Individuals and the Affordable Care Act

The health care law helps improve care and lower costs for healthy individuals and people with health conditions.

Healthy Individuals and the Affordable Care Act

Even if you’re healthy now, sooner or later there will come a time when you will need health insurance. Not having health insurance when you need it can result in large amounts of debt and bad credit ratings. Worrying about health insurance and the cost of your care is the last thing you want to do. The Affordable Care Act is expanding your options for health insurance and making them more affordable.

Top Things to Know for Healthy Individuals

• Under the health care law, insurance companies can no longer drop you when you get sick just because you made a mistake on your coverage application.
• Parents have new options to cover their children. If you have children under age 26, you can insure them if your policy allows for dependent coverage. The only exception is if you have an existing job-based plan, and your children can get their own job-based coverage.
• Job-based health plans and new individual plans are no longer allowed to deny or exclude coverage to any child under age 19 based on health conditions, including babies born with health problems.
• Starting in 2014, if your income is less than the equivalent of about $88,000 for a family of four today and your job doesn’t offer affordable coverage, you may get tax credits to help pay for insurance.
• Starting in 2014, if your employer doesn’t offer insurance, you will be able to buy insurance directly in an Exchange that gives you power similar to what large businesses and members of Congress have to get better choices and lower prices.

Individuals with Health Conditions and the Affordable Care Act

If you have a health condition, you know how important having health insurance is and how expensive it can be. Worrying about where to get coverage and the cost of your care is the last thing you want to do when you are dealing with chronic illness. The health care law is expanding your options for health insurance and making them more affordable.

Top Things to Know for Individuals with Health Conditions

• Under the health care law, if you have been uninsured for at least six months and have a health condition, you may be able to get health insurance through the Pre-Existing Condition Insurance Plan.
• If a new insurance plan doesn’t pay for services you believe were covered, you now have new, clear options to appeal the decision.
• Insurance companies can no longer drop you if you get sick just because you made a mistake on your coverage application.
• Starting in 2014, job-based and new individual plans won’t be able to exclude you from coverage or charge you a higher premium for a pre-existing condition, including a disability.
• Starting in 2014, if your income is less than the equivalent of about $88,000 for a family of four today, and your job doesn’t offer affordable coverage, you may get tax credits to help pay for insurance. 

If you have insurance and have problems with your plan or questions about your coverage, get help through the Consumer Assistance Program. If you have been rejected for insurance, learn more about your rights and find out how to appeal denied claims.
Download and print a PDF version of this fact sheet: Individuals and the Affordable Care Act (PDF – 90 KB) Learn more about the Affordable Care Act and share brochures and posters with others.

C1

selengkapnya ...

Clinicians and the Affordable Care Act

Many provisions of The Affordable Care Act are already in place, with more significant changes coming in 2014.  The law enacts comprehensive reforms that benefit clinicians.

Top 5 Ways You and Your Practice Benefit from the Affordable Care Act:

1. Expanded insurance coverage to more than 34 million people, resulting in more patients for your practice. The law eliminates exclusions based on pre-existing conditions and extends affordable health coverage to over 34 million uninsured Americans in 2014. This will reduce the burden of uncompensated care on physicians and hospitals and bring more patients into your practice.
2. Reduced administrative burdens and more time seeing patients. The law invests in programs designed to help you and your practice transition to electronic record systems. We’re working with your professional organizations to support new payment and record-keeping systems, with the goal of reducing administrative burdens. This will let you to spend more time in the exam room, and less on paperwork.
3. New models create more opportunities to coordinate care. We’re working to develop new models of patient-centered, coordinated care designed to give you more support and control: faster information flow across care sites, better consults, and provider support systems that help patients become active participants in their care. And Medicare pays bonuses to qualified primary care doctors.
4. New consumer protections hold health insurers accountable, putting patients and clinicians first. Insurers can’t cancel coverage when a patient gets sick, and they can’t set lifetime benefit limits that leave patients without coverage in times of catastrophic need. Insurers that don’t spend at least 80% of premium dollars on patient care have to provide rebates to consumers. Read more about consumer protections.
5. New protections strengthen patient coverage, your practice, and the entire health care system. The Affordable Care Act preserves guaranteed benefits under Medicare; makes recommended preventive services for people with Medicare available at no cost; and provides patients with an annual wellness visit. The law also requires insurers to cover an expanded list of preventive services for many people with private insurance for free. As a result, patients will be able to afford both routine preventive care and necessary treatments.

C1

selengkapnya ...

Families with Children and the Affordable Care Act

You do your best to keep your children healthy, but sickness and accidents are a part of life. Getting health insurance for your children gives you peace of mind knowing they have health coverage when they need it.  But for many hardworking families, affordable insurance can be hard to find. The Affordable Care Act is giving you more control over your family’s health care by expanding your options for health insurance and making them more affordable.

