AFFORDABLE CARE ACT 101

Read:

• HEALTHCARE.GOV: The Health Insurance Marketplace is Open! •
• WHITEHOUSE.GOV: What Obamacare Means for You •
• HHS.GOV: How the healthcare law is making a difference for the people of New Jersey •

• Now that the Health Insurance Marketplace is open, 901,289 uninsured and eligible New Jerseyans have access to affordable care. Open enrollment began October 1, 2013, coverage can begin January 1, 2014 and open enrollment closes March 31, 2014.
• Up to 73,000 young adults in New Jersey can now stay on their parents’ health insurance until they’re 26 years old.
• People from New Jersey with Medicare in the prescription drug “donut hole” are now able to get discounts on brand-name prescription drugs, thereby saving nearly $35 million.
• Up to 3,847,72 non-elderly New Jerseyans with pre-existing conditions, including 485,006 children, can no longer be denied coverage.
• Those with health insurance can keep it.  Children under 26 can stay on a parent’s health insurance plan.
• Pre-existing conditions are covered.  So are many vital preventive services and 10 essential health benefits:
  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Laboratory services
  5. Maternity and newborn care
  6. Mental health services and addiction treatment
  7. Rehabilitative Services and devices
  8. Pediatric Services
  9. Prescription drugs
  10. Preventive and wellness services and chronic disease treatment
• Depending on a family’s size and income, monthly premiums and out-of-pocket expenses may be lower than before.
• Families may also qualify for free or low-cost coverage from Medicaid or the Children’s Health Insurance Program (CHIP).   New Jersey is expanding Medicaid to cover more people in 2014.   Medicaid will have a larger pool of money and will be available to more people.
• For those who don’t have coverage in 2014, there will be a fee to pay.  In 2014 it’s $95 per adult ($47.50 per child) or 1% of income, whichever is higher.  The family maximum is $285.
• Medicare isn’t part of the Marketplace. Those people with Medicare can keep it.  Whether they have obtained Medicare through Original Medicare or a Medicare Advantage plan, benefits will not be changed. Medicare open enrollment period is October 15-December 7.  Visit www.Medicare.gov to explore Medicare coverage and choices.
• Medicare benefits have expanded under the health care law to include free preventive benefits, cancer screenings and an annual wellness visit.  Those who have coverage may now choose to explore other Marketplace plans. However, if an individual has an offer of insurance from an employer, they may not be able to get lower cost insurance on the Marketplace. This is dependent on their income.  It also depends on whether the employee considers that their employer’s insurance plan is affordable and whether it meets the employee’s  needs.
• The Act requires insurance companies to spend 80% of premium dollars on health care. If they don’t, they’ll be forced to give consumers a refund to make up the difference.
• A negative aspect of the Act is that long-term healthcare costs are not addressed.