Affordable Care Act - FAQ's
The University of Toledo Medical Center has recently started a new radio public awareness series with Cumulus radio stations to help those in the greater Toledo area learn more about changes to their health care due to the Affordable Care Act. The series, which began October 7th, will run through mid-December and will answer some frequently asked questions related to the new law. Below are some of the questions and answers you’ll hear on various local Cumulus stations. We hope this information will help our patients and the community better understand the changes we all face as a result of the law.
My employer doesn’t offer health insurance and I can’t afford to pay for it myself. How does this law affect me?
The Affordable Care Act REQUIRES that all Americans have health insurance, so you’ll have to BUY insurance yourself, OR pay a penalty- starting in 2014 – of either 95-dollars or one percent of your gross income, whichever is higher.
What happens if I lose my job and employer health care coverage once the new law takes effect?
Under the Affordable Care Act , you’ll have TWO options. You may elect to continue your existing plan – paying the full premium yourself – under the existing COBRA program. Or, you may elect to purchase new coverage through a health care exchange, provided for by the law
Will I have trouble obtaining health coverage if I have a pre-existing medical condition?
Under the Affordable Care Act , you can no longer be denied coverage – or charged a higher rate – due to a pre-existing medical condition. However, the law leaves it up to the states and insurance companies to define those “pre-existing conditions”.
Will I be able to keep my current doctor once the law takes effect?
Most health insurance plans offered in the Health Exchanges have networks of hospitals, doctors, and other health care providers. Networks include health care providers that the plan contracts with to take care of the plan’s members. If staying with your current doctors is important to you, check to see if they are included before choosing a plan
I currently receive Health Insurance through my employer. Do I have the option of buying it myself from one of the new health Exchanges?
Under the Affordable Care Act , you DO have the option of declining your employer’s plan and purchasing your own coverage. But remember- most employers pay a substantial portion of your premiums each month, and they are NOT required to do so if you shop for your own outside plan.
How does the new Healthcare Law affect my Health Savings Account?
There ARE some changes. One, the new law eliminates your ability to use HSA funds to pay for over-the-counter drugs. Second, the law INCREASES the penalty you’ll pay for withdrawing cash from your HSA before age 65. The penalty goes from 10% to 20%.
I’ve heard there are Gold, Silver, and Bronze plans. What do those designations mean?
The new law requires everyone to have health coverage which would pay a minimum of 60% of a patient’s costs. That’s the Bronze Plan. A Silver Plan pays 70 percent of your costs.. Gold pays 80 percent.. and a Platinum Plan pays 90 percent. Monthly premium costs and provider networks vary by plan, as well.
When does the Affordable Health Care Law take effect?
The provision that allows young adults up to age 26 to be covered under their parents’ plan has already taken effect, along with several other benefits. The meat of the plan – which REQUIRES you to have coverage, or else pay a penalty, takes effect January 1st, 2014.
Will I be able to change plans from year to year, if my individual needs or family situation changes?
Under the new Federal guidelines, there will be an Open Enrollment Period each Fall, during which you can select coverage. This period begins October first this year. There is no federal prohibition against changing plans, though individual states may have restrictions.
I just want to keep my current coverage. Can I do that?
((Answer))Yes.. and no. The ACA mandates a certain level of quality and services in insurance packages. If your current plan doesn’t meet those minimums, or cover a procedure it is required to cover under the new law, then your plan will become a different plan in order to comply with the law.
If I have health care coverage through the Veteran’s Administration, do I meet the minimum stands are healthcare?
Yes. If you’re enrolled in the Veteran’s Health Care Program, or the Civilian Health and Medical program – CHAMPVA – you already meet the minimum standard and will not have to pay a penalty.
I’m 23 years old. I have a job and an apartment, but no health care coverage and I can’t afford it myself. Can I stay on my parents’ plan?
Yes. You can remain on your parent’s plan until you reach the age of 26, even if you don’t live at home.
I’m a small business-person. How does this law affect the coverage I might offer my employees?
Under the law, an insurance plan cannot deny you access do the health care status of your employees, or their possible pre-existing conditions. Nor can they charge you higher premiums if you have emplyees with high medical costs.
I am a small businessperson, and I keep hearing that the SHOP program can help me. What is it?
The Small Business health Options Program is designed to simplify the process for companies with 50 or fewer employees to find the right health care plan for you. It will allow you to compare plans on an apples-to-apples basis.
In the past, I’ve had trouble getting health coverage because of some previous medical issues. Does the law help me?
Yes. You can’t be denied coverage, based on pre-existing conditions.. nor can they refuse payment for treatment of issues that began before you joined the new coverage plan.
I know I might have to start making some decisions soon. What can I do to get ready for the new law?
The first thing is to make sure you understand your current health plan, and have gathered complete information on your family’s finances. You MAY qualify for a subsidy to help pay your premiums. And visit healthcare.gov for a list of more questions you’ll need to be prepared to answer.
There are all kinds of confusing terms in health care. Where can I learn more about each type of health care option?
PPOs, HMOs, HDHPs, and many more. The government has set up a website – healthcare.gov
– with explanations of the many kinds of healthcare options you may be considering.
I don’t like change. Why should I be happy about this new health care law?
The new health care law sets minimum standards for everyone’s health care by requiring insurers to offer basics.. like preventative care, doctor visits, and hospitalization. And you can’t be denied coverage if you have existing medical issues.
Can I use a Flexible Spending Account to pay some of my medical expenses under the new law?
A Flexible Spending Account is a special account you put money into that you use to pay for certain out-of-pocket health care costs. An FSA is available only with job-based plans
I hear so much about MEDICAL coverage, but what about Dental? Is THAT part of the new health care law?
Yes.. and no. Dental is considered an essential benefit for children under 18, so it must be available to you as part of any health plan that would cover your children. This is NOT the case for adults, and you are not REQUIRED to have adult dental coverage.
I’m pregnant, and am wondering if the new health law provides coverage for breast-feeding support and equipment?
Unless you’re covered under a grandfathered plan, your insurance options must include coverage for equipment, counseling and support both before and after you deliver your baby.
I keep hearing about coverage of “preventative health services” under the new law. What does that mean?
Preventative care can help you stay healthy, and decrease your need for more serious treatments down the road. The new law provides for a long list of preventative servies for which there is no charge to you, even if you haven’t already met your deductible.
I keep hearing about coverage of “preventative health services” under the new law. What’s covered?
It’s a long list of preventative services, that are free under the law… everything from Blood Pressure, Aortic Aneurysm, alcohol, and cholesterol screenings to diet counseling and immunization vaccines. There’s full list available at healthcare.gov.
What kinds of health screenings for my children are included at no charge under the new law?
There’s no charge, or co-payment, for services like Autism, hearing, or Depression screenings, or for behavioral assessments, fluoride supplements, or obesity counseling, among many other programs. Check out the full list at healthcare.gov.
I keep hearing about the Health Insurance Marketplace. What’s that?
The Health Insurance Marketplace is the clearinghouse for all of your health care options. Through the Marketplace, you can learn about the available insurance plans in your area, and make your personal health care selections. While insurance plans are run by private companies, this Marketplace – or clearinghouse – is run by either your state, or the federal, government.