this section.
            (3) Nothing in this requirement shall be construed to require any QHP to provide coverage for any specific medical procedure provided by the essential community provider.
            (b) Alternate standard. A QHP issuer described in paragraph (a)(2) of this section must have a sufficient number and geographic distribution of employed providers and hospital facilities, or providers of its contracted medical group and hospital facilities to ensure reasonable and timely access for low-income, medically underserved individuals in the QHP’s service area, in accordance with the Exchange’s network adequacy standards.
            (c) Definition. Essential community providers are providers that serve predominantly low-income, medically underserved individuals, including providers that meet the criteria of paragraph (c)(1) or (2) of this section, and providers that met the criteria under paragraph (c)(1) or (2) of this section on the publication date of this regulation unless the provider lost its status under paragraph (c)(1) or (2) of this section thereafter as a result of violating Federal law:
            (1) Health care providers defined in section 340B(a)(4) of the PHS Act14; and

            14 Section 340B(a)(4) of the PHSA (Prescription Drug Pricing program, which provides drugs at deeply discounted prices to certain health care providers) defines those entities qualified to receive discounted drugs, which includes federally-qualified health centers, family planning projects receiving grant funds under Title X of the PHSA, Ryan White Care Act providers furnishing HIV/AIDS services, state AIDS drug purchasing assistance (ADAP) programs, black lung clinics, hemophilia diagnostic treatment centers, urban Indian health clinics, Native Hawaiian Health Centers, STC and tuberculosis treatment clinics, public hospitals receiving disproportionate share adjustment payments under Medicare, children’s hospitals, critical access hospitals, and rural referral centers and sole community hospitals meeting disproportionate share adjustment payment thresholds. See 42 USC §256(a)(4):

            (2) Providers described in section 1927(c)(1)(D)(i)(IV)15 of the Act as set forth by section 221 of Pub. L. 111-8.
            (d) Payment rates. Nothing in paragraph (a) of this section shall be construed to require a QHP issuer to contract with an essential community provider if such provider refuses to accept the generally applicable payment rates of such issuer.
            (e) Payment of federally-qualified health centers. If an item or service covered by a QHP is provided by a federally-qualified health center (as defined in section 1905(l)(2)(B) of the Act) to an enrollee of a QHP, the QHP issuer must pay the federally-qualified health center for the item or service an amount that is not less than the amount of payment that would have been paid to the center under section 1902(bb) of the Act for such item or service. Nothing in this paragraph (e) would preclude a QHP issuer and federally-qualified health center from mutually agreeing upon payment rates other than those that would have been paid to the center under section 1902(bb) of the Act, as long as such mutually agreed upon rates are at least equal to the generally applicable payment rates of the issuer indicated in paragraph (d) of this section.

            15See 42 USC §1396r-8 – Payment for covered outpatient drugs:

      •  Proof? All you have to do is look at plans (0+ / 0-)

        I'm seeing BCBS is using a more restricted network for ACA unless you go to a high deductible plan, which kind of makes it not so affordable after all. UNLIMITED (their word) for out of network costs.  Another insurer HealthPartners is making it clear that the out of pocket maximum is only for in-network services.  

        I haven't seen all the plans yet, but apparently if you go out of network there is no cap on what you can be charged and I still don't know if there is any requirement that plans provide a network broad enough to include all specialists.  

        I guess we'll find out how this works but people need to know the facts not spin when they sign up for coverage.

        If the provider network thing is a hole in the law, it needs to be fixed and people need to be aware of how important it is to review the provider network because it would indeed be a darn shame for them to find out that the "affordable"  Care Act left them with an UNLIMITED out of pocket cost if they found themselves in an out of network situation.

        •  You sound like you just moved to the USA (0+ / 0-)

          Do you have an existing emploer sponsored health plan? Have you ever had an employer sponsored health plan? Didn't your plan have a network? Didn't your plan have in-network charges and out-of-network charges? You make it sound like this is some kind of foreign, Kenyan communism, when it's just business as usual.

    •  How different is that from what we had? (3+ / 0-)
      Recommended by:
      ahumbleopinion, SingleVoter, mmacdDE

      I could go with a cheap HMO and pay huge out-of-pocket fees and get pinged by not being able to find providers in the preferred network.  This has been the case for years.

      •  Where is the "change we can believe in?" (0+ / 0-)

        O'care appears to be just the same ol.

        •  Well duh (1+ / 0-)
          Recommended by:

          it's the same private companies, offering coverage that's been more standardized and regulated.

          Why did you think it would be drastically different in function than what we had before?

          In some cases, it's more affordable. In most cases, you'll be better able to compare, because the plans have to cover just about the same things. And some things are covered 100% that weren't covered before.

          But it's still the same basic thing. Same in/out of network, same primary care doctor requirements for certain plans, etc.

          •  We got nothing. (0+ / 0-)

            HC costs going through the roof? Check.  For profit rentiers still in place (although now on steroids)?  Check.  Union non-profit TH plans excluded?  Check.  Medicaid clawback for 55+?  Check.  And fluffers on board to cheer us forward?  Check!