Top Things to Know for Families with Children

• Insurance companies can no longer impose lifetime dollar limits on essential coverage limits
• Job-based health plans and new individual plans are no longer allowed to deny or exclude coverage for your children (under age 19) based on a pre-existing condition, including a disability. Starting in 2014, these same plans won't be allowed to deny or exclude anyone or charge more for a pre-existing condition including a disability.
• Parents have new options to cover their children. If your children are under age 26, you can generally insure them if your policy allows for dependent coverage. The only exception is if you have an existing job-based plan, and your children can get their own job-based coverage.
• An Affordable Insurance Exchange is a new marketplace where individuals and small businesses can buy affordable health benefit plans. Exchanges will offer you a choice of plans that meet certain benefits and cost standards. Starting in 2014, members of Congress will be getting their health care insurance through Exchanges, and you will be able buy your insurance through Exchanges, too.
• Pregnancy and newborn care, along with vision and dental coverage for children, will be covered in all Exchange plans and new plans sold to individuals and small businesses, starting in 2014.
• In 2014, if your income is less than the equivalent of about $88,000 for a family of four today, and your job doesn’t offer affordable coverage, you may get tax credits to help pay for insurance.

Resources for Families with Children

Use these resources to find coverage and low-cost care:

• Learn about the Children’s Health Insurance Program (CHIP).
• Find the coverage and pricing options that work best for you.
• Find a community health center in your state.

Use these resources to get the most out of your insurance:

• Get help using insurance in your state through the Consumer Assistance Program.
• Learn about your insurance company and rate increases.
• Understand your health plan and learn how to make it work for you.

Download and print a PDF version of this fact sheet: Families with Children and the Affordable Care Act (PDF- 104 KB) Learn more about the Affordable Care Act and share brochures and posters with others.

VOC

C1

selengkapnya ...

Health Insurance - Usa.gov

Affordable Care Act

The 2010 Affordable Care Act will reform health insurance, over several years. Some new provisions are already in place; most changes will take effect by 2014. This law holds insurance companies more accountable, expands coverage for young adults, offers small-business tax credits, and provides access to insurance for uninsured Americans with pre-existing conditions.

• The Affordable Care Act and You – Learn how the health care law meets your needs.

Medicaid

States decide on the benefits provided under Medicaid, but Medicaid usually provides health care for low-income children and families, and people with disabilities. Covered services usually include doctor visits, hospital care, vaccinations, prescription drugs, vision, hearing, long-term care, and preventive care for children.

• State Medicaid Programs – Learn about the Medicare program in your state, and how to apply.

Medicare

Medicare is a government health insurance plan for people 65 or older, people under 65 with certain disabilities, and people with end-stage renal disease. Medicare helps to pay for care in hospitals, skilled nursing facilities, hospice care, and some home health care. Coverage can also include doctors’ services and prescription drugs.

• Medicare – Learn about the Medicare program; enroll online; and find a Medicare-enrolled doctor or health care facility.
• Replace Your Medicare Card – If your Medicare card is lost, stolen, or damaged, you can ask for a new one online.

Health Insurance for Children: CHIP

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for low-income children. Each state decides on the benefits provided under CHIP, but all states cover routine check-ups, immunizations, hospital care, dental care, and lab and x-ray services.

• Health Coverage Programs in Your State – Find child insurance programs and participating health care providers in your state.
• Free Vaccines for Children – Free vaccines are available for children younger than 19, who are medicaid-eligible, uninsured, underinsured, American Indian, or Alaska Native.

COBRA: Keep Your Insurance If You Leave Your Job

The Consolidated Omnibus Budget Reconciliation Act (COBRA) can help you temporarily keep your health insurance even though you left your job. Eligibility for the program is based on the reason you left your job, and even if you get to keep your insurance, you may be required to pay the entire premium for coverage.

• COBRA – Learn more about the costs and benefits of the COBRA program.
• An Employee's Guide to Health Benefits Under COBRA – This booklet explains your rights under COBRA to a temporary extension of employer-provided group health coverage, called COBRA continuation coverage.

How to Appeal a Health Insurance Claim

If your health insurer has denied coverage for medical care you received, you have the right to appeal the claim, and ask that the company reverse that decision. You can be your own health care advocate. Follow these five steps:

1. Review your policy and explanation of benefits.
2. Contact your insurer and keep detailed records of your contacts (copies of letters, time and date of conversations).
3. Request documentation from your doctor or employer to support your case.
4. Write a formal complaint letter explaining what care was denied and why you are appealing through use of the company's internal review process.
5. If the internal appeal is not granted through step four, file a claim with your state's insurance department.

C1

selengkapnya ...

Health insurance

 Health insurance

Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care and health system expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is available to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity C1

selengkapnya ...