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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.

What is healthcare reform?

Healthcare reform refers to the Patient Protection and Affordable Care Act (PPACA), also called the Affordable Care Act (ACA). In 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 was to expand access to coverage and to make health insurance available to more Americans.

Most U.S. citizens and legal residents are required to have health insurance coverage or pay a penalty to the government.

About the Affordable Care Act

  1. By law, most Americans are required to have health insurance coverage by January 1, of each year 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. All individual and small group plans in the marketplace must offer a core set of 10 essential health benefits (EHBs). 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. 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. 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. 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?

  • Open enrolement begins Nov. 15, 2014 and runs through Feb. 15, 2015
  • Coverage dates vary based on when you enroll:
    • If you enroll by Dec. 15, 2014, your new coverage will start Jan. 1, 2015
    • If you enroll Dec. 16 — Jan 15, your coverage will start Feb 1, 2015
    • If you enroll Jan. 16 — Feb. 15, your coverage will start Mar. 1, 2015

Special enrollment Periods

You can only enroll in new coverage outside of Open Enrollment if you have a qualifying life event that gives you a Special Enrollment Period. If you do have one of these events, in most cases you must sign up for new coverage 60 days prior to the event or within 60 days after it happened. It's important to remember that you can still be eligible for financial help if you enroll during a Special Enrollment Period. Your coverage start date will depend upon your specific qualifying life event.

    Qualifying life events such as:
  • You, or your spouse, lose your employer-provided coverage.
  • You have a change in family status, such as a marriage, domestic partnership, divorce or the birth of adoption of a child.
  • You have permanently moved.
  • You are no longer a dependent on someone else's plan.

Where can I learn more?