Health Care Reform... How Does it Affect Me?
2014 will bring sweeping changes in the health insurance industry, including dental insurance. Some of the rules and regulations can be pretty confusing. To help you figure it out, here are some popular questions and answers.
What is this Health Care Reform I keep hearing about? Does it apply to me?
Health Care Reform, also called Obamacare or the Affordable Care Act (ACA) is a law Congress passed in 2010. It makes many changes to health insurance. One you’ve maybe heard about says that everyone must have health insurance starting January 1, 2014.
The law will help more people get health insurance they can afford. Millions of Americans who don’t have insurance now may be able to get it. There is more information at www.healthcare.gov
When are these changes happening?
Many changes have already taken place. For example, children up to age 26 can stay on a parent’s insurance policy.
There are other changes coming soon. The new Health Insurance Marketplaces open on October 1. If you don’t have health insurance today, you can buy it on a Marketplace. You can buy it even if you have a health problem. And insurers can’t charge you more because you do. They can’t stop your insurance either, even if you get a health problem. You can start to use your health insurance on January 1, 2014 if you buy it before December 15, 2013.
You might be able to get help to buy the insurance. And you might be able to get help with some of the costs when you go to the doctor. This will help many to meet the requirement for everyone to have health insurance.
What if I already have insurance? Do I need to do anything? I have insurance now through my employer – does that count? If I have insurance at work can I buy it through the marketplace exchange instead if I want to?
If you already have insurance, you probably won’t need to do anything. Even if you can buy health insurance from work, you can still choose to buy it on the Marketplace. However, you may not be able to get financial help to do so.
Be sure to compare plans carefully. You can find out more about the rules for qualifying on www.healthcare.gov.
If your insurance doesn’t include dental coverage, you can buy it through your state’s Marketplace or directly from an insurance company.
I’ve seen the term Essential Health Benefits – what does that mean?
Starting in 2014, insurance plans must offer a set of Essential Health Benefits (EHB). These include things like emergency services, hospital stays, maternity and baby care, and dental and vision care for children.
Insurers have to pay 100% of the cost for wellness visits and other care that can help prevent diseases. You have to visit a network doctor to have your insurance pay 100% for these services, which can include wellness appointments, immunizations, and screenings for cancer and other diseases.
What is an Exchange? Is it the same thing as an Insurance Marketplace? Do I have to buy insurance through one of those marketplace exchanges, or can I buy coverage on my own?
An Exchange, also called a Marketplace or Health Insurance Marketplace, is a website where you can shop for insurance, including dental insurance. You can learn more about what’s offered in your state and how to shop at www.healthcare.gov.
How do I know if I can buy coverage on a Health Insurance Marketplace?
There are rules about who can buy insurance on a Marketplace. For example, you need to be a U.S. citizen or a legal resident of the United States. And you can’t be in prison. Go online to www.healthcare.gov to learn more about these rules.
Do I need to have Dental insurance? Can I buy Dental insurance on one of those exchanges? The dental coverage information says pediatric, but my kids are older. Do they still need coverage?
Children up to age 19 must have dental insurance. You can buy dental insurance through the Health Insurance Marketplace or directly from an insurance company. Many health insurance plans will also include dental.
Dental coverage for adults is not part of the EHBP. But remember, good dental health is important to your overall health, so think about a plan for yourself, too. You can buy dental insurance for yourself and your family on the Marketplace or directly from an insurance company. This family insurance will include adults.
What if I can’t afford to buy the insurance? Can I get financial assistance to buy coverage?
Many people may get financial help to buy insurance on the Health Insurance Marketplace. The amount and type of help depends on your income and if you can get insurance from your employer.
First, the insurance from your employer has to meet the standards set out in the law. Second, it has to meet standards for affordability. If the insurance you have or can get from your employer meets these standards, you can still buy on the Marketplace. However, you won’t be able to get any financial help if you do. There are other rules, so check www.healthcare.gov for more information.
There are two kinds of financial help. One helps you with the monthly premium. This is called the Advance Premium Tax Credit, or APTC. It’s also called the Premium Subsidy.
The other, called the Cost-Sharing Reduction, or CSR, helps with your share of the costs for visits to the doctor, dentist or hospital.
You have to meet certain requirements to get APTC and CSR. You can find out if you qualify when you visit the Health Insurance Marketplace. Visit www.healthcare.gov or call 1-800-318-2596.
This is a lot to understand. I could use some help figuring it out. Where can I get more detailed information?
You can learn more at www.healthcare.gov, or you can call 1-800-318-2596. You can learn more about what the law means, find out if you qualify for financial aid, and get help in figuring out what insurance you need. There are other helpful links below.
Health Care Reform will increase the number of Americans who have health coverage. This includes nearly three million children who may have access to dental insurance. Good oral health is important to good overall health, and United Concordia supports dental wellness in everything we do.
United Concordia is a qualified health plan issuer in the Health Insurance Marketplace.