No matter how you feel about the Affordable Care Act/Obamacare, it’s coming. For some it may already be here. Nearly all Americans will be required to have health insurance by Jan. 1, 2014. If they don’t, they’ll have to pay a penalty.
A very visible part of the law becomes active on Oct. 1, 2013: Insurance marketplaces offering various plan options begin operating and will continue to enroll people until March 31, 2014. Coverage through these marketplaces begins Jan. 1, 2014 for those who enroll by Dec. 31, 2013.
The marketplaces are aimed at the roughly 10% to 15% of the population who don’t have health insurance or people who buy their plans individually. The marketplaces are also open to people who have coverage through their employer, but that coverage is considered unaffordable. This means that either:
- their share of the monthly premium is higher than 9.5% of their income
- they pay more than 40% of their total medical expenses
For most people who already have health insurance, including people who are covered through Medicare, the marketplaces don’t apply.
Millions of people with low to moderate incomes will be eligible for discounts on the cost of the insurance in the form of tax credits and other subsidies. People with pre-existing medical conditions — including breast cancer — who’ve been turned down by insurance companies can buy insurance through these marketplaces — people can no longer be refused coverage based on health status or a pre-existing condition.
All the marketplace plans must cover what have been deemed essential health benefits such as:
- hospitalizations, including surgery
- maternity care
- mental health services
- physical exams
- preventive services
- substance abuse treatment
- emergency services
- rehabilitative services
- laboratory services
While insurance plans in each marketplace are offered by private companies, the marketplaces are run by either your state or the federal government. Each state may have different offerings.
To learn more about what’s available in your state, visit the HealthCare.gov Health Insurance Marketplace website. Scroll to the bottom of the page and select your state under the “Get State Information” headline.
In future blogs, we’ll be talking about what the Affordable Care Act means for women who’ve been diagnosed with breast cancer. Let us know if you have specific questions and we’ll try to get the answers!