Affordable Care Act: Still a knowledge deficit among general public
Part of the problem is there is so much to know about the health care reform legislation: the theory, the law, what is political rhetoric and what is fact and how to apply the real information to our day to day lives.
“Obamacare”, health care reform, and the Affordable Care Act (ACA) are all used to reference the same law. The Patient Protection and Affordable Care Act (ACA) was passed three and half years ago and set for full implementation January 1, 2014. The primary goal is to help the 16% of Americans without insurance gain access to quality affordable health care.
January 1, 2014 most Americans are required to have health care insurance coverage. You are considered covered if you have Medicare, Medicaid, CHIP, and job-based plan, most plans bought privately, COBRA, retiree coverage, TRICARE, VA health coverage or some other kinds of health coverage. Do not let the Medicare open enrollment period, October 15th through December 7th 2013, which overlaps the open enrollment for the ACA, October 1, 2013 ending March 31, 2014, confuse you. If you have Medicare you do not have to make any changes to your insurance coverage based on the Affordable Care Act.
By law, insurance plans offered in 2014 will not be allowed to deny health insurance coverage because of pre-existing or chronic (long-term) conditions like cancer or diabetes. Also, insurance plans will not be allowed to have a waiting period based on your pre-existing condition or health status. Due to these new regulations some of the Cover Tennessee programs will no longer be necessary and will experience changes effective January 1, 2014. For information on these changes go to www.tn.gov/tenncare/HeatlhInsurance.
The Health Insurance Marketplace, also known as Health Insurance “Exchange”, helps uninsured people find health coverage. In Tennessee it is estimated that 900,000 people are uninsured and eligible to use the marketplace. A health insurance exchange is an online store where consumers can compare and buy health insurance plans. Each state has a market place and
had the option to run its own market place, work in partnership with the federal government to run an exchange, or to use a federal exchange. The federal government operates the health insurance marketplace for Tennessee, www.healthcare.gov
. Each exchange will operate a toll-free help hotline and set up a Navigator program to help consumers understand and purchase coverage.
Health plans offered in a Marketplace will generally offer comprehensive coverage, including a set of “essential health benefits” with at least these items and services; 1) ambulatory patient services, 2) emergency services, 3) hospitalization, 4) maternity and newborn care, 5) mental health and substance use disorder services, 6) prescription drugs, 7) rehabilitative and habilitative services and devices 8) laboratory services, 9) preventative, wellness, and chronic disease management services, and 10) pediatric services to include oral and vision care. In Tennessee there are four companies selling individual health insurance plans through the marketplace: Blue Cross Blue Shield, Cigna, Community Health Alliance and Humana. You may begin enrolling in the Health Insurance Marketplace, starting October 1, 2013 with an effective date of January 1, 2014 at www.healthcare.gov.
The following reliable resources are also available now.
Marketplace.cms.gov: Where organizations and individuals looking to help can get the latest resources and learn more about the Marketplace
HealthCare.gov: Where individuals can learn about the Marketplace and the upcoming benefits (including where they can find local assistance), or be connected to appropriate resources in states that are running their own Marketplace.
Health Insurance Marketplace Call Center: If you have questions, call 1-800‑318‑2596. TTY users should call 1-855-889-4325.