#WellnessWednes: Ask an Expert featuring the Colorado Consumer Health InitiativePosted April 18th, 2012 by Claire Moshenberg and Ashley Wheeland
Welcome to the final post in our three part “Ask An Expert” series, featuring Ashley Wheeland from the Colorado Consumer Health Initiative! A few weeks ago, the Colorado Consumer Health Initiative hosted an informative Facebook chat with MomsRising about the Affordable Care Act. Here are a few commonly asked questions on health reform and health services
Check out our first two “Ask an Expert” posts:
- Ask an Expert: Pregnancy, Coverage for Kids, and Health Reform
- Ask an Expert: Women, Health Reform, and the Colorado Consumer Health Initiative
How do I know if I qualify for benefits under the Affordable Care Act?
Many Americans will benefit in some way because all new individual and small group market insurance plans will have to cover certain services, like maternity, laboratory, mental health, prescription drugs, prevention and wellness etc.
The Affordable Care Act will provide access through different doors that are not available for many uninsured people right now. Starting in January of 2014, people under 133% of the Federal Poverty Limit will automatically qualify for Medicaid. (For a single person their income can be $14,856, family of 4 $30,656.) Others will be able to purchase private insurance in new regulated marketplaces in each state (known as Exchanges). People under 400%of FPL will qualify for subsidies so that insurance is more affordable. (Single person is $44,680, family of 4 $92,200) For more information, click here.
I generally get care at my community health center. Will I be able to continue to receive care there?
Yes! Community health centers are an important safety net for many people without insurance, and they will continue to be a place for many people to get care.
What can I do if my private insurance premiums have gone up? Is there a limit on how much insurance companies can raise premiums?
Under health care reform there are important consumer protections of private market insurance – specifically for new individual and small group plans. One protection is known as rate review. Insurance companies will have to report and explain increased rates if they go up beyond a certain rate (around 10%). This way Americans will have information about which insurers are really keeping their costs consistent and that they are not overcharging. Transparency is always an important consumer protection and the #ACA provides it.
Is there any reason that my insurance company can still drop me right now?
Generally insurers can drop people from coverage – known as rescissions. However with the ACA prohibited insurers from retroactively dropping people because an individual or employer made a mistake on an application.
Another important protection in the ACA are new requirements for people to appeal decisions made by insurers. The ACA now requires specific procedures to appeal (known as internal and external review).
New rules that apply to health plans created after March 23, 2010 spell out how your plan must handle your appeal (usually called an “internal appeal”). If your plan still denies payment after considering your appeal, the law permits you to have an independent review organization decide whether to uphold or overturn the plan’s decision. This final check is often referred to as an “external review.”
How does ACA impact lifetime limits on health care coverage? Will my benefits eventually be financially capped and prevent me from being fully covered?
This is also an important for families who have a family member with a high cost health issue (like one of our colleague’s son has hemophilia which has very expensive treatments that easily reach an annual and lifetime limit). Obamacare prohibits lifetime limits (A cap on the total lifetime benefits you may get from your insurance company) on most benefits in any health plan or insurance policy issued or renewed on or after September 23, 2010. In 2014, Obamacare prohibits new plans and existing group plans from imposing annual dollar limits (a cap on the benefits your insurance company will pay in a year) on the amount of coverage an individual may receive.
Where can I go for more information about coverage in my state?
You can find information on your state and the ACA at HealthCare.gov’s “Find Insurance Options” tab.