There has been a tremendous amount of information distributed about Obamacare, which has caused considerable angst among people who may be eligible. We will try to put some of the myths and misconceptions to rest in the hope that you find some of the answers you seek about such an important topic.
If you presently have health insurance — either public or private — and that coverage will be in place in 2014 AND it meets minimum coverage requirements, then there’s nothing you have to do to comply with the Patient Protection and Affordable Care Act (ACA). You’ll be able to keep your insurance, uninterrupted.
That’s because the ACA, also known as Obamacare, doesn’t — and isn’t intended to — replace private health insurance. Instead, the act is about expanding the existing health insurance net to include as many people as possible. It aims to do this by expanding public and private insurance coverage, and reducing the costs of health care for individuals and the government. It provides a number of mechanisms — including mandates, subsidies and insurance marketplaces — to increase coverage and affordability.
If you do not currently have health insurance, then it’s highly recommended that you shop at healthcare.gov to find one that’s best for you. As you explore this site, you’ll find that some plans available through the healthcare market are very affordable, but they only offer minimum coverage. So a bronze plan will cover 60 percent of costs, a silver plan 70 percent, a gold plan 80 percent and a platinum plan 90 percent.
Your access to wheelchairs and related medical equipment, assistive technologies, prescription drugs and medical supplies is highly dependent upon which health insurance carrier and which health insurance plan you choose. Pay close attention to what is covered under “Rehabilitative and Habilitative Devices and Services” under each plan and what medical equipment, prescription drugs and medical supplies are available. It is very possible that a platinum plan (the highest level) is actually cheaper than the bronze plan (the entry level), when you take into account the purchase of a wheelchair and/or medical supplies that you use regularly.
- Everyone must have insurance by March 31, or risk paying a fine. If you are already on Medicare, Medicaid or any other government-funded health care, nothing will change for you. If you have no insurance, or if you are self-employed and paying a whole lot for insurance, you are encouraged to log onto the health care exchange at www.healthcare.gov. Although this website was plagued with problems when it first went live in October, most now report they are able to log on, compare plans, and buy one that works for them. And, thanks to tax subsidies that are immediately applied, most people are reporting these plans are significantly cheaper than what had been available to them in the past.
- Pre-existing clauses are gone — no longer can any insurance company turn a potential customer down because of a spinal cord injury/disease. Also, since everyone must buy into the system or pay a fine, there will be enough healthy people in the system to offset costs of those whose disabilities require more care.
This reform alone will dramatically expand employment opportunities for people with SCI/D. People with SCI are no longer tied to whichever insurance carrier was in place at the time of their injuries or the onset of our spinal cord disorders, and many will no longer be forced to remain on SSI or SSDI for fear of losing health benefits. In short, the opportunity to find a job, or move from one employer to the next is now easier for people who have the desire and capacity to work.
- Health insurers can no longer limit or deny benefits to children under 19 due to a pre-existing condition. That’s right, insurance companies were previously able to deny coverage to the children of otherwise insured parents, because of a congenital SCI/D.
- If a plan covers children, then individuals under age 26 can be included on their parents’ plan. In many cases this is true even if they’re married, not living with their parents, attending school, not financially dependent on their parents, and eligible to enroll in their employer’s plan. It’s no secret we need as many young, healthy people enrolled in health insurance as possible, and this is one way to make that happen.
- Lifetime caps on coverage for most benefits end. Let’s face it, we’re expensive and many of us reach that $1 million lifetime cap pretty quickly. Additionally, annual dollar limits on coverage will be phased out by 2014.
- Your insurance carrier can no longer arbitrarily withdraw insurance coverage due to mistakes on insurance applications. This was a frequent occurrence for people with SCI/D, or a history of SCI/D, if they didn’t fully disclose their medical history. Considering how involved many of our disabilities are, these types of mistakes were common. Now we don’t have to worry about losing our health insurance because of an oversight.
- Insurance companies must now publicly justify any unreasonable increases in premiums. In the past, insurance companies could encourage people to “voluntarily” dump their coverage by making the plan unaffordable.
- Also, insurance companies must now spend at least 80 percent of premium dollars on actual health care and if they don’t, they must issue a rebate. This is one way to try to keep them honest.
- Changes to Medicare’s prescription drug coverage will reduce the out-of pocket cost impacts of the “doughnut hole” gap. Some of this has already begun happening, as subsidies to help pay for generic drugs were put in place in 2011. This year, more subsidies will be phased in to help pay for brand-name drugs. By 2020, the gap will shrink from 100 percent to 25 percent.
- If you currently have coverage through the federal Pre-Existing Condition Insurance Plan (PCIP), be aware that this plan will end Dec. 31, 2013. You must enroll in a new health plan by Dec. 15, 2013 to ensure pre-existing condition coverage that starts Jan. 1, 2014. PCIP was a temporary program put in place to provide immediate relief for people who could not otherwise obtain health insurance, but now that the exchange is up and running, PCIP is being phased out.
To Learn More
- “Health Law Helper,” Consumer Reports; www.healthlawhelper.org
- “Health Reform and People with Disabilities,” American Association of People with Disabilities; www.aapd.com/resources/fact-sheets/health-reform-people-with-disabilities.html
- “The Affordable Care Act Kicks In: Important Facts for People with MS and Their Families,” National MS Society; www.nationalmssociety.org/government-affairs-and-advocacy/health-care-reform-resources/index.aspx
Quick Links Via Healthcare.gov
The Health Insurance Marketplace, Affordable Care Act can be found at Healthcare.gov and this is the site where you can shop for insurance. It’s an easy process and people are encouraged to explore before they make a final purchase. Following are some links within Healthcare.gov that provide useful additional information:
- “Get Covered: A one-page guide to the Health Insurance Marketplace,” www.healthcare.gov/get-covered-a-1-page-guide-to-the-health-insurance-marketplace/
- “How do I get help enrolling in the marketplace?,” www.healthcare.gov/how-do-i-get-help-enrolling-in-the-marketplace. This link can connect you to “health care navigators,” trained professionals in your local area who can help you figure out the best plan for your situation.
- “What if I have PCIP Coverage?,” www.healthcare.gov/what-if-i-have-pcip-coverage/.
No computer? No problem. You may call the Health Insurance Marketplace at 800.318.2596.