FAQ: Health Care Reform
Obtaining health insurance or financial assistance to cover all health costs can be challenging for those who need it most. In 2010, The Patient Protection and Affordable Care Act was signed into law to ensure all Americans have access to affordable health care. As a result of this law, the “Health Insurance Marketplace” was created to help uninsured people find health coverage. Below are some questions and answers to help you understand the Marketplace as well as your health insurance options.
What is the Health Insurance Marketplace?
The Health Insurance Marketplace is a new way to find quality health coverage in one place. Within the Marketplace you can learn about your health insurance options, compare insurance plans and submit an application. This will be helpful if you do not have coverage or would like to explore more cost-effective options. Further, all plans are considered “Qualified Health Plans,” meaning that they must cover certain essentials, including but not limited to: ambulatory patient services, emergency services, hospital coverage, behavioral health, prescription drugs, lab services, and chronic disease management. For more information about the Marketplace or to apply for coverage, visit: www.healthcare.gov
When can I begin to enroll in the Marketplace to see my options?
Open enrollment ended for the 2014 year as of March 31, 2014. Outside of open enrollment, you cannot enroll in Marketplace coverage unless you have a qualifying life event. In order to obtain health coverage for 2015, open enrollment will begin again on November 15, 2014 and will remain open until February 15, 2015. This will be the next time period in which you can enroll in a Marketplace plan (unless you have a qualifying life event).
Will my pre-existing condition be covered under the Marketplace?
Yes. Health insurance plans within the Marketplace cannot deny you coverage or charge you more due to a pre-existing health condition. Coverage for your pre-existing condition(s) begins as soon as the insurance plan is in effect. This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past.
Will coverage be lower cost within the Marketplace?
Depending on income and family size, you may have the opportunity to save money within the Marketplace in three ways:
1. You may qualify for lower out-of-pocket costs for co-pays and deductibles.
2. You may be able to lower costs on monthly premiums when you enroll in one of these plans.
3. You may be eligible for Medicaid as some states will be expanding Medicaid eligibility in 2014.
Below are two additional links which can help you estimate your costs for coverage within the Marketplace, as well as offer information about your eligibility to save on monthly premiums:
How do I know if I qualify for Medicaid or if my child qualifies for Children’s Health Insurance Program (CHIP)? What if I was previously denied?
You qualify for Medicaid based on family size and income. If you are eligible, you get free or low-cost healthcare and will not need to purchase a Marketplace plan. When you complete an application within the Marketplace, it will let you know if you are eligible for Medicaid/CHIPS, and the Medicaid agency will be notified so your coverage can start in 2014.
If you have previously applied and were denied, you may qualify for the 2014 year if your state is participating in Medicaid expansion. To see if your state is participating in Medicaid expansion and to find more information about your specific state, please visit: https://www.healthcare.gov/do-i-qualify-for-medicaid/
How do I get help enrolling in the Marketplace?
The Marketplace offers several ways to help you choose a plan that meets your specific needs, including:
· Visiting www.healthcare.gov to review online questions and answers.
· Using the www.healthcare.gov website’s “live chat” feature
· Calling their toll free call center at: 1-800-318-2596
· RECOMMENDED: Finding local help by visiting https://localhelp.healthcare.gov/ to get personalized assistance from a Marketplace navigator in your area.
Additional Helpful Resources for Consumers:
- U.S. Department of Health & Human Resources
- Centers for Medicare & Medicaid Services
- American Public Health Association
- Putting Patients First
For further information, call the Irwin M. and Suzanne R. Rosenthal IBD Resource Center (IBD Help Center): 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: July 1, 2010
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