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The Facts About Healthcare Reform

To help make healthcare reform easier to understand we’re giving you the basic, yet important details of what you need to know about the Affordable Care Act.

There's a lot to learn and understand about the new healthcare reform laws, which is why we’re here to help. We’ve partnered with Highmark and Anthem to provide you with information about healthcare reform, including what it may mean for you and your family, the important dates involved with it and the next steps you should take. To learn more, simply attend one of our FREE in-store sessions to speak with a representative from Highmark or Anthem!

What is healthcare reform?

Healthcare reform refers to the Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA). On March 23, 2010, President Obama signed sweeping health reform legislation into law. “Obamacare” is another term some people use when they talk about this law.

One of the biggest provisions of the Affordable Care Act goes into effect January 1, 2014. This provision includes changes that will expand access to coverage. It strives to make health insurance available to more Americans.

In 2014, most U.S. citizens and legal residents will be required to have health insurance coverage or pay a penalty to the government.

What are the effects of healthcare reform?

Starting in 2014,

  1. By law, most Americans will be required to have health insurance coverage by January 1, 2014 or pay a penalty to the government.
  2. Under the new law, you can’t be turned down or charged more for health insurance because of any health conditions in the past or present.
  3. As an important part of the new healthcare law, all individual and small group plans must offer a core set of 10 essential health benefits (EHBs), starting in 2014. This means that all qualified health plans sold by private insurance companies must provide coverage for core healthcare services, such as doctor visits, hospitalization, emergency room care, prescriptions, mental health services and more.
  4. Starting in October 2013 when you visit the government’s Health Insurance Marketplace, you’ll find new qualified health plans (QHPs) among other coverage choices available in your area. Highmark is one of many private insurance companies participating in the government-run Health Insurance Marketplace when it opens in October 2013. The Marketplace — also referred to as the health insurance “exchange” — is a virtual shopping place that gathers plan options and an application for financial help, all in one place.
  5. Effective in 2014, the Affordable Care Act includes two kinds of cost savings to help make health insurance more affordable for working families and people with modest incomes. (You may hear these referred to as “subsidies.”)
    • One kind of savings is a new tax credit that can lower the cost of your insurance premium right away. This is called an advanced premium tax credit, or APTC.
    • Another kind of savings could lower the out-of-pocket costs you pay when you get care. This is called a cost-sharing reduction, or CSR. For example, a CSR could reduce the share of money you’re responsible to pay directly for copays, deductibles or coinsurance.

Cost savings are only available for individual, qualified health plans purchased through the Health Insurance Marketplace. Cost-sharing reductions (CSRs) are only available for certain individual, qualified health plans purchased through the Marketplace. In order to get the benefit of cost savings, you will need to fill out and submit an application to the government’s Health Insurance Marketplace before you begin shopping.

When can I enroll?

  • October 1, 2013 — Enrollment in new plans offered through the Health Insurance Marketplace begins. There will be a specific enrollment period every year during which you can renew or change your plan.
  • January 1, 2014 — Coverage becomes effective on this date for new plans purchased in the Marketplace by December 15, 2013. Those without health insurance coverage by this date may be subject to a government penalty.
  • It takes a minimum of 15 days for your coverage to take effect after you enroll.
  • March 31, 2014 — Open enrollment for plans purchased in the Marketplace ends.

In 2014 and years that follow, the annual open enrollment period is October 15 — December 7.

Where can I learn more?

PENNSYLVANIA & WEST VIRGINIA:
Highmark

OHIO:
Anthem

Content provided by Highmark Health Services.

Please note that information contained on this website regarding the Patient Protection and Affordable Care Act of 2010 (“PPACA”), as amended, and/or any other law, does not constitute legal advice and is subject to change based upon the issuance of new PPACA guidance and/or change in laws.

The information provided is intended to provide general information only and does not attempt to give you advice that relates to your specific circumstances. State laws and regulations governing health insurance and health plans may vary from state to state. Further, any information regarding any health plan will be subject to the terms of its particular health plan benefit agreement and some health plans may not be available in every state.