AFFORDABLE CARE ACT

| 2013 Fall | story by Janice Early, MBA, Vice President, Marketing & Communications, Lawrence Memorial Hospital |

No doubt, you’ve been hearing about the new Health Insurance Marketplace, a key part of the Affordable Care Act (ACA), the federal health care reform that was signed into law in 2010. The law was designed to make affordable health care and health insurance available to more people.

According to the U.S. Census Bureau, about 365,000 Kansans – or 13.1 percent of the population – were uninsured in 2010-2011. That rate is significantly lower than the uninsured rate of 16 percent for the United States as a whole in 2010-2011. But the numbers in Douglas County tell a different story. During that same time, about 17.7 percent of Douglas County residents under age 65 were uninsured – that’s about 15,500 of our community neighbors. And just who uninsured Kansans are might surprise people:

• More than half are between 19 and 44 years old.
• Two-thirds have family incomes above the federal poverty level.
• Two thirds are white non-Hispanic.
• Three out of four adults in Kansas are working

Beginning January 1, 2014, the new law says, almost all people must have health insurance or pay a tax penalty. To learn more about insurance offerings for Kansans, including a Cost Calculator, visit the Kansas Insurance Department’s website insureKS.org. The federal website HealthCare.gov provides information about the Health Insurance Marketplace and is the place to enroll online.

This website has been compared to travel websites that let consumers compare flight or hotel rooms. The Marketplace will list all health insurance policies that you are eligible to buy and will provide side-by-side comparisons.
All health insurance plans offered on the Marketplace are qualified health plans and must cover these “essential health benefits”:

• Ambulatory (outpatient) services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance use disorder services,
including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices,
• Laboratory services,
• Preventive and wellness service and chronic disease managment
• Pediatric services, including dental and vision care

Plans are categorized into bronze, silver, gold and platinum. All offer the same set of essential health benefits.

In general, bronze-level plans with lower premiums will have higher out-of-pocket costs, which may be good for relatively healthy people who do not need a lot of medical care or prescription drugs. On the other hand, platinum-level plans will tend to have the highest premiums, but you will pay less out-of-pocket costs. A platinum level plan may be right for you if you expect a lot of doctor or hospital visits or require many prescription drugs.

Everyone is eligible to buy health insurance, even people with pre-existing conditions. Insurance companies may no longer charge more just because someone has been sick in the past, and women may not be charged more than men.
Previously, insurance companies would use health status and other factors to determine premium costs. Now companies may only use these four factors to determine premium amounts:

• Your age
• Whether you are purchasing coverage for yourself
or for yourself and family members.
• Where you live
• Whether you use tobacco

Enrollment starts October 1 for coverage that begins as soon as January 1, 2014, and enrollment will be open until March 31. The website, HealthCare.gov, provides information about the Health Insurance Marketplace. For Spanish-speaking consumers, CuidadoDeSalud.gov also has been updated in preparation for the coming Marketplace. On the websites, you also can see if you qualify for Medicaid or the Children’s Health Insurance Program, or savings you can use now to lower your health insurance premiums.

Consumer assistance will be available online, on the phone or in person. A toll-free number, 1-800-318-2596, will be answered 24 hours a day, seven days a week. Customer service representatives will be available to speak in English and Spanish, and there will be a language line to assist callers with more than 150 languages.

Trained, unbiased professionals – known as certified navigators and certified application counselors – also will be available in the community. In Lawrence, Heartland Community Health Center was awarded funding for a navigator, and many other community organizations, including Health Care Access, Douglas County Senior Services, Lawrence Public Library, Lawrence Memorial Hospital, are expected to offer education and assistance. Watch for announcements in the media about efforts to educate the community about this complex law. ■