            •  A Story Untold... (0+ / 0-)

              Can PK be serious?  Part 1

              323,000 Tenncare Cuts  Part 2

              This video may be a little lengthy, but it is definitely worth watching. [Which is the reason that I didn't attempt to make a short "clip."]

              As usual, the "most horrendous of stories" do not always make it into the (national) mainstream media headlines.

              BTW, I saw a brief article in a Knoxville TN newspaper that mentioned asking Governor Phil Bredesen how he felt "about being considered by the President for the position of Secretary of Health and Human Services."

              So, I figure that the "rumor" was accurate.

              Hello?  This is what and who we cheer for?
  •  I've refused to join AARP b/c their policies (8+ / 0-)

    seemed seflish to me - like opposing higher taxes for schools b/c their members were mostly too old to reproduce. They're everybody's kids, people. So this is good, though. If they're out there helping counter the rethug disinformation campaign, maybe I'll look again. As long as they promise not to send me any mail!

  •  thanks, jamess, for your continuing good work. n/t (3+ / 0-)
    Recommended by:
    davehouck, ladybug53, jamess
  •  I'll wait. (2+ / 0-)
    Recommended by:
    CitizenOfEarth, Nattiq

    I'll reserve judgment for now. Who can say with certainty how it will turn out. Experience tells me to be wary.

    I don't trust the PP&ACA. It was created by a group of Republicans at Heritage, taken up by President Obama, has now arrived in a fog of confusion.

    I look at it with the same suspicion as I did the surge in Afghanistan, the attempt to keep troops in Iraq beyond the pull-out dates agreed to by Bush, the treatment of the criminals in the previous administration, Obama's promise to work for single pay, the appointment of shysters from Wall Street to Obama's financial team, the many whistleblowers who have been shafted....the goddamn list just goes on and on and on.

    I don't trust the PP&ACA and the reason I don't is because I don't trust the President.

  •  Basic info very clear from AARP (3+ / 0-)

    AARP only covers the basics.  There are many twists and turns in the PP&ACA that cannot be covered in anything this brief.  And, there needs to be technical corrections, but the Republican Congress refused to pass a technical correction bill--repeal, defund, blah, blah, blah.

    The trained Navigators, Enrollment Assisters, and Certified Application Counselors have the training and resources to find answers to all the details.

    Look at the actual marketplaces (a.k.a. exchanges) for one's state.  Look on October 1, but wait a while for any technical changes to be made to the marketplace web sites--their will be errors to be corrected.

    What time period is needed for processing?  A couple of weeks?  We need to know this.  If you sign up on December 31, don't expect coverage to begin on Jan 1.  Medicaid and CHIP offer immediate coverage.

    Open Enrollment this first year only is October 1 to March 31.  This first year only.  Next year and every other year it will be a shorter period--the next open enrollment period will be from October 15, 2014 to December 7, 2014 for 2015 coverage.  Tell anyone interested that if they miss the Open Enrollment Period, they may be stuck without insurance next year. There are a small number of exceptions.

    •  One of those Open Enrollment exceptions... (0+ / 0-) for a change in family size--divorce, birth, etc.  

      So, if the Republicans feel they should confer personhood on a fertilized human egg, does that mean that they'll campaign to allow a woman who learns that she is pregnant to enroll in Obamacare health insurance at that time???

    •  Outside enrollment period there is a 90 day waitin (3+ / 0-)
      Recommended by:
      highacidity, WisVoter, MRA NY

      period. I don't know where you got the 'stuck without healthcare next year' part.

      •  Where did you hear that? (0+ / 0-)

        You MUST enroll during the open enrollment period or you have to wait until the next open enrollment.

        There are exceptions like losing coverage through an employer, end of COBRA etc. All the normal qualifying events apply. Enrollment must be done within 30 days of the qualifying event.

        The only programs that can enroll all year long are Medicaid & CHIP.

        (FTR- I am a NYS certified IPA/Navigator)

  •  It's a train alright. A runaway train! (0+ / 0-)

    Sure looks to me like the ACA is coming on board, no matter how much screaming and hand-wringing the Teapeople do.  Lordy, if you were paying no attention at all to the clowns in Washington, you'd think we're all getting a new healthcare plan!  

  •  I understand AARP stands to (1+ / 0-)
    Recommended by:

    make a lot of money off the ACA.  Could you elucidate on how that all works?

  •  Happy for this, but AARP still has something to (1+ / 0-)
    Recommended by:

    prove to me.  I'm still steamed that they supported Bush Manchild's Medicare Part 'D' in 2003, so I'm not joining them.

    Actually, to be most fair, AARP has done a lot right in the last 10 years, but I still feel the need to give them more time to see where they're sensibilities really lie.

    When they call roll in the Senate, the Senators do not know whether to answer 'Present' or 'Not guilty'. --Teddy Roosevelt

    by thenekkidtruth on Tue Sep 24, 2013 at 09:10:49 AM PDT

  •  AARP is an insurance company. (0+ / 0-)

    Of course they are interest in the health insurance law. They stand to financially benefit from it, adding billions more to their already swollen coffers.

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